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April 16, 2020

Written Orders for Inhalation Drugs

In a recent report (OIG A-09-18-03018External pdf), the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) improperly paid suppliers for inhalation drugs. As stated in CMS Internet Only Manual (IOM) Pub 100-8, Chapter 5, in order for an inhalation drug to be eligible for Medicare reimbursement, the supplier must have 1) a signed, detailed written order from the prescribing physician; 2) proof of delivery; and, 3) for refills of the original order, a documented refill request. The supplier should obtain as much documentation from the beneficiary’s medical record to assure that the coverage criteria for an item are met.

In response to some of the recommendations in the OIG Report, CMS developed a new “Provider Compliance Tips for Nebulizers and related DrugsExternal pdf” Medicare Learning Network fact sheet. 

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