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Medicare DME Program

DME Alert Blog

 

Bill Popomaronis, R.Ph., NCPA vice president, home health and long term care pharmacy services, provides his thoughts and explanations on the latest DME information from CMS.


Friday, December 14, 2007

CMS to Announce DMEPOS Accreditation Deadlines

The Centers for Medicare & Medicaid Services will host an Open Door Forum on DMEPOS Accreditation Deadlines Wednesday, Dec. 19, from 2 to 3:30 p.m.

CMS will announce the following during the Forum:


  • The deadline by which new suppliers must apply to the National Supplier Clearinghouse (NSC) for a supplier number in order to qualify for a special accreditation grace period;


  • The deadline by which new DMEPOS suppliers who qualified for the accreditation grace period will need to be accredited; and


  • The deadline by which all DMEPOS suppliers will need to be accredited.



To participate, dial: 1-800-837-1935 and use the Reference Conference ID: 27829970.

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880 and for Internet Relay services click here http://www.consumer.att.com/relay/which/index.html. A Relay Communications Assistant will help.

For more information on DME Accreditation, visit www.pharmacistelink.com/medicaredme.


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posted by dme alert service @ 6:59 AM 

Friday, October 19, 2007

Four Reasons Pharmacists Are NOT Yet Accredited

Four Reasons Most Pharmacists Are NOT Yet Accredited to Sell DMEPOS

1. Diabetes supplies are exempt from competitive bidding in the first round (However, you STILL must obtain accreditation to sell them.)
2. The mandatory accreditation deadline for ALL suppliers has NOT been announced (see DMe-Alert, Oct. 19).
3. Accreditation costs still remain prohibitive (approximately $8,500).
4. Surety bond requirements will further increase the costs to maintain a Part B supplier billing number.

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posted by dme alert service @ 7:09 AM 

Wednesday, September 5, 2007

My 'Accreditation Corner'

A new feature has been added to the DME Resource Center (www.pharmacistelink.com/medicaredme) entitled "Accreditation Corner."

As you know by now, in order to maintain a Medicare Part B supplier billing number ALL suppliers must obtain accreditation through one of 10 CMS approved accreditation agencies.

Except for those suppliers that are bidding to supply DME in the first 10 competitive bid areas (deadline 10/31/07), CMS has NOT, as yet, determined when the remaining suppliers, including pharmacies must be accredited.

Authored by Harry Lattanzio, president of PRS Pharmacy Services, Accreditation Corner breaks up the quality standards into an easy-to-understand format and provides helpful tips on how to meet the standards.

Read the pieces and use this time to prepare your staff. Remember agency surveyors won’t just be looking for a manual, but for clear indicators that your business practices executed daily protect the beneficiary and limit fraud.

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posted by dme alert service @ 10:54 AM 

Wednesday, August 29, 2007

Poorly Completed Applications Slow Independents' Accreditation

Some accreditors have voiced their concerns over the lack of attention placed on correctly filling out the agecy's application. In particular, agency customer service representatives are spending an inordinate amount of time trying to sort through the paper work presented because it is unclear. At the very least, improperly filled out applications will delay accreditation and may cause prices to increases to accommodate the increased scrutiny required when dealing with independents.

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posted by dme alert service @ 8:55 AM 

Thursday, August 16, 2007

Is It Any Wonder?

Is it any wonder pharmacists aren’t rushing to obtain accreditation or competitively bid to sell DME! On a positive note, diabetic testing supplies, at least in this first round, are exempt.

However, what is not so good is that CMS has yet to set a date when all suppliers must obtain accreditation.

Additionally, with its selection of less than $3.5 million in aggregate sales as the benchmark for defining a small DMEPOPS supplier, CMS has removed the incentive for small supplier pharmacies to competitively bid. Typically, only 8 percent of a pharmacy's sales come from DMEPOS products, and most of that is from diabetes testing supplies.

Now, add the proposed requirement that suppliers must spend an additional $2,000 to obtain a $65,000 surety bond to bill Medicare, and you can see why pharmacists aren’t banging down accreditation agency doors.


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posted by dme alert service @ 6:09 AM 

Thursday, May 31, 2007

CMS is Puzzled

I tried to tell them. Most pharmacies now gross more than $3.5 million in total sales; thereby removing them from small supplier status. With diabetes testing supplies exempt from competitive bidding at retail, and no deadline for accreditation outside of the ten MSAs, is it any wonder that pharmacies are not beating down the doors of accreditation agencies!

Nonetheless, you should take advantage of this temporary reprieve and prepare for accreditation NOW. Sooner or later, its going to get to you!

