Included in this newsletter
- R.J. Hedges & Associates Legal Business Name Change – For CPAs
- Chain Pharmacies Continue to Close Locations Nationwide
- AAHomecare Payer Transparency Portal Launching January 2025
- DMEPOS Calendar Year 2025 CPI-U Increase
- Pharmacy Benefit Managers (PBM) Reform
- Justice Department Files Nationwide Lawsuit Alleging CVS Knowingly Dispensed Controlled Substances in Violation of the CSA and the FCA
- New CMS Part D Audit Flag for 2025
- Save on DMEPOS Accreditation Costs with a Pharmacy Exemption
- ACHC announces their Standards Unchanged
- DMEPOS Fee Schedule Updates
- R.J. Hedges Billing Apology
- Moving Sale: Hazardous Drug Spill Kits
- DEA Update
- New & Updated P&P, Forms & Support Documents
R.J. Hedges & Associates Legal Business Name Change – For CPAs
Please send this information to your bookkeeper and CPA for preparation of the 1099s. Copies of these W9’s can be found on the Portal Message Center
- R.J. Hedges & Associates LLC, d/b/a R.J. Hedges & Associates
- 20-4867192 January 1, 2024 to September 27, 2024
- Connecture LLC, d/b/a R.J. Hedges & Associates
- 58-2488736 October 1 to December 31, 2024
- IRS 1099s will be returned for correction if the full year is credited to our former company ownership.
Chain Pharmacies Continue to Close Locations Nationwide
CVS, Rite-Aid, and Walgreens continue to close pharmacies nationwide at a rate faster than independents selling or going out of business. Opportunities continue to present themselves, however. As the new administration is about to take office, PBMs are squarely in the Trump administration’s sights. No one knows where this will lead, but any change must be for the better. Patients are looking for pharmacies that will take them.
Everyone should know by the 20th of January what Part C and Part D plans are good for business and which ones will cause the pharmacy to lose money. Post a sign stating which plans provide a reasonable reimbursement. Market these plans to the dispensing area. If reimbursement policy changes, you will be in a better spot to grab the lion share of patients looking for a pharmacy.
AAHomecare Payer Transparency Portal Launching January 2025
AAHomecare is excited to announce a groundbreaking new benefit for HME provider members coming in January 2025: the AAHomecare Payer Transparency Portal!
Here’s what this benefit means for HME provider members:
- Nationwide payer insights: Tap into data from over 60 major commercial insurers to understand reimbursement trends and payment rates.
- Competitive benchmarking: Compare your reimbursement rates to your peers and competitors.
- Smarter negotiations: Leverage detailed data segmented by payer, geography, and billing codes to advocate for fair, competitive rates. Click here for more information.
DMEPOS Calendar Year 2025 CPI-U Increase
CMS has published the Consumer Price Index for All Urban Consumers (CPI-U) adjustments for the Calendar Year 2025 DMEPOS fee schedule.
The CPI-U for the 2025 DMEPOS fee schedule is set to increase from 2.4% to 3%. The adjustment will be different depending on if the item is part of the competitive bid program and if the zip code of the patient is in a previous competitive bid area. Read more…
Pharmacy Benefit Managers (PBM) Reform
President Trump and his administration have been focused on the unfair practices of the PBMs with their reimbursements and regulatory authority. There are a lot of opinions on what is or what will occur. Any reform or relief from the PBM predatory markets will only come through a “reconciliation bill”. The reality is that the only way forward for relief will come from this process. Last year, Mitch McConnel and Chuck Schumer pulled the PBM reform act from the reconciliation bill at the last minute. We need everyone to work with their Congressmen and Senators to ensure the new leadership in Congress does not repeat last year's backroom dealings.
Justice Department Files Nationwide Lawsuit Alleging CVS Knowingly Dispensed Controlled Substances in Violation of the CSA and the FCA
A legal case just lodged by the Justice Department claims CVS Pharmacy contributed to the U.S. opioid crisis by knowingly dispensing prescriptions for controlled substances that should have been denied. Those included prescriptions for dangerous and excessive quantities of pain medications; early fills; so-called trinity prescriptions, including an opioid, benzodiazepine, and muscle relaxant; and prescriptions written by prescribers known to order controlled substances without a legitimate medical purpose. Court documents allege the company, driven by financial motivation, ignored red flags raised by its pharmacists and other sources that it was crossing a legal line. “Our complaint alleges that CVS repeatedly filled controlled substance prescriptions that were unlawful and pressured its pharmacists to fill such prescriptions without taking the time needed to confirm their validity,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department's Civil Division. “The practices alleged contributed to the opioid crisis and opioid-related deaths, and today's complaint seeks to hold CVS accountable for its misconduct.” The case hinges on CVS' purported violation of the Controlled Substances Act and also the False Claims Act, in cases where it requested reimbursement from federal health care programs. See more...
