April 16, 2020
Written Orders for Inhalation Drugs
In a recent report (OIG A-09-18-03018
), 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 Drugs" Medicare Learning Network fact sheet.
Additional Resources:
- Medicare Benefit Policy Manual, Chapter 15, Sections 110, 110.1, 110.3
- Medicare Program Integrity Manual, Chapter 5, Sections 5.2, 5.7, 5.8, 5.9
- 2018 Medicare Fee-For-Service Supplemental Improper Payment Data (data from Claims Submitted: July 1, 2016 – June 30, 2017)
- Local Coverage Determination: Nebulizers (L33370)
- National Coverage Determination for Durable Medical Equipment Reference List (280.1)
- Medicare Improperly Paid Suppliers an Estimated $92.5 Million for Inhalation Drugs OIG Report, October 2019
- Liberty Medical, LLC, Received Unallowable Medicare Payments for Inhalation Drugs OIG Report, August 2018
- Lincare Pharmacy Services Inc. Generally Complied With Medicare Requirements When Billing for Inhalation Drugs OIG Report, December 2017
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