Pharmacy extension could be a reality

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