Advanced Search

Medicare Compliance & Reimbursement

DME:

Suppliers Declare Victory On Face-To-Face Exams Dispute

Published on Sun Nov 14, 2004

$57 monthly dispensing fee for inhalation drugs finalized.

The final physician fee schedule is out, and it holds plenty of good news for durable medical equipment suppliers and pharmacies.
 
The Centers for Medicare & Medicaid Services sets a $57 monthly dispensing fee for the inhalation drugs ipratropium bromide and albuterol sulfate, and an $80 fee for three months' supply, according to the final rule slated for publication in the Federal Register Nov. 15.
 
CMS used the study conducted by Muse & Associates and commissioned by the American Association for Homecare to set the rates, it says in the rule. CMS stripped out some of the costs it didn't like, such as marketing and bad debt, from the $68 recommendation to arrive at its final monthly fee of $57, CMS explains in the rule.
 
Then CMS used the methodology from last month's Government Accountability Office report on the subject to apply that fee to a three-month period at $80, CMS details.
 
"Patients, providers and the entire homecare community will breathe easier with this important dispensing fee," AAH CEO Kay Cox praises in a release.
 
But suppliers shouldn't get too comfortable with the generous dispensing allocation. CMS will study the issue next year and may make significant changes to the fee, it warns. The agency needs to study the fee components, and some of the services included in this year's calculations might be "outside the scope of a dispensing fee," CMS says.
 
Suppliers were also happy to see CMS delay implementation of the controversial requirement for physicians to examine patients face-to-face before ordering or renewing orders for any DMEPOS items.
 
"Due to the timeframe and the extensive number of public comments received, we will implement this provision at a later date," CMS says in the final rule.
 
"An unnecessary visit to the physician just to get the [equipment] adds more costs than the price of the DME," says Edward Ratner, former president of the American Academy of Home Care Physicians and medical director for the Minneapolis branch of Heartland Home Healthcare & Hospice.
 
But it won't be too long before this issue raises its ugly head again. Erik Sokol of the Power Mobility Coalition expects to see the face-to-face exam addressed in regulations CMS will issue later this month.
 
Editor's Note: The final physician fee schedule is at www.cms.hhs.gov/regulations/pfs/2005/1429fc.asp. The face to face exam portion is on pp. 487-488. The dispensing fee portion is on pp. 489-522.

Other Articles in this issue of

Medicare Compliance & Reimbursement

View All