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posted by dme alert service @ 2:31 PM 

Tuesday, April 10, 2007

An Easy Way to Find Your MSA

Here is a link to some easy to read maps that detail the DMEPOS competitive bid areas in the first 10 MSAs selected,
http://www.dmecompetitivebid.com/cbic/CBIC.nsf/(Pages)/Competitive+Bid+Areas.

You can search by zip code as well.

Areas outside of the MSAs are designated as rural locations, currently exempt from competitive bidding. However, you still MUST be accredited to maintain you Part B supplier billing number.

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posted by dme alert service @ 9:57 AM 

Thursday, April 5, 2007

Accreditation Required for All DMEPOS Suppliers…Except

Suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must obtain accreditation or at least have applied for accreditation from a CMS-approved agency IF they contemplate bidding on DMEPOS.

The ONLY exception to the rule is a pharmacy that maintains a Part B supplier billing number in order to submit Part B drug claims and administer vaccinations.

These supplier pharmacies must meet the current 21 national supplier clearinghouse (NSC) standards, BUT do not have to obtain any further accreditation.

Remember though, if you bill for just ONE box of glucose test strips at retail you must obtain accreditation.

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posted by dme alert service @ 11:11 AM 

Wednesday, April 4, 2007

Competitive Bidding: Community Pharmacy, Beneficiaries with Diabetes Win

Congratulations NCPA members! Your e-mails, completed surveys, letters, and phone calls alerting Congress to the burdensome impact Medicare Part B billing supplier standards would have on your ability to provide access to important DMEPOS has been heard loud and clear.

NCPA’s successes include:


  1. Modifying accreditation standards so they take into consideration the already stringent standards pharmacies and pharmacists must comply with on the state level.

  2. Reducing accreditation agency fees and the introduction of pharmacist-friendly DMEPOS accreditation agencies (i.e. NABP, HQAA).

  3. The exclusion of diabetic monitors and testing supplies from competitive bidding for retail suppliers ONLY. Mail-order firms must competitively bid.

  4. Protections that require 30 percent winning bidders be small suppliers.



The bidding process will begin later this month, with CMS accepting bids for 60 days. Winning bids will be announced in December. CMS will use the median of the winning bids to establish “Medicare single payments,” which will apply universally to like products within each CBA. The Medicare single payments will replace current fee schedule amounts for those products, and will go into effect in April 2008.

If you plan to competitively bid, submit you accreditation application today! For more information on accreditation, visit NCPA’s DME Resource Center at www.pharmacistelink.com/medicaredme.



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posted by dme alert service @ 10:58 AM 

Thursday, March 29, 2007

DMEPOS Networks: Advantage Chains

CMS currently allows drug stores chains with common ownership to obtain DMEPOS accreditation with only 25 to 35 percent of its locations (accreditor determined) being surveyed; thereby, lowering costs. Obviously, ALL locations must meet CMS’s DMEPOS quality standards; however, this proves to be a big advantage for chain drugstores.

If the 2003 MMA states that small suppliers should have every opportunity to competitively bid, then doesn’t it stand to reason that CMS should provide similar cost savings opportunities to independents?

Pharmacy buying groups currently meet insurer quality standards and bid on behalf of member pharmacies. CMS should take a creative approach to the challenges and costs associated with its accreditation requirements. Lowering accreditation costs WILL result in more community pharmacies competitively bidding; thereby, improving beneficiary access to needed DMEPOS products and services.

Developing…

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posted by dme alert service @ 8:19 AM 

Monday, March 19, 2007

Competitive Bidding Final Rule at OMB

CMS's final rule for national competitive bidding is in clearance at the Office of Management and Budget (OMB). This is not the first time the industry has expected, but not seen, the final rule. However, this time, it was actually published on the agency's docket.

What I really don’t understand is that if competitive bidding is to begin in October 2007, as has been signaled to the industry in the past, what challenges are holding up the release.

The Government Printing Office will publish the rule in the Federal Register and CMS will post it on its Web site as soon as it clears the OMB. This should occur quickly.

I expect the rule to outline CMS's timeline for rolling out competitive bidding. I’m hopeful CMS will finally identify the first 10 metropolitan statistical areas AND the DMEPOS product categories.

Keep your fingers crossed that CMS will have the good sense to exclude diabetic testing supplies.



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posted by dme alert service @ 12:02 PM 

Wednesday, March 14, 2007

Observations from NCPA's Steering Committee Meeting

Community pharmacy leaders from throughout the country converged on NCPA headquarters in Alexandria March 8th and 9th to address the challenges and opportunities that lie ahead for our profession.

