Pharmacy Profits

pharmacy medicare part B

Pharmacies and Medicare Part B

Pharmacies need to be looking at some of their options for becoming a Medicare Part B Provider/Supplier as a large part of the United States population are becoming Medicare Beneficiaries.  This blog will discuss four practice areas payable by Medicare Part B that Pharmacies need to consider to diversify and increase profits.  These areas are: Drugs and Biologics (Application: CMS-855S or PECOS) DMEPOS (Application: CMS-855S or PECOS) Immunization (Application: CMS-855B or PECOS) Point of Care Testing (Application: CMS-855B or PECOS)…

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Pharmacy Self-Audits: Preventing PBMs From Taking Back Monies

How do you prevent a PBM auditor from clawing back monies? Pharmacies deal with the threat of PBMs clawing back money daily.  Fortunately, many audits resulting in the clawback of monies can be prevented by proactive activities, training, and overall employee understanding.  These activities start before the prescription is filled and dispensed and continue after the patient walks out the door. These activities mean more work, but it is work that you and your employees need to be considering as…

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Point of Care Testing in Pharmacy

Let’s talk about starting a CLIA-Waived Point of Care Testing Program in a Pharmacy setting to diversify your services and bring additional revenue as third parties continually lower reimbursements and we see continual DIR creep.  In most cases, your POCT will be a cash service, but CMS and privacy payers may pay for these services. Depending on your State, the Pharmacist can order these Tests and, in some cases, actually prescribe medication (or alter medications that have already been prescribed)…

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Pharmacy Can Now Temporarily Enroll as an Independent Clinical Diagnostic Laboratory with Medicare

  Attention CLIA Certified Pharmacies: Over ten thousand Pharmacies have a CLIA Certificate of Waiver.  Most of these Pharmacies have been providing CLIA waived testing as a cash service only, increasing revenue and helping to offset dropping reimbursements and DIRS. But earlier this month,  CMS issued an MLN Matters Article allowing Pharmacies with CLIA Certification already enrolled in Medicare to fast-track a temporary enrollment as an independent clinical diagnostic laboratory to help combat the spread of COVID-19 during the public…

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