APA

Under Section 3109 of the Affordable Care Act (ACA), certain pharmacies are exempt from Medicare accreditation requirements to supply durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), according to information provided in anOpen Door Forum conference call hosted by CMSon October 13.

By January 1, 2011, all pharmacies supplying DMEPOS through Medicare must either have accreditation, or have provided an attestation of meeting the exemption criteria and received an exemption letter from the National Supplier Clearinghouse (NSC), according to the call, which included 391 participants from across the country. Pharmacies that bill only for Medicare Part B drugs do not need accreditation.

Pharmacies must meet all three of the following criteria to qualify for an exemption, Sandra Bastinelli, Senior Technical Advisor in CMS’s Center for Program Integrity, said on the call:

Less than 5% of pharmacy sales (not including front end or other sales, such as groceries) were DMEPOS for the past 3 calendar years

The pharmacy must have been enrolled as a DMEPOS provider, with a valid provider number, for the past 5 years

The pharmacy must not have had any federal adverse action against it for the past 5 years

The attestation will require a signature by the authorized, delegated official of the entity, as defined in Section 15 of the enrollment application form, known as the855S, she said.

CMS will randomly audit 10% of exempt pharmacies in 2011.

For chain pharmacies, the individual locations must meet the three criteria; therefore, chains may have both exempt and nonexempt locations. Also, pharmacy locations that are new, or have had a change of ownership within the past 5 years, including a change to their tax ID number, don’t meet the second criterion, and are therefore not exempt.

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