NCPA fights 'improper and unwarranted' Part B recoupment efforts

WHAT IT MEANS AND WHY IT'S IMPORTANT Independent pharmacy clearly has found its voice.

(THE NEWS: Indie pharmacy applauds move in Congress to end aggressive Part B recoupment efforts. For the full story, click here)

In yet another testament to the growing stature of local pharmacy owner-operators in the endless give-and-take on Capitol Hill, two more members of the majority party in Congress have allied themselves with community pharmacy. How? By demanding that the White House put a stop to aggressive bill-collecting practices by Medicare Part B contractors trying to extract additional funds from retail pharmacies.

In many cases, the bills are for durable medical equipment, diabetic supplies and other health products sold years ago to Part B beneficiaries.

The bill-collection efforts are not only aggressive, said the National Community Pharmacists Association and other pharmacy groups. They’re also improper and unwarranted, they argued.

Medicare DME contractors want to recoup the full costs of products they supplied to retail pharmacies, and according to the NCPA are dunning owner-operated community pharmacies for payment. But it’s all but impossible for those pharmacies to provide a full accounting for products sold to patients who may or may not have been covered through a Medicare Advantage or Home Health Agency at the time of purchase, the NCPA asserted -- especially when the Centers for Medicare and Medicaid Services was playing catch-up in processing patient applications for MAs or HHAs. And at any rate, it’s up to the MA or HHA serving the Medicare Part B program to make up any payment discrepancy, the NCPA argued.

At least two influential members of Congress, Democratic Reps. Tammy Baldwin of Wisconsin and Bart Stupak of Michigan, agreed. They drafted a letter to CMS, demanding that the agency put an end to the aggressive collection efforts by contractors, and noting that the services and supplies provided by independent pharmacies to Medicare recipients were “billed in good faith.”

The battle to shield community pharmacies from the DME bill collectors may mark the final legislative campaign for the NCPA’s highly regarded top executive Bruce Roberts, who is retiring this month after nearly nine years as EVP and CEO.

In a statement June 17, Roberts summed up the industry’s position, noting that pharmacists must do what they can to serve patients with the health supplies and services they need, whether or not those patients are covered by Part B, and whatever form that coverage takes. “The DME contractors,” he said, “need to target MA or HHA in their collection efforts and not the pharmacists.”

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