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by: Theresa Flaherty - Thursday, October 22, 2009

images-11Provider Vicki Jones is tickled pink. She opened a branch of the Women's Health Boutique in Dallas yesterday.

"Channel 11 covered our ribbon cutting," she said. "A full minute! Wow! That was fabulous for us."

It doesn't hurt that it's National Breast Cancer Awareness month, when fall colors everywhere mingle with ubiquitous pink ribbon products.

"We wanted to play off that. The media seems more open to the stories we have to tell during October," said Jones.

Jones has been doing this for 20 years and welcomes the attention breast cancer gets these days. It wasn't always like that.

"Back then, you didn't even say the word breast cancer, no one even knew what the word mastectomy was or how to say prosthesis," she said. "Now, we have NFL football teams wearing pink ribbons during games. That's wonderful."

Theresa Flaherty

by: Theresa Flaherty - Wednesday, October 21, 2009

Undercover police in Phoenix this week busted up a diabetes test strip ring.

Yup, you read that right.
Samuel Camerano, 49, is charged with trafficking in stolen goods. He allegedly buys stolen test strips and resells them on sites such as ebay and to other distributors who then sell them back to the pharmacy.
According to an article on KPHO.com, police said that during the operation Camerano bought 30 boxes of test strips with a value of $2,254 for only $215 on five different occasions believing them to be stolen property. Authorities said the final sale of test strips to Camerano was on Oct. 8, and he was arrested and charged with trafficking stolen property immediately following the transaction.
Police launched their investigation when area Target stores reported an increase in test strip thievery.
In Sarasota, Fla. sheriff's deputies arrested to people, also for stealing test strips—and, randomly, cologne—from two area Target stores.
Personally, I wonder what Target is thinking? I can't even buy store brand glucose tabs without getting a pharmacy staffer to unlock the case for me (and if you've followed my CVS saga, you know how I love to interact with them).

But I digress. Once again, I must ask, why, oh why, do test strips cost so much?

Theresa Flaherty

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by: Theresa Flaherty - Tuesday, October 20, 2009

A bill making the rounds in Ohio would exempt prosthetics from the DME category and make private insurance companies provide the same coverage for limbs as Medicare and Medicaid.

Rep. Denise Driehaus, D, introduced HB 310 last week.

At least 15 states have passed similar bills in the past few years. It's a good idea to pay for limbs. Without them, people are unable to work. That means, in addition to quality of life issues, they typically cost states money to care for them, through increased need for services.

Theresa Flaherty

by: Theresa Flaherty - Thursday, October 15, 2009

President Obama signed HR 3663 into law. Pharmacies have another 3 months to complete the accreditation process.

NCPA executive VP and CEO Bruce Roberts said the association continues to work toward a permanent exemption as well:

“With the signing of H.R. 3663 into law by President Obama, Congress now has a three-month window to add pharmacists to all the other health care providers exempt from the time-consuming, costly, and redundant Medicare Part B DME accreditation requirement.  Both the House and Senate have included pharmacy exemption provisions in the health care reform proposals working their way through Congress. When this permanent solution is added to this temporary solution of a delay, seniors will be the ones who truly benefit. They will be able to continuing getting these critical medical supplies, like diabetes testing strips, from their local pharmacy where many of their health care needs are being met. Without additional action, thousands of independent community pharmacies will be forced out of the program.”

Theresa Flaherty

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by: Theresa Flaherty - Wednesday, October 14, 2009

I spoke with a pharmacy provider this afternoon who is awaiting his accreditation survey. For him, the recent deadline extension for pharmacies is a welcome relief.

For Joe  the HME provider, however, that extension may not seem fair. Maybe it is, maybe it isn't; I can see both sides of the equation: it's what keeps HME News fair and balanced.

Pharmacist John Keegan, who received his accreditation in June, sympathizes, but says it's like comparing apples to oranges.

"We're licensed by our states, we're inspected at least once a year," he said. "That's not to slight DMEs. I don’t believe they understand the nature of our profession—the practices we're built on and the nature of those practices. If the pharmacy is being inspected regularly, its hard to say it’s a fraudulent operation."

As to the extension for his fellow pharms? Eh. Keegan's pleased as punch to have his accreditation wrapped up.

"I don't think they are going to escape accreditation completely," he said.

Theresa Flaherty

Theresa Flaherty

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by: Theresa Flaherty - Tuesday, October 13, 2009

By now you have heard that pharmacies have until Dec. 31 to get accredited. The NSC has posted a few tidbits of information to try and clear up some of the unsurprising confusion:

• DMEs with pharmacists on staff DO NOT qualify for the extension.

