NCPA Lauds Letter Asking CMS to Call Off the MACs

WASHINGTON — In a letter to CMS, Reps. Tammy Baldwin, D-Wis., and Bart Stupak, D-Mich., asked 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.”

The National Community Pharmacy Association applauded the representatives’ request, and said pharmacists across the country should, too.

According to association, which represents nearly 23,000 independent pharmacists, the DME MACs want recoupment from as far back as 2006 on claims for some beneficiaries who became affiliated with a Medicare Advantage plan or a home health agency after the claims were filed.

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

In their June 14 letter, Baldwin and Stupak told CMS that “Medicare Part B auditors are demanding complete recoupment from the pharmacy for the entire cost of the supply provided to the beneficiary. These pharmacies provided necessary services to patients in good faith and yet CMS asserts these claims were paid in error.”

On Thursday, Bruce T. Roberts, RPh, NCPA executive vice president and CEO, issued the following statement in response to the representatives’ letter:

“Pharmacists in Wisconsin, Michigan and across the country should applaud Representatives Tammy Baldwin and Bart Stupak for their leadership on this issue. 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.

“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. 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. Representatives Baldwin and Stupak’s call for CMS to use its authority to have the contractors end this practice is the right solution. 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.”

Read the Baldwin-Stupak letter on NCPA’s Web site.