Briefs: Pharmacies seek exemption, Graymark, sleep apnea

Thursday, July 22, 2010

Exemption rules issued for small Rx

BALTIMORE – CMS in July released instructions for exempting most small pharmacies from accreditation requirements, a provision included in the Patient Protection and Affordable Care Act that passed in March. Pharmacies that want to be considered exempt must meet the following criteria: The total billings by the pharmacy for DMEPOS are less than 5% of total pharmacy sales for the previous three calendar years; the pharmacy has been enrolled as a supplier of DMEPOS and has been issued a provider number for at least five years; no final adverse action has been imposed on the pharmacy in the past five years. Pharmacies that don’t meet the criteria for an exemption have until January 1, 2011 to become accredited.

Graymark sets CPAP record

OKLAHOMA CITY – Graymark Healthcare sold a record number of CPAP machines in the second quarter of 2010, the company said in June. The company provided machines to more than 750 patients and served more than 1,275 patients through its CPAP re-supply service, it said in a release. In 2009, Graymark launched a “comprehensive care model” to improve the number of patients diagnosed with obstructive sleep apnea who get treated with CPAP therapy. “We believe that our model better serves our patients and is more cost effective than the fragmented care provided in other settings,” stated Chairman and CEO Stanton Nelson. Graymark owns and operates sleep centers, independent pharmacies and a DME.

Sleep apnea rises among veterans

WASHINGTON – More than 63,000 veterans receive benefits for sleep apnea at a cost of $500 million per year, according to data released by the Department of Veterans Affairs. That’s up 61% since 2008. Exposure to dust and smoke in Afghanistan and Iraq is believed to be a factor, according to an article in USA Today. About 20% of veterans have sleep apnea, compared to 5% of the general population.

Nebulizers up

for review

WASHINGTON – National Heritage Insurance Co. (NHIC), the Medicare DME MAC for Jurisdiction A, announced in June that a widespread prepayment review of nebulizers with compressors (E0570) resulted in a 52% denial rate. NHIC plans to continue with the review. Providers will receive additional documentation request letters and must respond within 30 days of the date on the letter or risk claim denial.