Medicare Compliance & Reimbursement

... but CMS pledges to set DMERCs straight on G codes.

Durable medical equipment providers that have been experiencing inexplicable denials for inhalation drug dispensing fees should know they're not alone - and that federal officials have promised to fix the problem.

The denial issue came up at the Centers for Medicare and Medicaid Services' Open Door Forum for home health, hospice and durable medical equipment providers on April 21.

DME regional carriers are denying code G0371, the dispensing fee for inhalation drugs, reported Paul Gabos, CFO for Clearwater, FL-based Lincare Holdings. The problem has been occurring in all regions, but most consistently in Region B, he observed.

"Currently we have over 10,000 claim denials for these dispensing fees," Gabos said. The denials seem to occur when the period between claims for G0371 is less than 30 days, he noted.

However, Medicare policy allows suppliers to ship drug refills up to five days prior to the end of the 30-day usage period. The overlap allows time for refills to reach patients before their supply runs out.
 
Good news: Denials for inhalation drugs due to overlaps of five days or less violate agency policy, CMS confirmed at the forum.

"We did tell the DMERCs verbally that they need to give these new G codes the same wiggle room they give the mail orders," an agency official noted. CMS promised to take the matter up with the DMERCs.

Avoid Multiple Claims with G0370

Region B DMERC Adminastar Federal recently identified another problem with G codes that could be leading to denials.

When suppliers submit separate claims for different drugs - or for the same drug at a different strength - and supply fee code G0370 with the same date of service, the supply fee is denying as a duplicate, Adminastar warned in an April 15 notice to suppliers.

"When these items are provided on the same day suppliers are required to submit the items for payment on the same claim to avoid duplicate denials," it stated.