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OMNISYS E-NEWS - DMEPOS ACCREDITATION

NEW INFORMATION FOR PHARMACIES

Medicare has extended the deadline for pharmacies to submit, to the Secretary, evidence of accreditation until January 1, 2011. Also, in general with respect to durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) furnished on or after January 1, 2011, in implementing quality standards, such standards and accreditation requirements shall not apply to such pharmacies if the pharmacy meets certain criteria.

All pharmacies that want to be considered to be exempt by January 1, 2011 must meet all of the following criteria:

The total billings by the pharmacy for DMEPOS are less than 5 percent of total pharmacy sales for the previous 3 calendar years.
The pharmacy had been enrolled as a supplier of durable medical equipment, prosthetics, orthotics and supplies and has been issued a provider number for at least 5 years.
No final adverse action has been imposed on the pharmacy in the last 5 years.
The pharmacy submits an attestation, in the manner and at the timeframe to be determined, that the pharmacy meet the criteria listed in 1-3.
The pharmacy agrees to submit materials as requested during the course of an audit conducted on a random sample of pharmacies selected annually.

Total DMEPOS billings are considered as less than 5 percent of the total pharmacy revenue. For example, if a pharmacy is part of a larger location, such as a grocery store that also has a pharmacy or a pharmacy that sells other items; the DMEPOS sales would be less than 5 percent of the pharmacy sales.

Chain pharmacies defined by the National Supplier Clearinghouse as having more than 25 locations, may not be able to meet the 5 percent exemption criteria. Currently a chain is accredited as one entity and, thus all the locations receive one accreditation decision. In order to determine whether the chain qualifies for an accreditation exemption, the chains total pharmacy and DMEPOS sales, including sales from all its locations, will be considered if the total DMEPOS sales are less than 5 percent of the total pharmacy sales, then the pharmacy would meet that particular exemption criterion.

Newly opened locations are required to be accredited because they do not meet the exemption requirement of having been enrolled in the Medicare program as a DMEPOS supplier for at least 5 years. Therefore, newly opened locations within chains or single locations would have to be accredited.

If a location is part of a franchise, then that location is not considered a chain and thus each location would have to receive a separate accreditation decision, if required. Accordingly, each location in this case is reviewed separately to determine whether it meets all of the exemption criteria.

Please contact your Account Executive at 800.432.1383 or Customer Service at 877.664.2234 if you have any questions.

Melinda Giese
VP, Account Management
Office: 800-448-6891 ext. 2079

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