March 15, 2010
Widespread Prepayment Probe for Nebulizers (L11499) – Nebulizers with Compressor (E0570)
DME MAC A will be initiating a widespread prepayment probe review of claims for Nebulizers with Compressor (E0570). This review is being initiated due to a high volume of claim errors found by the Comprehensive Error Rate Testing (CERT) Contractor.
Suppliers will be sent a documentation request for information listed below. The requested documentation must be returned within 30 days from the date of the letter to avoid claim denials.
Documentation should include the following per LCD (L11499)- Nebulizers:
A detailed order* that includes the following:
Patient Name
The Description of item to be dispensed
The type of solution
Administration instructions:
Amount of Solution
Frequency of use
The ordering physician’s legible signature
The date of the ordering physician’s signature
*Note: A new order is required every 12 months for ALL Inhalation Drugs (even if the prescription has not changed).
Clinical records that document the treating physician’s oversight, continued medical necessity, and the patient’s compliance to the treating physician’s treatment plan for the aerosol treatments.
A payable diagnosis
Delivery slip
It is important for suppliers to be familiar with the coverage criteria and documentation requirements as outlined in the LCD and Policy article. Suppliers can review the Nebulizers LCD on the DME MAC A Web site
A common problem in these reviews is missing or incomplete records. Please ensure when submitting documentation requests that all requested documentation is included with your file and respond in a timely manner.