Pharmacy Benefit Managers (PBM) have begun auditing pharmacies nationwide. PBMs have audit authority for Medicare Part C and Part D. LTC Pharmacy at Home has several requirements, with the most notable being that medications must be delivered to the patient’s residence by a pharmacy delivery vehicle, in adherence packaging, and must be billed with key billing codes under a separate NPI and NCPDP. In addition, the patient’s eligibility must be documented, noting reasons for eligibility such as chronic conditions, number of daily medications, ADLs (Activities of daily living or IADLs (Instrumental activities of daily living).
We’re excited to announce that our LTC at Home Compliance Program is officially available for purchase!
If your pharmacy delivers monthly medications, provides compliance packaging, and coordinates care for Medicare patients in their homes, you’re already providing Long Term Care at Home services! Now let’s make sure you’re getting paid for it.
Designed specifically for independent pharmacies, this self-service solution helps you:
Client-Exclusive Offer: 50% Off Through September 30, 2025
CDC's latest update reveals that 1,333 measles cases have been confirmed this year across 38 states, far outpacing last year's total of 285. The number of outbreaks is also greater in 2025 compared with 2024 (29 vs. 16), as is the share of infections linked to outbreaks (87% vs. 69%). CDC also reports that approximately two-thirds of the cases involved persons aged 19 years or younger, who accounted for 121 of the 169 infections serious enough to warrant hospitalization. The overwhelming majority of confirmed cases (92%) presented in individuals who were not vaccinated against measles or whose immunization status was unknown. U.S. residents are advised to protect themselves by getting the measles, mumps, and rubella vaccine, especially if they have travel plans in the near future. See more…
HHS and the CDC are pushing hard for providers to have access to immunizations for their patients. There is a significant lack of trust and respect towards the Centers for Disease Control and Prevention (CDC), which is leading parents to reconsider these proven vaccines. This is a consequence of the COVID-19 pandemic.
Trust can only come from local pharmacists. We recommend reaching out to local physicians, school nurses, churches, places of worship, and any other locations where people congregate with their children. You are still the most trusted healthcare professional in the U.S. The R.J. Hedges Immunization Compliance program offers pharmacies marketing materials, standing orders, and comprehensive travel information for destinations worldwide. Please take advantage of this resource as we approach the 2025/2026 influenza season. Opinion article from Jeff Hedges.
Floods, storms, volcanoes, tornadoes, and wildfires appear to be increasing every year. When was the last time you reviewed your Disaster Recovery Plan within your compliance programs? This is a perfect time to take 30 minutes and review the information contained within your plan. If there are any updates, please document them and send them to your Project Manager. She will be able to update your plan, and it will be available on the Compliance Portal®.
CMS is considering a change to DMEPOS accreditation by increasing on-site surveys from every three years to annually. If the number of accreditation surveys increases, so will the fees. Surveyors are paid for travel, meals, and expenses, plus the accreditation organization’s reviews and documentation will increase threefold. These costs will be assessed to the accredited facility.
Documenting complaints isn’t just a regulatory requirement, it’s a best practice for protecting patients and strengthening operations. Every recorded concern provides insight into potential risks, helps identify patterns before they escalate, and demonstrates your pharmacy’s commitment to quality and accountability. By maintaining clear complaint records, you not only stay prepared for CMS inspections but also build trust with patients and staff. ACHC has posted this article concerning complaints. Compliance Portal's complaint policy and procedure, as outlined in HIPAA, DMEPOS, and Pharmacy, align with this article. See More…
Medicare PTANs for DMEPOS providers/suppliers are increasingly being deactivated. Why? Federal NPE contractors are finding expired or obsolete information in PECOS records. If your PTAN is deactivated, your pharmacy exemption will be lost and you will need to be accredited to reactivate your PTAN. See More…
Point-of-care testing (POCT) is an essential service for communities and independent pharmacies are increasingly the place where it's done. The NCPA Innovation Center partnered with NASPA to develop the “Guide to Implementing Point-of-Care Testing Services in Community Pharmacy”, sponsored by QuidelOrtho. It explains how to set up and provide POCT services, market them in your community, and navigate reimbursement. Read more...
Proposed legislation aims to protect and strengthen the federal government's 340B drug discount program, which provides discounted pricing for prescription medications purchased by “safety-net” hospitals serving low-income populations. The initiative has come under fire in the last 5 years due to providers' increasing use of contract pharmacies for dispensing, with some drugmakers denying or restricting 340B discounts channeled through these local businesses. The 340B PATIENTS Act reinforces manufacturers' obligation to offer cut-rate pricing to covered entities even if they use a contract pharmacy to dispense the medications and prohibits them from placing conditions on covered entities to receive the program discount. Additionally, the bill imposes civil fines on noncompliant drugmakers. The measure was introduced in the U.S. House by Rep. Doris Matsui (D-CA) and in the upper chamber by Sen. Peter Welch (D-VT) and is supported by multiple organizations. See more…
When preparing for an anticipated or a surprise compliance audit or inspection, the Compliance Portal® has a valuable resources ready for your use. On the Compliance Portal® Home Page, scroll down to the “Compliance Tools & Resources” section and click on the link titled “Checklist for Inspection & Surveys”.
This link provides checklists covering Accreditation Surveys, CMS, DEA, PBM, and other types of inspections. These checklists include:
If you receive advance notice of an audit or inspection, use the appropriate checklist to gather and print the required documents, attaching each one to its corresponding checklist item. This preparation often impresses surveyors and facilitates the smooth progress of audits.
In the case of a surprise inspection, there’s no need to panic. Staff should simply open the Compliance Portal®, select the relevant checklist, and follow the steps. The checklists are formatted similarly to the monthly task lists to reinforce consistency and independence in completing compliance duties.
If you encounter a new audit format or notice discrepancies in checklist content (e.g., new or removed items), forward the audit notice to your Project Manager.
LTC at Home:
Pharmacy:
DEA:
LTC at Home