Med dispensing fee falls short

Thursday, October 22, 2009

The dispensing fee for nebulizer medications needs a boost, say providers.

When the average sales price model for nebulizer medications was implemented in 2006, providers began to rely more on the fee ($57 for the first month, $33 for subsequent months) to maintain margins. That margin is getting pretty thin, they say.

“Since the ASP system has been instituted, we’ve taken five postage increases,” said Dave McDonald, president/CEO of Texarkana, Texas-based Senior Respiratory Solutions. “That’s troublesome. I’ve spoken to Congressman Mike Ross about this and he says he’s working on it, but they’ve got more important issues to discuss than our little lonely ASP.”

Not only can providers not charge beneficiaries for shipping, but Medicare rules tie them into more expensive shipping methods.

“Medicare requires that you have proof of delivery (to get paid), so we have to use priority mail, UPS or FedEx,” said Sam Jarczynski, president of St. Petersburg, Fla.-based RxStat.

And, like many other segments of the HME industry, a heavy focus on fraud and abuse has providers scrambling to stay on top of compliance.

“I have a dedicated compliance team,” said McDonald. “We are doing self-audits and spending more money just to make sure that if and when we get audited (we are in compliance).”

The neb-med market has shrunk considerably over the past few years and could continue to do so, said Chuck Makarov, president/CEO of the Letco Companies. That could impede access for patients, he said.

“Sooner or later somebody is going to have to do something to make sure there are providers out there to service those patients,” said Makarov.