Accreditation: The Pharmacy Exemption

DME pharmacies, the community pharmacies that also provide home and durable medical equipment, have unique circumstances when it comes to DMEPOS accreditation.

Of course, dedicated HME providers aren’t the only DMEPOS suppliers. DME pharmacies, the community pharmacies that also provide home and durable medical equipment, also can serve DMEPOS clients, but for them, accreditation isn’t as cut and dry.

Why? Those pharmacies can apply for an exemption with Medicare when it comes to DMEPOS accreditation. So, if a DME pharmacy believes the DMEPOS benefit might not play as large a role in their revenues and services in coming years, they might consider that exemption. How should they approach?

“There are really three things you need to have to apply for that exemption,” says Matt Gruskin, MBA, BOCO, BOCPD, CDME, credentialing director 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 dispensing 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 reimbursement 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 pharmacies. 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 under 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.

This article originally appeared in the January/February 2021 issue of HME Business.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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