Category : Pharmacy News


Pharmacy News: How important is DME Accreditation?

yes-no-buttonsHow important is DME Accreditation to independent pharmacy owners?

It’s hard to believe, but it’s already time for renew your DME Accreditation. It may seem a bit early, but per CMS, your Accrediting Organization needs your application around six months prior to your expiration date to ensure you can be surveyed prior to the expiration of your current accreditation.

You may be asking yourself, should I stay accredited?

The answer is – Harry Lattnazio | yes-word1

Why? Well, there are three interrelated factors to consider.

Let’s go over them now:


No matter how long you have owned your pharmacy and how successful you have been, you know what is going on in the industry – drug reimbursements are going down. In most cases this is not true for DME, they continue to have a higher profit rate than drugs.

Another item I am sure you are becoming more keenly aware of lately is the number of Medicare audits that are occurring across the country, clawing back billions of dollars annually from providers and suppliers. These audits are made easier when your pharmacy is accredited. And Accreditation provides you with a solid intake process that will help you and your employees better understand and comply with the Medicare Documentation Requirements and the Supplier standards.


Pharmacists have been one of the top respected professions for decades. This puts us in a unique position to care for our patients across the health spectrum, from drugs, DME and even education.

One of the areas that pharmacies have not taken advantage of in the past when it comes to DME, is the potential for cash and add-on opportunities to increase the patients quality of life, especially with your basic Mobility patients (including walker, canes, crutches and wheelchair patients). In many cases, these patients or their caregivers do not know what kind of items are available to them to make their lives simpler and more importantly safer.


No one is sure what will happen in the future, the exemption could go away.

But what we do know, several insurers, both private and state funded, have been in the process of requiring accreditation for DME.

Some of the insurers doing this recently have been:

  • Security Blue (Pennsylvania)
  • Maryland Medicaid
  • Anthem
  • two New Jersey Medicaid HMOs.

This will begin happening more and more, and we could see even our diabetic patients being pulled from us to get their testing supplies from an accredited pharmacy. Will they take their prescriptions with them?


Pharmacy News: Medicare Audits Are On the Rise

clawbackIn recent Medicare Audits, over 80% of glucose testing supplies and nearly 70% of nebulizer and nebulizer solutions claims were denied.  This resulted in BILLIONS of dollars being recouped from Medicare Suppliers and providers.

As a Pharmacy Owner, are you prepared if an Auditor comes to your door?

When working with clients, I let them know there are several things that they can do in their pharmacy help prevent the clawback of  hard earned revenue.

  • Be sure you are in Compliance with all 30 Medicare Supplier Standards, whether you are Accredited or not.
  • Understand your DME-MAC’s LCDs (Local Coverage Determinations)
  • Have a Checklist available of all information that is required in a patient’s file.
  • Perform internal audits and quality assurance checks to ensure all of your patient files have the proper information included in them.
  • Have an open relationship with dispensing physicians so you can easily obtain needed information before sending your claims to Medicare.
  • Keep an eye on your mail, most audits will be a request for documentation sent to you by a Medicare Contractor and give typically 30 days to respond.  If you don’t reply, you will have lost your monies.
  • MOST IMPORTANTLY — Keep your staff trained and up to date on all requirements!

Make these practices part of your daily routine and you will be ready when that Medicare Auditor comes knocking. 



Pharmacy News: How to Get Started in Competitive Bidding

biddingAs a Pharmacy Owner have you taken advantage of Competitive Bidding?

If not, read on to see the advantages.

If you have yet to decide whether or not you will be participating in Competitive Bidding for Round two, you should still register as soon as possible.  Registeration does not obligate you to actually submit a bid, it simply allows you to submit one if you decided to do so.  Once the registration is closed on 2/9/2012 you will notbe able to register.  The Competitive Bidding Implementation Contractor (CBIC) recommends that you register by 12/22/2011 to ensure you give yourself enough time to begin working on your Bid Proposal.

CMS and the CBIC are currently projecting that the 60 day bid window will open on 1/30/2012.

To register your pharmacy or facility for competitive bidding, please go to the CBIC Website at

Below is the Getting Started: Registration Checklist instructions from CMS and the CBIC

You should complete the following activities prior to registering in IACS (Individuals Authorized Access to the CMS Computer Services). All suppliers intending to submit a bid application to participate in the DMEPOS Competitive Bidding Program must first register in IACS to obtain a user ID and password to access the DMEPOS Bidding System (DBidS).

The authorized official (AO) will register ONE time with ONE Provider Transaction Access Number (PTAN) issued by the National Supplier Clearinghouse (NSC). You may register with any active PTAN associated with your organization. Please refer to the IACS Reference Guide on the Competitive Bidding Implementation Contractor (CBIC) website,, for additional information and specific guidance.

