Bonding Informationbr /br / br /Pharmacies are required to have surety bond for each practice location unless the supplier is a sole proprietor by October 2, 2009. br /If your pharmacy is enrolled as a DMEPOS supplier with the NSC and bills the DME MAC (formerly a DMERC) for non-accredited products, including Epoetin, immunosuppressive drugs, infusion drugs, nebulizer drugs, or oral anticancer drugs, you are required to have a surety bond. Note: The DMEPOS Surety Bond final rule did not establish an exception to the bonding requirement for pharmacies. Any supplier enrolled with the NSC is considered a DMEPOS supplier.br /Accreditation Informationbr /“Survey ready” DMEPOS suppliers (including pharmacies) who obtain facility accreditation and a surety bond after September 1, 2009 but before October 1, 2009, should submit proof of both to National Supplier Clearinghouse (NSC) via submission of an amendment to their CMS-855S (Medicare enrollment application). br /br /Sections 1, 2, 12 and 15 (if you are the authorized official) or 16 (if you are a delegated official) should be completed and accompanying documents described in Section 17 should be provided. You will need proof of delivery, therefore it is suggested you mail the amended application and accompanying documents, to the overnight mailing address identified on page 2 of the application, certified mail, return receipt requested or use another verifiable package tracking system. Keep a copy of your amended CMS-855S in your files. br /br /While pharmacies have until close of business September 30, 2009 to amend their CMS-855S, pharmacies are encouraged to update their Medicare enrollment application with the NSC as soon as possible. br / br /Here are CMS answers to the most frequently asked questions by NCPA members regarding the accreditation and surety bond deadlines. br / br /1. I’m “survey ready” but unlikely to be inspected prior to the October 1, 2009 (accreditation) deadline. I have obtained a surety bond. What are my options?br / br /Answer – You have two options. br /br /Option 1 – Amend your CMS-855S to furnish only drugs and biologicals (including Epoetin, immunosuppressive drugs, infusion drugs, nebulizer drugs, or oral anticancer drugs). br /br /To amend the CMS-855S, complete sections 1, 2 and 12, 15 or 16, attach a copy of the surety bond, and mail the amended enrollment application to the NSC. Note: You do not have to complete the entire CMS-855S.br /br /You can send the enrollment package to the NSC via overnight express. The NSC overnight express address can be found on page 2 of the CMS-855S. You will need proof of delivery, therefore it is suggested you mail the amended application and accompanying documents, certified mail, return receipt requested or use another verifiable package tracking system. Keep a copy of your amended CMS-855S in your files.br /br /Option 2 – Voluntarily Withdraw/Terminate from the Medicare program. br /You can voluntarily terminate your enrollment in the Medicare program by completing the sections associated with voluntary termination on page 4 of the CMS-855S. You can even notify the National Supplier Clearinghouse of a future date termination. After completing the applicable sections, the Authorized or Delegated Official should sign, date and mail the completed termination request to the NSC.br /Note: If you voluntarily withdraw/terminate your enrollment with Medicare, you will be br /required to re-enroll at future date to be eligible to participate in the Medicare program. br /Thus, this option should only be considered by pharmacies who are not furnishing br /drugs and biologicals (including Epoetin, immunosuppressive drugs, infusion drugs, nebulizer drugs, or oral anticancer drugs). br /br / br /2. I received my facility accreditation certificate after October 1, 2009. Now what do I do?br / br /Answer – Amend your 855S to add DMEPOS products back into your product offerings. br /br /To amend the CMS-855S, complete sections 1, 2, 15 or 16, attach a copy of the accreditation certificate, and mail the amended enrollment application to the NSC. Note: You do not have to complete the entire CMS-855S.br /br /You can send the enrollment package to the NSC via overnight express. The NSC overnight express address can be found on page 2 of the CMS-855S. You will need proof of delivery, therefore it is suggested you mail the amended application and accompanying documents, certified mail, return receipt requested or use another verifiable package tracking system. Keep a copy of your amended CMS-855S in your files.br /br /While it may take up to 60 days for NSC to notify you that you can once again bill for DMEPOS, you can begin billing for claims retroactive to coincide with the date of facility accreditation. br / br /3. Can I meet the October 1st deadline if I receive my facility accreditation certificate on the 28th of September? I have my