Pharmacies slow to grasp accreditation
BALTIMORE - CMS made it clear during its Dec. 19 Open Door Forum that pharmacies who want to continue billing Medicare will have to be accredited by Sept. 30, 2009, just like everyone else.
Pharmacies that bill Medicare for even tiny amounts of DME and diabetic testing supplies need to be accredited, said CMS officials.
Pharmacies that offer Part B drugs--such as respiratory medications--do not need to be accredited if they are only billing for the drugs. But pharmacies that offer those drugs along with covered supplies, like nebulizers, need to be accredited in order to continue billing Medicare for the covered items.
"If a pharmacy doesn't want to go through the hassle of accreditation, make an agreement with a local HME for referrals," said Bob Weir, a surveyor for HQAA.
A particular concern for pharmacies and diabetes advocates has long been whether competitive bidding would hamper patient access to diabetic testing supplies.
"I am the only pharmacy in a one-hour radius," said one caller. "I will have to be accredited, and if it's expensive, I won't be able to do it."
That's a problem, said Scott Williamson, director of facility accreditation for the American Board for Certification in Orthotics, Prosthetics and Pedorthists.
"We can't afford to let people close up shop," he said.
Pharmacy providers that decide the expense of accreditation outweighs the value of continuing to service Medicare customers are "missing the boat," said Sandra Canally, president of the Compliance Team.
"Pharmacies equate the cost of accreditation to the amount of money that is spent, for say the strip," she said. "It's not just about that. It's about losing those patients completely. The patients who are no longer able to get their strips there will go to a competitor."
Most accrediting agencies offer pharmacy programs with lower costs, said Tom Cesar, president and CEO of ACHC.
For example, accreditation might include a one-day survey at a cost of $2,000 to $3,000. Average that over three years and the cost per month is $55 to $83--not a huge amount of money, he said.
"They have to determine what is the revenue stream they earn from Part B," said Cesar. "If it's too small, they might not want to."