Two members of Congress have asked the Centers for Medicare and Medicaid Services (CMS) to stop aggressive efforts by Medicare Part B durable medical equipment (DME) contractors to recoup costs from pharmacies, according to the National Community Pharmacists Association.


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Lawmakers: Rx unfairly targeted for DME costs

June 17th, 2010

ALEXANDRIA, Va. – Two members of Congress have asked the Centers for Medicare and Medicaid Services (CMS) to stop aggressive efforts by Medicare Part B durable medical equipment (DME) contractors to recoup costs from pharmacies, according to the National Community Pharmacists Association.

NCPA said Thursday that Reps. Tammy Baldwin (D., Wis.) and Bart Stupak (D., Mich.) sent a letter this week to CMS requesting that the agency "immediately instruct all Medicare Part B durable medical equipment Medicare Administrative Contractors (MAC) to cease their recoupment activities for services provided and billed in good faith by independent pharmacies."

According to NCPA, the contractors want recoupment from pharmacies for the entire costs of supplies, like diabetes testing strips, provided to Medicare patients from as far back as 2006, despite Medicare Advantage (MA) and Home Health Agency (HHA) bearing responsibility for the payment discrepancies.

"DME contractors are being intrusive and unrealistic in demanding pharmacies go back several years to account for the supposed overpayment of Medicare Part B supplies," NCPA executive vice president and chief executive Bruce Roberts said in a statement.

"Either patients were getting Part B supplies in the middle of a prescription cycle before they signed up for an MA or HHA, or the patients got the Part B supplies while CMS was processing their application for MA or HHA coverage. In either scenario the fault does not lie with pharmacists," he explained. "Part B claims do not happen in the rapid-fire, coordinated fashion of other programs like Medicare Part D. Instead, pharmacists must rely on getting information from their patients concerning any changes to their prescription drug coverage, which can be confusing and cause further delays.

"That's why the DME contractors need to target MA or HHA in their collection efforts and not the pharmacists," Roberts added.

In the letter, directed to CMS acting administrator Charlene Frizzera, Baldwin and Stupak told CMS that Medicare Part B auditors are demanding full recoupment from pharmacies for the cost of supplies provided to beneficiaries. "These pharmacies provided the necessary services to patients in good faith, and yet CMS asserts these claims were pain in error," the lawmakers stated.

"We strongly urge immediate review and correction of these recoupment activities and ask that CMS instruct DME MACs to seek reconciliation directly with the appropriate MA plan or HHA," the letter said. "Pharmacies should not have to return reimbursement monies for services provided and billed in good faith. The claims process and recoupment issues described by CMS and its contractors are creating administrative burdens that limit the time pharmacists can spend providing Medicare beneficiaries and other patients with quality consultation and care."

The issue was raised earlier this year in a joint letter to CMS from the NCPA, National Association of Chain Drug Stores and National Alliance of State Pharmacy Associations.

Pharmacists nationwide "should applaud Reps. Tammy Baldwin and Bart Stupak for their leadership on this issue," Roberts commented.

"Reps. Baldwin and Stupak's call for CMS to use its authority to have the contractors end this practice is the right solution," Roberts stated. "We hope CMS will heed their advice and act accordingly. This will allow pharmacists to continue doing what they do best: care for their patients without getting caught up in a bureaucratic nightmare."

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