surety bond. br / br /Answer – Yes. br /br /Complete sections 1, 2 and 12, 15 or 16, attach a copy of the surety bond and accreditation certificate, and mail the amended enrollment application to the NSC. Note: You do not have to complete the entire CMS-855S.br /br /You can send the enrollment package to the NSC via overnight express. The NSC overnight express address can be found on page 2 of the CMS-855S. You will need proof of delivery, therefore it is suggested you mail the amended application and accompanying documents, certified mail, return receipt requested or use another verifiable package tracking system. Keep a copy of your amended CMS-855S in your files.br / br /4. I received an NSC notice of revocation of my Medicare billing privileges; however I submitted my facility accreditation and surety bond certificates along with an amended CMS-855S PRIOR to October 1st 2009. What are my next steps?br / br /Answer – br /br /You should submit a corrective action plan within 30 days of the revocation date or an br /administrative appeal within 60 days of the revocation date. If you should submit a copy br /of the amended CMS-855S along with copies of the facility accreditation and surety bond br /certificates. br /br /Attach to the letter of revocation, the certificates along with the proof of delivery receipt br /to the NSC prior to October 1, 2009. Again, you will need proof of delivery, therefore it br /is suggested you mail the documents to the overnight mailing address identified on page br /2 of the CMS-855S enrollment application (or other address as identified in the letter of br /revocation), certified mail, return receipt requested or use another verifiable package tracking br /system.divimg width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3923455664267743244-3140023916328030651?l=diabetessupplycentral.blogspot.com' alt='' //div

Overviewbr /br /Historically, diabetes self-management education/training (DSME/T) services have been provided through hospital-based outpatient programs. Recently with reimbursements falling, many of these programs have left the hospital setting and entered the community. Today, DSME/T multidisciplinary healthcare professionals are aligning community pharmacists to bring DSME/T training to patients through community pharmacies. Evidence shows that DSME/T is cost-effective and improves health outcomes as patients maintain better control of their A1C, change their behavior, and adopt healthier lifestyles. br /br /There are two distinct opportunities for incorporating a DSME/T program into a community pharmacy. Both require the pharmacist to apply for accreditation either to the American Association of Diabetes Educators (AADE) or the American Diabetes Association (ADA). NCPA has aligned exclusively with AADE to encourage pharmacists to establish community based facility accredited programs. If the pharmacist has room sufficient to conduct classes, patients can be referred to the accredited or “site recognized” pharmacy for DSME/T services. If there is insufficient room in the pharmacy, , the pharmacist can take his or her classes out into the community, acting like an independent/ freestanding program by renting space. br /br /Medicare and many other private/commercial insurers reimburse only AADE or ADA recognized programs. Diabetes education programs accredited by AADE meet the National Standards for Diabetes Self-Management Education, but AADE also goes a step further by providing diabetes education programs with online tools that allow programs to easily accumulate and track the data needed to maintain their accreditation status. br /br /Next Step - The Joint AADE-NCPA DSME/T Programbr /br /The next step for certified providers is to be trained to provide the training/education. AADE and NCPA have created a 16 hour DSME/T certificate program. After fulfilling the 16 hours of certified training, comprised of online and live training, the community pharmacist will be eligible to serve as an instructor within an AADE accredited diabetes education program. Additionally, training will be provided on how to apply to become an accredited DSME/T program, which is necessary for reimbursement. In order to offer DSME/T, community pharmacists should have sufficient room for conducting classes. These can either be within their pharmacy or in a community setting such as senior centers and assisted living homes.br /br /br /Under the National Standards for DSME/T and the AADE accreditation requirements, a pharmacist can be a program’s coordinator and/or instructor. Pharmacists meet Medicare’s definition of a certified provider if they are already submitting claims to Medicare HOWEVER to bill Medicare to DSME/T services, pharmacists must take the AADE-NCPA DSME/T Program (or equivalent) and achieve AADE pharmacy facility accreditation.br /br /This exclusive joint AADE-NCPA DSME/T program and will be