Pharmacy Accreditation Exemption Statement of Fact Sheet
November 2010
As of January 1, 2011 pharmacies that meet all of the following criteria may file an accreditation exemption statement which enables them to be enrolled in Medicare to supply durable medical equipment, orthotics, prosthetics and supplies (DMEPOS) which require accreditation, without having an accreditation.
The criteria are as follows:
1. The pharmacy has been enrolled in Medicare as a DMEPOS supplier for at least 5 years;
2. The pharmacy has not had an unrescinded final adverse action during the past five years;
3. The pharmacy’s Medicare billing for DMEPOS, other than drugs and pharmaceuticals which are not subject to accreditation, is less than 5 percent of pharmacy sales for the previous 3 calendar or fiscal years. Pharmacy sales are those that are in a separate pharmacy account(s) for entities whose accounting system has such a breakout. For pharmacies whose accounting system does not provide a breakout of pharmacy items versus non-pharmacy items (usually small pharmacies), the total gross sales of the pharmacy shall be considered to be the pharmacy sales.
A. If you are a currently accredited pharmacy that meets the exemption criteria who desires to no longer be accredited, you may submit a signed copy of the accreditation exemption statement shown below anytime after January 1, 2011. You do not have to wait until your accreditation has ended. The National Supplier Clearinghouse (NSC) will send you an acceptance by mail. If you do not qualify for the exemption, the NSC will notify you that your accreditation exemption statement has been rejected and provide an explanation for the rejection. It is recommended that you do not terminate your accreditation until you receive notice from the NSC that your accreditation exemption statement has been accepted. We make this recommendation because if you are no longer accredited and do not qualify for the exemption, your Medicare billing privileges will be revoked.
B. If you are a currently accredited pharmacy who will meet the exemption criteria after January 1, 2011, who desires to no longer be accredited at that time, you may submit a signed copy of the accreditation exemption statement as of the date of your 5-year anniversary of enrollment in Medicare. You cannot sign the statement before the 5- year anniversary date. It is important that you are certain that you qualify for the exemption prior to terminating accreditation. Therefore, it is recommended that you continue accreditation until you have received notice of acceptance of your accreditation exemption statement from the NSC. We make this recommendation because if you are no longer accredited and do not qualify for the exemption, your Medicare billing privileges will be revoked.
C. The attestatin for exemption from accreditation statement must be signed by the Authorized or Delegated Official of your company shown on Section 15 or 16 of your previously submitted CMS-855S Medicare enrollment application.
D. If your pharmacy has more than one practice location, each individually enrolled practice location must submit a separate attestation for exemption from accreditation statement. New locations of enrolled multiple- location pharmacies are not considered to have been enrolled for 5 years. Pharmacies that have had a change of ownership in the prior 5 years which resulted in a change in their legal business entity, including a change in their Taxpayer Identification Number (TIN), do not qualify for the accreditation exemption.
E. For more information or if you have questions, contact the National Supplier Clearinghouse at (866) 238-9652, M-F between the hours of 9:00 am – 5:00 pm, Eastern Time.