Magazine article Drug Topics

Medicare Part B: To Stay or Go?

Magazine article Drug Topics

Medicare Part B: To Stay or Go?

Article excerpt

The preeminent role that community pharmacies play in home care is being directly challenged today by the Centers for Medicare & Medicaid Services' DMEPOS (durable medical equipment, prosthetics, orthotics, and supplies) competitive bidding program and requirement for mandatory accreditation. These provisions were passed by the Medicare Modernization Act (MMA) of 2003.

Since shortly after the passage of the MMA, whenever I spoke to a group of pharmacists about accreditation, it was apparent right from the start that of all the different types of DMEPOS providers I have come across in my travels around the United States, pharmacists have been, by far, the most vocal when showing their frustration with Medicare. Many pharmacists/owners I have met are rightfully concerned about their future. Who can blame them? My worry is that community pharmacies will decide to sit out this next phase of the MMA's implementation and elect to not continue their participation in Medicare Part B.

Let's face it, few among us like being told how to run our businesses. As a fellow entrepreneur, I also share some of the same concerns that owner /operator s have about counterproductive laws and rulings.

However, the fact of the matter is that CMS is moving forward with implementing all of the provisions of the MMA, and my instincts as a nurse of many years tell me that if community pharmacies choose to sit on the sidelines and not participate in Part B, many of their longtime patients and steady customers will suffer.

For the second time in less than 18 months, community pharmacy owners and managers need to think long and hard about their participation in Medicare. Only this time, it is Part B. One thing is certain, if a pharmacy has a Medicare Part B billing number, whether it accepts assignment or not, CMS says that it must become accredited.

Sure, some patients will pay out of pocket and wait for their reimbursement check from Medicare. Eventually, though, in spite of their old loyalties and friendships, many will have little option but to find a DMEPOS provider that is accredited and has maintained its Medicare Part B eligibility.

Although we won't know until next spring what effect competitively bid contracts for DMEPOS products and services will have, we do know that mandatory accreditation is here and now. …

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