Regarding DMEPOS, almost every steering committee member I spoke with was still perplexed and a little unsure of the facts. Most were wondering what steps they should take to protect their businesses when accreditation deadlines are set by CMS and competitive bidding for DMEPOS begins.

My best advice for them and you is to sign up for the DMe-Alert newsletter. You will get updates on accreditation and competitive bidding as NCPA receives them from CMS. While NCPA cannot make your business decisions for you, be assured that NCPA will have you asking the right questions to make economically-sound decisions for your pharmacy.

I hope to see many of you at the NCPA Legislative Conference NCPA Legislative Conference scheduled for May 13-16 in Washington, DC.





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posted by dme alert service @ 1:22 PM 

Monday, February 19, 2007

DME Questions…

I traversed the snow covered Appalachian Mountains last Friday to visit PRS Pharmacy Services (www.prsrx.com) in Latrobe, Pa., 30 miles outside of Steel City. As a Baltimore boy, it was a little uncomfortable running into so many black and gold Pittsburgh Steeler fans, but I pressed on and found it was worth the trip.

I was in search of products and services that may assist pharmacists in understanding the economics of competitive bidding and how to streamline the accreditation application and survey processes.

If I put on my 22-year-old independent pharmacy owner hat, the first questions I would ask regarding accreditation and competitive bidding include:

  1. Is it still profitable for me to be in the DME business?
  2. Can I handle the additional, lower margin business? (CMS expects that winning bidders should be able to increase service capacities by an additional 20%)
  3. If I exit the DME marketplace, what will be the economic impact on my prescription business?
  4. Who can assist me in creating or updating my business policy, protocol, and procedure manuals that will serve as evidence to accreditation agencies that my facility complies with the new CMS quality standards?

Check PRS out. See if what they have fits your business needs. Remember, manuals are more than just the paper on which they are written. Surveyors will expect the pharmacist in charge (PIC), or other designee, to be able to discuss the standards and provide evidence that the policies are woven into the fabric of your business.

Stay tuned…



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posted by dme alert service @ 7:07 AM 

Friday, February 16, 2007

Don’t Lose Sight of the Big Picture

CMS estimates that 90% of suppliers in the top 10 metropolitan statistical areas (MSA) will competitively bid on DMEPOS in an effort to hold on to or grow their Medicare business. They also estimate that 50% would likely become “winning bidders,” representing approximately 18,000 suppliers located in the top 10 MSAs.

(Keep your eyes open Miami!)

According to NCPA surveys, less than 10% of independent community pharmacies are accredited – allegedly the first step to competitively bidding. Accreditation agencies have a big, and possibly insurmountable, challenge in meeting CMS accreditation deadlines.

I wish I knew what those deadlines were so I could share them with you, but CMS has not been clear in sharing that information. One thing is sure, while CMS would “like” suppliers to obtain facility accreditation PRIOR to submitting a bid to provide DMEPOS to beneficiaries, CMS has the authority to proceed with competitive bidding whether suppliers are accredited or not.

Stay tuned!



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posted by dme alert service @ 7:26 AM 

Thursday, February 8, 2007

Welcome to the DME blog


Hello Friends!


I’m William “Bill” Popomaronis, R.Ph., vice president, long term and home health care services for the National Community Pharmacists Association (NCPA). Welcome to my DME Blog. This is where we will discuss the latest information on CMS’s DME Accreditation and Competitive Bidding programs. My goal is to answer your questions, provide the facts, and clear up the rumors and innuendo related to these topics.

I have special insight because I am the only pharmacist member of Medicare’s Program Advisory and Oversight Committee (PAOC), which provides advice on the development and implementation of the DME Competitive Acquisition Program, and in my role at NCPA, it is my job to study these regulations so you don’t have to.

This blog is part of a bigger DME Resource Center located on Pharmacist e-Link ™ (www.pharmacistelink.com/medicaredme). The Resource Center is provided by NCPA with support from Bayer HealthCare, Diabetes Care. It includes fast facts and resources concerning accreditation, competitive bidding, NSC supplier standards, as well as the DMe-Alert service providing you the latest, fact-based information via an email newsletter once each week.

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posted by dme alert service @ 12:28 PM 

Bayer HealthCare, Diabetes Care, has underwritten the costs of this communication. The information expressed in this communication are the views of NCPA. Bayer is not responsible for the accuracy of the information expressed in this communication. Any questions related to DME Accreditation and/or Competitive Bidding for DMEPOS should be directed to the Centers for Medicare and Medicaid Services or NCPA.