December 2022 - Newsletter

Included in this newsletter


CMS Announces Consumer Price Index for all Urban Consumers (CPI-U) Adjustments for DME in 2023

CMS published Medicare fee schedule adjustments for DMEPOS for calendar year 2023. Adjustments differ depending on whether the items serviced are competitive bidding program (CBP) items or in former competitive bidding areas (CBAs). Below is the breakdown:

  • CBP items in former CBAs: +6.4%
  • CBP items in non-CBAs: +9.1%
  • Non-CBP items: +8.7%

Express Scripts Contracts

Express Scripts is in the process of notifying patients in many areas of the country that on January 1, 2023, prescriptions must be filled by chain pharmacies or Express Scripts mail-order pharmacies. Most independent pharmacies are being dropped from their Express Scripts and PBM contracts. What to do:

  • Offer the patient's prescriptions at the cash price.
  • Both the pharmacy and patients should contact their US Senators and US Representatives and file a complaint.
  • Contact your local news media outlets.
  • The more pressure on Cigna and Express Scripts, the better the chance to stop this change of services.
  • Provide NCPA with documented information on where Express Scripts is making a change.

The Office for Civil Rights (OCR) Issues a Warning - Use of Online Tracking Technologies by HIPAA-Covered Entities and Business Associates

Tracking technologies are used to collect and analyze information about how users interact with regulated entities' websites or mobile applications ("apps"). For example, a regulated entity may engage a technology vendor to perform such analysis as part of the regulated entity's healthcare operations. The HIPAA Rules apply when regulated entities collect information through tracking technologies or disclose to tracking technology vendors, includes protected health information (PHI). Reference

Accreditation Commission for Health Care (ACHC) - Accreditation for Compounding

R.J. Hedges & Associates is updating the compounding policies and procedures (P&Ps) with the new USP <795> Non-Sterile Compounding. In addition, we are adding the ACHC standards into the respective P&P. When completed, ACHC will review all of the compounding documents. Once approved, ACHC will not check P&Ps before or during an on-site inspection for compounding accreditation.

In addition, if you are seeking or renewing ACHC accreditation, ensure you add R.J. Hedges & Associates, and a discount will be deducted from your application.

Alliance for Patient Medication Safety (APMS)

With rising costs, we have made the hard decision to remove the APMS service to avoid a service fee increase. The AMPS PQC+ program was provided free of charge for every R.J. Hedges & Associates Pharmacy Compliance and Compounding Compliance client. As of January 1st, facilities wishing to continue with this program will need to contact AMPS directly to pay for the pharmacy's account.

APMS has agreed to honor the renewal rate for all current clients transitioning from R.J. Hedges & Associates to their own APMS PQC+ account. For any client that notifies them before December 31st that they wish to continue with the program, the rate will be $275 per pharmacy location. The annual renewal rate goes up in January 2023 to $300. After March 31st, if you wish to rejoin, you will need to set up a new account and pay the new account fee of $350. Please email to notify APMS of your intention to migrate to your own account and they will set it up and send you an invoice. You will be able to continue seamlessly with the same log in credentials.

The Alliance for Patient Medication Safety (APMS), a federally listed Patient Safety Organization (PSO) since 2008, helps pharmacies put safety at the center of pharmacy operations. APMS is a vital part of the patient safety requirements in healthcare and as a PSO, they meet both Health and Human Services (HHS) and Pharmacy Benefits Management’s (PBM) requirements.

You can meet your state, accreditation, and Medicare Part D Quality Assurance (QA) requirements in a legally protected environment with the PQC+ products and other Continuous Quality Improvement (CQI) services. APMS makes it easy for you to set up and maintain a continuous quality improvement program so that you can quickly pinpoint process breakdowns and implement corrective training and workflow adjustments to reduce risk. Visit to learn more about APMS.

We continue to support their efforts and encourage all pharmacies to participate in their PQC+ program. Their link will continue to be live on our Compliance Portal® for ease of access.

CMS Sets Patient Deductible for 2023

CMS has released the new Part B beneficiary deductible for 2023. Medicare Part B beneficiaries will pay the first $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.

If your pharmacy or DME facility bills immediately after dispensing, the staff will need to know what the deductible is in order to collect the full, authorized amount. The deductible is mandatory as part of the Medicare Part B patient agreement. The first claims received will have the deductible applied. It is always easier to return money than to try and get it after the claim has been paid.

Targeted Probe and Education (TPE) Pre-Payment Reviews

The DME MAC Medical Review Departments conduct pre-payment supplier-specific reviews for the specialties below. The following quarterly edit effectiveness results from July 2022 to September 2022 can be located on the Medical Record Review Results webpage. Targeted Probe and Education (TPE) Pre-Payment Reviews include: Ankle-Foot Orthotics, Glucose Supplies, Manual Wheelchairs, Ostomy Supplies, Pneumatic Compression Devices, Therapeutic Shoes, Spinal Orthotics, Surgical Dressings, and Urological Supplies.

These audits are not an issue as long as your staff uses the Detailed Product Descriptions in the DMEPOS Compliance program.

Compliance Portal eLearning Center

We are pleased to announce the Compliance Portal® eLearning Center will start going live on January 1st. Facilities can choose to continue to use the paper training logs, certificates, and access trainings from the pdf video link list under the “Compliance Tools & Resource” section of the portal, or they can start utilizing the eLearning section which will assign trainings to users based on Compliance Services, User Type, and Employee roles within the facility. The eLearning Center does have the ability to house and store trainings logs and certificates. For the eLearning Center to operate properly, each employee should be made a user of the Compliance Portal® with their own unique email address.

This will only be used for receiving login credentials and password resets. We will be loading trainings as they become due throughout the year. Please review this how-to video:


Holiday Schedule

Our company will have a limited work schedule through the holiday season as we enjoy this time with our families:

  • Our office will be closed:
    • December 23-26, 2022
    • January 2, 2023
  • Limited staffing - December 27-30, 2022
  • We will maintain a staff contact to meet any CMS application requests.