The Ins and Outs of Completing an Independent Pharmacy Medicare Attestation

*Note this article is not legal advice, but represents only strategies for completing a Medicare attestation. Please contact a lawyer and your state board for more information.

Medicare is one of the biggest components of an independent pharmacy’s financial picture and the necessity and loopholes of the program have created a deep love/hate relationship among pharmacists. Direct and indirect remuneration (DIR) fees have been the source of intense scrutiny from lawmakers and stress for pharmacies across the US, with retroactive clawbacks from PBMs and Medicare Part D plan sponsors a hot topic when it comes to why drug prices continue to soar.

Attestations are key in protecting your pharmacy against clawbacks. PBMs request these annual documents proving that employees have completed all the requirements defined by Center for Medicare & Medicaid Services (CMS) to be compliant enough to continue Medicare/Medicaid contracts. Without meeting these requirements, PBMs and Medicare can “claw back” Medicare payments, leaving you at a significant loss.

It is a legally binding document, and should be handled with honesty, exactness, and as completely as possible. In order to give you the best chance for success, here are the best practices for handling completing your attestation.

Create a Strategy for Completing Your Attestation On Time

Typically, attestations are sent out in the fall with a deadline to be completed by the end of the year. Separate attestations are sent for each Medicare prescription or Medicare Advantage plan you have a contract with. This means, you need to already have a head start on completing the requirements for all your employees so that you attestation can be started before the first one ever arrives.

Begin looking for the updated training schedule in January and make sure that you schedule trainings with new employees within 90 days of their hire.

Keep Detailed Documentation and Records

Because the attestation is a legally-binding document, you have to think like a lawyer when documenting the completion of trainings. Incorporating trainings into your process is a great idea, but altering the language of the training in any way will make the training for purposes of the attestation void.

Best practices are to create separate attestation compliance files for each your employees using the direct attestation and training documents from the PBM or Medicare. Then, make sure to follow any specific rules to verify completion (notary, witnesses, etc.) and store them in several places with HIPAA-approved electronic record-keeping software.

Follow Specific Attestation Guidelines Carefully

Make sure to read the attestation carefully, regardless of how daunting it may seem. Highlight specifics like due dates, timelines, and other pertinent information. Some payers suggest that attestations are completed online at the NCPDP website. Although this seems like double-duty, take advantage of these options to have your attestation information stored in the way that will protect your pharmacy the most.

As previously stated, new hires must complete Medicare trainings such as the Combatting Medicare Part C and D Fraud, Waste, and Abuse Training and the Medicare Part C and D General Compliance Training within 90 days of their hire.

Still, every other pharmacist and pharmacy tech must complete these trainings as well. Make sure that there is a large window for your staff to complete the trainings. Although there is no set deadline, it is wise to have an internal deadline for your staff to complete them, far in advance of the end of the year.

Be Aware of What the Attestation Entails

There are several areas of an attestation, which is typically sent to an independent pharmacy from a Pharmacy Benefits Manager (PBM) for each Medicare prescription or Advantage plan you are contracted with. It is important to have an idea of how to best complete each attestation to avoid clawbacks. Some of the key elements of these documents may include:

Cultural Competency - Several payers have started requiring cultural competency training as a part of the attestation. This includes a specific training about how to best support a diverse client base and meeting cultural and language-based needs in the community.

Exclusion List Checks - All employees must have a recorded approval from the Systems for Award Management (SAM) and the OIG List of Excluded Individuals and Entities. This shows that they are eligible to help patients with Medicare and Medicaid plans. It’s best to print off a screen shot showing each employees’ eligibility every month, showing the date as per the requirement.

Conflicts of Interest Screening - Review the attestation, as some payers require proof that there are no conflicts of interest with those who manage Medicare and Medicaid processes or who might “steer” patients or doctors in an unethical way.

Offshore Vendors - Payers may request to see a list of offshore vendors to ensure that they are HIPAA-compliant and are managing business in a way that meets protected health information (PHI) standards to retain Medicare and Medicaid payments.

Dual-Eligible Beneficiaries - Payers in some states require training on how to manage those patients who qualify for both Medicare and Medicaid and how to support them in addition to identifying potential areas for fraud.

Code of Conduct - Every pharmacy must have a personalized Code of Conduct that meets the standards of the Prescription Drug Benefit Manual Chapter 9 Compliance Program Guidelines.

Conclusion

Consider the attestation one of the great protections of the business that you do with Medicare and Medicaid. As such, it is vital that you treat each attestation as the valuable and legally-binding document that it is. With the right kind of preparation, documentation, and training, completing attestations with confidence and foresight will keep you in the Medicare and Medicaid business for the foreseeable future.