A Medicare DMEPOS revocation can have serious consequences for a community pharmacy, particularly when the pharmacy depends on Medicare reimbursement to continue providing durable medical equipment, prosthetics, orthotics, and supplies to beneficiaries.

MDRXLAW recently represented a community pharmacy in a Medicare enrollment matter involving the revocation of its DMEPOS supplier billing privileges. The matter was ultimately resolved favorably, and the pharmacy’s Medicare DMEPOS supplier status was preserved.

Challenging the Revocation

MDRXLAW initially pursued an internal appeal challenging the revocation. The appeal presented evidence demonstrating the pharmacy’s compliance with applicable Medicare requirements and addressed the basis for the revocation.

When the initial appeal was unsuccessful, the matter did not end there. MDRXLAW filed a request for review before an Administrative Law Judge and continued to advocate for reversal of the determination.

The matter was ultimately resolved favorably, allowing the pharmacy to retain its Medicare DMEPOS supplier status and continue serving Medicare beneficiaries.

Why Medicare Enrollment Appeals Matter

A revocation of Medicare billing privileges can affect a provider’s ability to submit claims and participate in the Medicare program.

Providers that receive a revocation or other adverse enrollment determination should promptly review the reasons for the decision, identify supporting documentation, and determine what appeal rights may be available.

Pharmacies facing Medicare or Medicaid reimbursement issues may also benefit from reviewing their broader pharmacy audits and compliance practices before an adverse determination occurs. MDRXLAW represents pharmacies in Medicare and Medicaid audits as well as other payer-related disputes.

Acting Quickly Can Protect Appeal Rights

Medicare enrollment disputes are often subject to specific procedural requirements and deadlines. Waiting too long to evaluate a revocation can limit the options available to a provider.

Pharmacies and DMEPOS suppliers should therefore consider obtaining legal guidance promptly after receiving an adverse enrollment decision. The appropriate strategy will depend on the reason for the revocation, the provider’s records, and the procedural stage of the matter.

MDRXLAW also advises pharmacies on regulatory compliance and defense, including Medicare and Medicaid billing and reimbursement compliance, DEA matters, state pharmacy board issues, and other regulatory concerns.

MDRXLAW’s Healthcare Regulatory Experience

MDRXLAW represents pharmacies, DMEPOS suppliers, and other healthcare providers in Medicare enrollment disputes, DMEPOS matters, audits, administrative appeals, and regulatory enforcement proceedings.

The firm also represents healthcare providers in government investigations involving Medicare, Medicaid, audits, subpoenas, and other government inquiries.

If your pharmacy or healthcare organization has received a Medicare revocation, enrollment denial, or other adverse determination, contact MDRXLAW at info@mdrxlaw.com or 212.668.0200