offered on a limited basis no more than three times a year throughout the nation.br /br /br /Practice Benefits br /br /1. Opportunity for pharmacists to be paid by Medicare for providing lifestyle change services (DSME/T) rather than as a supplier of the commodity (glucose meters) br /2. The program is portable (can be offered at the Senior Center, Assisted Living Home, or Kiwanis Club)br /3. These services cannot be received in a mailboxbr /4. It can be your pharmacies “purple cow”, distinguishing you from the chain competition. (along with shoes, medicines, and diabetes supplies)br /5. Create a new and profitable community pharmacy business model teaming with appropriate DSME/T multidisciplinary healthcare professionals (Physicians, CDEs, RN, Dieticians)br /6. DSME/T services provides can be applied to experience required to become a certified diabetes educator(CDE) if that pathway is desired. br /br /For more information contact William Popomaronis at 800 544 7447 x 2644 or William.popomaronis@ncpanet.orgdivimg width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3923455664267743244-6284675468309593018?l=diabetessupplycentral.blogspot.com' alt='' //div

On September 16th, 2009, Chairman Baucas’s Senate Finance Committee released the proposed America’s Healthy Future Act of 2009. It's 223 pages and is going to make every American personally responsible to purchase health care insurance by 2013 then report it to the IRS.br /Now, that’s the big picture but “in the weeds”, on page 113, is where my eyebrows raised. It proposes that Certified Diabetes Educators (CDEs) be recognized as providers. Here is the rational.br /Current Law br /Medicare covers diabetes self-management training (DMST) under certain conditions to help a beneficiary learn how to successfully manage their diabetes. The training must be prescribed by a physician or qualified non-physician practitioner. When Congress passed the DMST benefit in 1997, it did not include CDEs as providers. However, most CDEs worked in hospital outpatient clinics where diabetes education and care is generally provided. br /Chairman’s Mark br /The Chairman‘s Mark would provide for the recognition of state- licensed or registered health care professionals who are certified diabetes educators as Medicare providers of diabetes outpatient self-management training services. CDEs would still provide DSMT services according to physician referral, but they would be able to provide such services in appropriate, non-hospital locations to meet current needs. br /I commend Senator Baucus for recognizing hard working CDEs as providers but how about licensed pharmacists? br /Pharmacists have individual NPI numbers also, nonetheless billing Medicare for DSME/T services must be done through the PHARMACY because the business owns the Part B supplier number. Even though the new AADE Diabetes Education Accreditation Program (DEAP) will allow the pharmacy to bill, CMS currently does not allow pharmacists to bill them directly for any services. Two examples include immunizations which must be billed through a DMEPOS supplier number and MTMs which can only be billed through Part D sponsors.br /br /Pharmacists are licensed and heavily regulated professionals. They maintain professional and product liability insurance. Patients can petition State Boards of Pharmacy is service levels are unsatisfactory. It’s the pharmacist NOT the pharmacy undergoing AADE DEAP training to provide DSME/T. In addition many are already facility accredited to provide DMEPOS (glucose meters) br /br /NCPA continues to pursue CMS to recognize pharmacists as legitimate, qualified providers for cognitive service and encourages CDEs, pharmacists, dieticians and other appropriate professionals to work collectively to provide convenient access to DSME/T in communities. br /To see all 223 pages of Baucas’s America’s Healthy Future Act of 2009 click here (http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf)divimg width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3923455664267743244-5799438297919074143?l=diabetessupplycentral.blogspot.com' alt='' //div

I thought I’d start this blog out with a little good news…Medicare fees for diabetes testing supplies went up effective January 1. Check out the a href="http://www.cms.hhs.gov/DMEPOSFeeSched/downloads/D09_JanR.zip"fee schedule/a amounts for 2009 along with information on floors and ceilings for all procedure codes and payment categories, jurisdictions, and a short description assigned to each procedure code.br /br /Make sure your billers are aware of the fee changes.br /br /Remember, Medicare beneficiaries can purchase their testing supplies from your pharmacy. While mail order is an option, it is NOT mandatory.divimg width='1' height='1' src='https://blogger.googleusercontent.com/tracker/3923455664267743244-4600156922102444378?l=diabetessupplycentral.blogspot.com' alt='' //div