• Pharmacies that were not accredited prior to the October deadline are not subject to the revocation of
Medicare billing privileges at this time.
• Any pharmacies that submitted a voluntary termination that now wish to withdraw this request, must submit a letter to the NSC signed by the authorized official.

• The letter MUST be received by the NSC no later than October 23, 2009.

• Letters may be faxed to the NSC by geographic location.

Fax Numbers
East Team - 803-382-2405
Central Team - 803-382-2408
West Team - 803-382-2406

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by: Theresa Flaherty - Thursday, October 8, 2009

Sleep Solutions did it again. A year after raising $20.5 million in venture capital, the manufacturer of home sleep diagnostic devices just announced it has raised another $20 million. In this economy, that's pretty eye-opening.

The Glen Burnie, Md.-based company said last year that it plans a nationwide launch.

by: Theresa Flaherty - Tuesday, October 6, 2009

The Senate joined the House yesterday when it voted to give community pharmacies until Dec. 31 to get accredited

“The Senate acted wisely to ensure seniors can continue purchasing essential
medical supplies from their community pharmacies,” said Bruce T. Roberts,
NCPA executive vice president and CEO in a release. “Senators Max Baucus, Charles
Grassley and Jon Tester, in particular, deserve recognition for shepherding
the bill through. Without it, thousands of independent community pharmacies
would be forced to stop supplying diabetes testing supplies and other
products to their patients.”

Theresa Flaherty

by: Theresa Flaherty - Monday, October 5, 2009

While the community pharmacy industry waits to see what happens with a last minute Congressional push to extend the accreditation deadline for pharmacies, there is confusion over what they should do in the meantime. See previous blog for some details from the National Community Pharmacists Association.

In particular: If a pharmacy has voluntarily terminated from Medicare Part B OR has “stepped down” on their 855S form and NSC HAS NOT processed your application, you can continue to bill for DMEPOS and Part B drugs. NSC will not process that application. The key is KNOWING whether the application has been processed. NCPA has secured a commitment from CMS that they will ask the NSC to NOT process and further pharmacy applications that request a “step” down or voluntarily termination from the program. Therefore, if you submitted either form within the last few days, it is not likely that it has been processed. If you application has not been processed, CMS has indicated that you can continue to bill for Part B drugs and DMEPOS – assuming you have a surety bond. If you WANT NSC to process the application to step down or voluntarily terminate, then CMS is going to ask pharmacies to send a letter to the NSC, asking that they process the application. Pharmacies can also call the NSC to see if their application has been processed, but it may take some time to get through given the number of calls going into the NSC.

However, a pharmacy provider contacted me today to say the NSC hadn't heard from CMS yet regarding this instruction.

It could take a few days for the two bureacracies to communicate and as we hear, we will update you.

Small comfort in the meantime, I know.

Theresa Flaherty

by: Theresa Flaherty - Friday, October 2, 2009

Pharmacies are likely to receive an extension on getting accredited, but what do you do in the meantime?

Bill Popomaronis, from the NCPA which has been working with CMS to alleviate some confusion, sent me the following:

• If a pharmacy has voluntarily terminated from the Medicare Part B program OR has “stepped down” on their 855S forms (that is, indicating that the pharmacy would be providing only Part B drugs BUT not DMEPOS) and the National Supplier Clearinghouse (NSC) has processed your application, then you are unable to bill for DMEPOS even if the extension passes next week.  A pharmacy should receive a confirmation letter from NSC regarding their change in status. If your “stepped down” application has been processed, UNLESS you modify your 855S again to indicate that you are going to also be dispensing Medicare DMEPOS in addition to Part B drugs, you cannot provide DMEPOS even if the extension passed. Processing these applications could take some time, so you would be able to bill again for DMEPOS, but it may take several weeks for CMS/NSC to process the “step up” application.

•  If you have “stepped down” and are waiting for accreditation, CMS has said that your billing privileges exist as of the date on the accreditation certificate.

•  If a pharmacy has voluntarily revoked its Medicare Part B billing number OR has “stepped down” on their 855S form (that is, indicating that the pharmacy would be providing only Part B drugs but not DMEPOS)and NSC HAS NOT processed your application, you can continue to bill for DMEPOS and Part B drugs. NSC will not process that application. NCPA has secured a commitment from CMS that they will ask the NSC to NOT process and further pharmacy applications that request a “step” down or voluntarily termination from the program.

You still need a surety bond and CMS has said it will be flexible on this requirement, for a FEW DAYS.

Theresa Flaherty

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