Page 14 - HME Business, November/December 2020

There are many community phar- the big box stores. And not only will they go for
macies that offer durable medical equipment and home medical equipment (DME and HME) on
a retail basis. Items such as bath
safety products, orthopedic braces, pain man- agement offerings, and standing and walking aids can really help drive revenue.
Moreover, those items also ensure that the pharmacy can serve as a single healthcare prod- uct source for its local marketplace. That role can be particularly important if the pharmacy is in a rural area where finding in-person access to those types of products can be difficult.
However, many DME items are funded under Medicare, and that puts the DME pharmacy in a tough position. If one of its many Medicare ben- eficiaries comes in to pick up a prescription and also is interested in a DME item he or she knows is funded by Medicare, the pharmacy is going to be in the difficult position of only being able to offer it on a cash basis.
And besides running the risk of alienating steady clients, many DME pharmacies want
to become a supplier for Medicare’s Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) benefit because that lets them access a new revenue stream. However, to bill Medicare as a DMEPOS supplier, a phar- macy must be accredited.
THE ACCREDITATION IMPERATIVE
Accreditation is both important and imperative for being a DMEPOS supplier for Medicare ben- eficiaries. First off, if you plan to derive more than 5 percent of your revenue from DMEPOS, then you must have Medicare accreditation.
“The easy answer is that, going back to the Medicare Modernization Act of 2003, it was man- dated that anybody that wanted to bill Medicare for DME items had to be accredited by one of the approved agencies,” says Sandra Canally, RN, the founder and CEO of accreditation organization The Compliance Team (thecomplianceteam.org). “... What I tell pharmacists is that you want to have a Medicare part B number to be able to bill and service your Medicare beneficiaries for everything that they need.
“If, for example, diabetes patients are coming to your pharmacy right now for scripts, you want to be able to give them the diabetic strips, to give them the diabetic shoes, or give them walkers, or whatever,” she continues. “Because if you’re not able to do that, it gives them the opportunity to go down the street to your competition, or go to
6
December 2020 | DME Pharmacy
hme-business.com
that, but they’ll take their strips with them. Why wouldn’t they?”
It’s also important to note that while DMEPOS accreditation is for Medicare, it has become a gold standard with other funding sources.
“It’s not all about CMS,” says Tim Safley, pro- gram director for the Accreditation Commission for Health Care (ACHC; achc.org). “And that’s one of the things that people forget. There are other payers. ... If the pharmacy itself is looking for other avenues of revenue, such as third-party pay- ers, or even Medicaid, some of those still require accreditation.”
And that means that when a customer comes into the accredited DME pharmacy, they know they have a one-stop-shop.
“When the patient comes in, the pharmacy has a full line of availability, they can service every- thing,” Safley says. “The pharmacy is building that relationship with the patient, and can eventually serve him for everything.”
THE PHARMACY EXEMPTION
First off, when considering accreditation for DMEPOS, it’s important to note that pharmacies can apply for an exemption with Medicare when it comes to DMEPOS accreditation.
“There are really three things you need to have to apply for that exemption,” says Matt Gruskin, MBA, BOCO, BOCPD, CDME, credentialing direc- tor for the Board of Certification/Accreditation (bocusa.org). “You need to be enrolled for five years with a PTAN number. You have to have no adverse actions against you. And then you have to have less than 5 percent of your revenue come from DMEPOS. So for example, if you are dis- pensing nebulizers to everyone that comes in for albuterol, and you look at your finances and you’re at 7 percent of your revenue is coming from those nebulizers, you’re not going to qualify for it. So you’re going to need that accreditation still.”
This is important for a community pharmacy offering DME to consider. Even a pharmacy initially starts providing DME not necessarily from a profit perspective, but more in terms of trying to provide a community health service, It could still quickly eclipse that 5 percent, given the reim- bursement on some of these items.
“It’s something that we focus on when we speak with customers that are pharmacies,” Gruskin says. “You want to provide continuity of care, especially for the community-based pharma- cies. So, when the physician refers them to your business, they can ask you questions about their nebulizer. And you know what? Their mother-in-
law Might be an insulin-dependent diabetic, and she may get the insulin from you. Well, now you can also dispense the pump as well, right?
“So I do think it’s super relevant for these pharmacies to look at the product categories un- der the DMEPOS benefit and take a look at what they’re doing from a Part D perspective and see if any of that complements it,” he adds.
STEPS TO ACCREDITATION
So, assuming the pharmacy is going to exceed that 5 percent, what is the accreditation process like? It starts with the pharmacy submitting an application, Canally says. What happens next depends on the accreditation organization (AO). Some AOs will be out of touch until about six months later, when it conducts a site survey (this has traditionally been done on-site, but during COVID-19 they have been conducted virtually).
In those instances, Canally says, “There’s nothing in between with assistance or prepa- ration. The pharmacy usually hires an outside consultant that helps them develop policies and procedures and so forth.”
In the case The Compliance Team and AOs like it, there’s more of an effort to provide a turnkey solution. “We assign them an educator, who is going to walk them through the stan- dards; what they need to do on their end; and more or less keep monitoring them via telecon- ferences,” Canally says. “Also, we give them a toolbox. In that toolbox, they have assessment checklist, and they have templates of policies, so they don’t need to start from scratch.”
Safley echoes that point: providers should seek out AOs that will help them chart a path through the process.
“The pharmacy needs to research as to
“You want to provide continuity of care, especially for the community-based pharmacies.”
— Matt Gruskin, MBA, BOCO, BOCPD, CDME, the Board of Certification/ Accreditation