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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

by: Theresa Flaherty - Wednesday, September 30, 2009

I was talking to the folks over at the National Home Infusion Association yesterday. Sen. Max Baucus' admission that Congress needs to do something about the lack of Medicare coverage for home infusion is a "step forward," said executive director Russ Bodoff.

"It's always nice when the chairman of the finance committee recognizes the need for the fix," he added.

The next step is getting a revised CBO score that demonstrates the true costs of home infusion therapy, as well as the savings it offers the Medicare program when patients are treated in the home (about $200 per day, vs about $1,200 per day in the hospital).

The association is asking providers to contact their lawmakers now and ask for the CBO score.

Theresa Flaherty

by: Theresa Flaherty - Monday, September 28, 2009

My editor occasionally groans when she sees I am doing an update on the home infusion industry's efforts to get Medicare coverage for their equipment and services. She supports the legislation, don't get me wrong. But, it's been a long battle and I am sure that she sometimes feels like she's rereading the same story.

But, the HME industry at-large could take a page from the National Home Infusion Association's government playbook. The Medicare Home Infusion Coverage act has stayed consistent and on-message from Day 1. The most recent version is an update of one launched in 2007, during a different Congress.

There's no public bickering, backstabbing or boo-hooing going on among the players. Wow, what a concept. A unified front to show Congress the industry stands behind itself.

Last week, during discussions on the pending health care reform legislation, Sen. Max Baucus acknowledged that, when it comes to home infusion coverage, "There is certainly a gap in benefits."

That must be music to infusion providers' ears.

Theresa Flaherty

by: Theresa Flaherty - Friday, September 18, 2009

The FDA says its time to tighten the standards for glucometers. That's because the current error rate for the devices is  a whopping 20%.
As someone who depends on these devices—to the ouch-inducing tune of 8 to 10 times a day—to make sure I am not in any clear and present danger, I find it appalling that a 20% inaccuracy rate has been acceptable for so long.
Not to mention the long term repercussions if my blood sugars have actually been, say, 20% higher than I believed over the last 10 years.
FDA Commissioner Margaret Hamburg says the devices have been "generally effective" in managing diabetes since they launched in the 70s (that's a long time ago now, folks). What does that even mean?
Apparently, manufacturers are content with the standard so why bother with improvements? After all,  some of these companies only have a few measly billion dollars to show for all my finger sticking.
According to a Wall Street Journal article, J&J doesn't break out the sales, but they are part of its diabetes-care franchise, which had $2.5 billion in sales last year. Abbott's diabetes-care unit had $1.35 billion in sales last year.
Theresa Flaherty

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by: Theresa Flaherty - Monday, September 14, 2009

I'm all for fundraisers to support diabetes research and programs, especially for type 1. Really.

A supermarket chain in the Charlotte area this past weekend held a fundraiser for Juvenile Diabetes Research Foundation. For a donation, you can get a hot dog, a root beer float and a cookie. First, let me say kudos to the business that puts up the time and money  for this event.

But this fundraiser kind of leaves type 1's with an empty plate. None of those are healthy food choices, for anyone. And, despite the common misperception among the masses that eating poorly contributes to type 1 (it doesn't), I still don't think is the best sort of message to be sending. The fat/calories/sodium content alone should be enough to send us all screaming to the salad bowl.

Don't even get me started on the carb count.

Theresa Flaherty

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