New compounding fee schedule an unknown

Saturday, March 31, 2007

Providers who compound respiratory medications are doing so without a fee schedule, despite new HCPC codes that went into effect Jan. 1.
"They've just been dribbling information about payment schedules and, unfortunately, it's so sporadic that we can't put anything together to really analyze what it is they plan on paying," said Micky Letson, president of Decatur, Ala.-based Letco Companies. "First customers were told the new compounding codes weren't any good. Then they were told to go back and use the old codes and then those were denied, and then they were told (again) to use the new codes."
Some providers have billed using code modifiers and been paid--not a lot, said Wayne Vega, a consultant for New Iberia, La.-based Stat Vial.
"(Medicare) told us how to handle the confusion," said Vega. "Just slap your modifiers on it. If they should have been somewhere else, it's not your fault. Providers should be billing for the preparations."
However, during a Feb. 20 conference call hosted by The MED Group, one provider said he'd been advised by his Medicare ombudsman to hold his claims.
"We've got a whole month's worth of claims to release, but we've decided not to do that," said another caller. "If we don't release and receive some income soon from these claims, it's going to shut down abruptly."
Providers in Jurisdiction C have been asked by Palmetto to submit their invoices for packaging, diluents and raw materials, something the caller was not happy about.
"They don't calculate any compounding," said a conference caller. "We have licensed pharmacists preparing this stuff. There's no allowance for a respiratory therapist to go out and instruct patients or look for adverse reactions."