More than one person may enter and/or view data in DBiddingS at the same time. However, they must be entering or viewing data on different forms (Form A or Form B). It is very important to note that each person who intends to view or enter data in DBidS must be registered and have his or her own user ID and password. Users may not share user IDs and passwords. They are for the individual’s use only and serve as an electronic signature. Sharing of accounts may result in termination of system access privileges and/or adverse action up to and including legal prosecution.

Designate one (1) Authorized Official (AO) listed on the CMS-855S enrollment form to act as your AO for registration purposes. AOs must register first and must approve other users’ requests to access DMEPOS Bidding System.

It is highly recommended that you designate at least one (1) AO listed on the CMS-855S enrollment form to serve as your backup authorized official (BAO) for registration purposes in order to avoid disruption in the bidding process should the AO leave the organization or become unavailable during the bid window.

Ensure your enrollment information on file with the NSC and the Provider Enrollment, Chain and Ownership System (PECOS) is current and correct. In addition to your organization’s mailing address, the following information for the AO and BAO provided during registration must match exactly with NSC records:

  • Legal name
  • Date of birth
  • PTAN
  • Social Security number

Make sure your e-mail address is working prior to and at the time of registration. Important information will be sent to this e-mail address during the registration and bidding processes.

Prepare your computer. Refer to the IACS Reference Guide on the CBIC website for specific instructions.

Sign up to receive e-mail updates and announcements on the CBIC website by selecting “Contact Us” on the home page.


Pharmacy News: Medicare Compliance for Refills

Are you Billing Medicare Part B for Blood Glucose Testing Supplies and other items that are refilled on a recurring basis?

If you are, Medicare has some new rules and clarified some older ones. These apply to ALL suppliers, whether accredited or not.

Pharmacies are required to contact the beneficiary or designee regarding refills. This must take place no sooner than 14 calendar days prior to the refill due date and you  may not dispense the item to the beneficiary sooner than 10 calendar days prior to the end of usage for the current product.  This is regardless of delivery method.

rx-prescription-pad1Additionally, Medicare Compliance for refills requires a new prescription when:

  • There is a change of supplier.
  • There is a change in treating physician.
  • There is a change in the item(s), frequency of use, or amount prescribed.
  • There is a change in the length of need or a previously established length of need expires.

Medicare has also enacted new rules regarding “proof of refill request” for items that are going to be delivered to the beneficiary.  We will see if the large mail-order entities follow this one.  For these items, you need to document the request for refill either with a written document received from the beneficiary or a contemporaneous written record of a phone conversation/contact between the supplier and beneficiary.  The refill request must occur and be documented before shipment.

The refill record must include:

  • Beneficiary’s name or authorized representative if different than the beneficiary
  • A description of each item that is being requested
  • Date of refill request
  • Quantity of each item that the beneficiary still has remaining

For the “proof of refill request” for items that are going to be picked up at the Pharmacy, the pharmacy only needs to obtain a signature from the beneficiary or caregiver that they have actually received the supplies.

This information (in addition to other Medicare required documentation) must be kept on file and be available upon request.

BE SURE to train your staff to make these requirements a part of their daily tasks.


Pharmacy News: American Pharmacist Month

Pharmacy Owners — October is American Pharmacist Month.

phrmonth10Read on to learn how to take this opportunity to celebrate your profession, your staff and your dedication to your customers!

This year’s theme, as seen on is – KNOW YOUR PHARMACIST, KNOW YOUR MEDICINE.

advertise-hereReach out to your customers by hosting a “Brown Bag”review, where customers can bring in both their prescription and nonprescription drugs into the store for a personal consultation with your pharmacists—all in an effort to ensure customers are taking medications safely and properly (in conjunction with other medicines).   This promotion illustrates to your customers that their health is important to you and your pharmacy. And it’s an excellent time to emphasize good health and wellness.

Advertise the event by:

  • Advertising in your local paper
  • Contact your local paper to see if they will run a FREE special article on the event
  • Create a flyer to use as bag stuffers, distribute at local community centers, and doctor’s offices
  • Ask your local radio station to read a Public Service announcement announcing the event
  • Announce Event on your Social Networks: Facebook, Twitter, LinkedIn

During the event:

  • Decorate your pharmacy highlighting Pharmacist Month
  • Have goody bags for customers to take with them that include an informational brochure about what your pharmacy has to offer, as well as other educational materials.
  • Stress the role that you, as the pharmacist can play to ensure that they are using their medicines as safely and effectively as possible

Other ideas to help celebrate YOUR month:

  • Hold a flu shot clinic
  • Blood pressure clinic
  • Osteoporosis screenings

This is your time to shine, use one of the ideas above, or come up with something on your own and HAVE FUN!