New CMS Part D Audit Flag for 2025
If your pharmacy receives paid claim responses from Medicare Part D plans with Approved Message Code 057 Beneficiary participating in Prescription Payment Plan, you absolutely need to send a subsequent claim for the copay amount due to the Part D plan's Medicare Prescription Payment Plan processor. Effective Jan. 1, 2025, make sure everyone who works in the pharmacy department knows this because it's an easy audit flag to find pharmacies that fail to process the MPPP claim for the copay.
Contact your pharmacy management system right away if you don't know how to check for Approved Message Code 057, or where to look to find the MPPP processing information in the COB/Other Payer segment. For more information on the MPPP, including a continuing education program for pharmacists and pharmacy technicians, See More
Save on DMEPOS Accreditation Costs with a Pharmacy Exemption
If your pharmacy is accredited to dispense DMEPOS items, but those sales account for less than 5% of your total pharmacy sales over the past three calendar years, you may qualify for a Pharmacy Exemption.
This exemption allows you to eliminate the expense of maintaining an accreditation certificate while still complying with DMEPOS Supplier Standards and maintaining the required $300,000 liability insurance. By filing for this exemption, you can avoid the recurring accreditation costs typically paid to your Accreditation Organization every three years.
For more details, refer to the NPEast and NPWest Pharmacy Exemption Attestations in the Checklist section of the Compliance Portal.
DMEPOS Fee Schedule Updates
Updates to the CMS DMEPOS Fee Schedule for 2025 took effect January 1. Revisions include payment policy changes, new HCPCS codes, and updates to existing codes, according to a recent MLN Matters article that details changes. No codes were deleted.
The 2025 fee schedule also includes national payment amounts for lymphedema compression treatment items.
DMEPOS Fee Schedule files are provided on the CMS website. The list includes fee schedule amounts and floors and ceilings for procedure codes and payment categories.
ACHC announces their Standards Unchanged
ACHC announced that no changes will be made to their DMEPOS Accreditation Standards in 2025. They state, “Even though standards are unchanged, you still must maintain compliance throughout your accreditation cycle.”
R.J. Hedges Billing Apology
Please accept our heartfelt apologies regarding any billing confusion or concerns that occurred during the December/January time period. We greatly appreciate the feedback from our clients and have worked to rectify the situation.
While integrating to our new billing software and processes, our previously scheduled auto drafts for clients that elect to pay by ACH were not pulled in December. The payments were drafted in the 2nd week of January, and unfortunately, closely followed by a second draft to cover the January invoices for those clients, which caused concern for many clients. If you mailed a paper check and had ACH drafts, you will have a credit on your account that will carry over to the February Invoice.
We also experienced an issue with the previously shared email for our new accounts receivable group AR_RJHedges@harriscomputer.com and a breakdown in receiving those emails. The issue has been remedied and inquires going to that address are now being addressed. Please feel free to reach out to Our Director of Operations, Becky Templeton- if you experience any further issues. Becky@rjhedges.com 724-357-8384
Compliance Portal Updates:
During the month of January our staff email system was migrated to the new system within our Parent Companies IT Structure. This migration did cause a mild disturbance in our Compliance Portal and the website failed to send notices when new users were created and when Tickets were submitted. Both items have been corrected and integrated.
During the Month of December and January we updated the coding language in our Compliance Portal. Although thorough testing was conducted prior to its deployment, several glitches occurred, all of which have been corrected. If you experience any further issues- please use the ticketing system within the portal or notify your project manager.
DEA Update
The DEA has been updating their website and items frequently and without notice. Our DEA Program will be getting modified due to several changes within the DEA Website. Previously public links and files are now being housed within user CSOS account; these include items such as the DEA forms for Registrant, Coordinator, and Alternate Coordinator. For additional resources and tools please consult https://deadiversion.usdoj.gov/drugreg/csos/csos.html
Moving Sale: Hazardous Drug Spill Kits
R.J. Hedges & Associates is having a Moving Sale for our Hazardous Drug Spill Kits. These kits can be used for Hazardous Drugs, Hazardous Chemicals, and Bio-Hazards containment and cleanup. Get yours while they last for $65.00 + shipping. Email sales@rjhedges.com or order online https://www.rjhedges.com/usp-800-hazardous-drugs-compliance-retail-pharmacies.
New and Updated Policies & Procedures- None this month
New and Updated Forms & Support Documents- None this month
