Three issues, all affecting DME suppliers, are applicable for the District of Columbia, Connecticut, Massachusetts, Maryland, Maine, Delaware, New Jersey, New York, New Hampshire, Pennsylvania Rhode Island and Vermont.
The issue of Pharmacy Supply and Dispensing Fees premiers this week as a new issue approved by CMS. The other DME issues approved for Region A of Wheelchair Bundling and Urological Bundling, had previously been approved for Connolly, the RAC in Region C.
Pharmacy Supply and Dispensing Fees:
Pharmacy supply and dispensing fees when billed by a DME supplier are required to be accompanied with an oral anti-cancer, oral anti-emetic, immunosuppressive drug or inhalation drug. The absence of one of the aforementioned drugs billed on the same date of service or a denial of one of the aforementioned drugs represents an overpayment.
A potential vulnerability may exist if certain procedure codes are billed in conjunction with other procedure codes for the same date of service and the same beneficiary.
A potential vulnerability may exist if certain urological procedure codes are billed in conjunction with other urological procedure codes for the same date of service and same beneficiary.
The only states that do not have approved issues for automated reviews are Illinois, Kentucky, Ohio, and Wisconsin. All four RACs have now posted approved CMS issues for automated reviews.