Dispensing fee denials plague Lincare, others

Tuesday, May 31, 2005

WASHINGTON -- A hiccup in the process of billing for respiratory medications and the newly established dispensing fee has caused more than a few problems for providers -- and a mountain of denials for one industry giant.
"We have more than 10,000 claim denials for these dispensing fees," said Lincare's Chief Operating Officer Paul Gabos during an April CMS open Door Forum.
Gabos said that the DMERCs, most consistently DMERC B, deny claims for the dispensing fee code when the time span between the two ship dates is less than 30 days.
Medicare officials said during the forum that they would work with the DMERCs to clarify the problem.
"We told the DMERCs verbally that they need to give these codes the same wiggle room that they give mail-order drugs. The same overlap should be allowed," said one CMS official during the meeting. "We did that a couple weeks ago. We will get back to Region B specifically."
CMS indicated while devising 2005's final rule for respiratory medications that it would allow a five-day grace period. This allows suppliers to ship refills after 25 days and prevents patients from running out of medication and suppliers from needing to pay next shipping charges. Medicare will only cover 180 doses of medications and one dispensing fee per 30-day period.
"Most people were told going into this year that there was going to be that five-day grace period, but Medicare never actually officially put it in place," said Mickey Letson, president of the Letco Companies.
Letson said he encountered many companies that were receiving denials on the dispensing fee. In some cases, Medicare was also denying claims for the drugs when the number of doses shipped in a 30-day period exceeded 180, he said.
As a result, he advised providers to be careful or avoid billing within the grace period.
"When Medicare denies something they don't ever come back and say, 'Sorry, it was our problem,'" he said. "They just put a denial code on it. So providers are forced to re-bill it -- try to correct the claim and try to get it paid, which just continues to drag down payments rates."