NCPA Summary and Timeline of CMS Implementation of
Pharmacy Exemption for DME Accreditation
June 28, 2010
• To qualify for an exemption from accreditation, CMS will automatically send letters to pharmacies that
are not accredited to sell DME, but have had a supplier number for 5 years, asking them to attest that their
Medicare DMEPOS billings are less than 5% of total pharmacy sales. The timeline is below:
• September 30, 2010-Deadline by which the National Supplier Clearinghouse (NSC) must make a list of
enrolled pharmacies, based on individually enrolled practice locations, which are not accredited and have
been enrolled for 5 calendar years prior to January 1, 2011. New locations of enrolled chain
pharmacies shall not be considered to have been enrolled for 5 calendar years.
• October 1, 2010 through October 31, 2010-NSC shall mail letters to individually enrolled pharmacy
practice locations that meet the 5 year enrollment requirement for them to attest that they are exempt from
accreditation because their total DMEPOS billings are less than 5% of their total pharmacy sales over the
last three years. DMEPOS billings only include those items provided by a pharmacy that are subject to
accreditation.
o The attestation letter must be signed by the pharmacy’s authorized/delegated official, as defined
in the pharmacy’s Medicare Enrollment Application and PECOS enrollment application.
o Pharmacies must attest for each individually enrolled practice location.
o Pharmacies with a change in ownership in the last 5 years which resulted in a change in
their legal business entity do not qualify for attestation exemption.
o NSC shall ensure that pharmacies with properly signed attestation letters be deemed exempt.
• January 1, 2011-Non-exempt pharmacies must begin submitting proof of accreditation as a condition of
enrollment.
• January 10, 2011-Deadline by which NSC shall send notices of revocation to all enrolled pharmacies who
are not accredited and do not meet the 5 year enrollment requirement, or who were sent an attestation
letter and did not properly complete and return it.
• April 1, 2011-April 30, 2011-NSC shall compile a sample listing of at least 10% of the pharmacies that
have submitted an NSC accepted attestation, including all who have a high fraud level indicator.
• NSC will mail audit letters to the 10% sample of pharmacies to determine if their accreditation exemption
attestations are correct.
o The letter will request submission of evidence supporting the attestation, including, at least, a
certification by the pharmacy’s accountant or tax returns filed during the relevant periods.
o NSC shall determine the acceptability of the replies received, using DMEPOS billing data for
only products and services requiring accreditation.
• June 30, 2011-NSC shall send a notice of revocation to all enrolled pharmacies that were sent an audit
verification letter and did not submit satisfactory evidence of compliance with the accreditation
exemption requirements.
• These procedures shall be followed for all succeeding years, but the change request is silent as to the
deadlines for succeeding years.
• Further provider education information is available at http://www.cms.hhs.gov/MLNMattersArticles/