WASHINGTON--In recent weeks, an uptick in denials for inhalation drug dispensing fees has been causing some ripples in the industry--and some larger waves for at least one major player.

On Thursday, Clearwater, Fla.-based Lincare Holdings CFO Paul Gabos told CMS at an Open Door Forum that the company has had more than "10,000 claim denials for these dispensing fees."

The denials concern dispensing fees for drug refills, Gabos said, explaining that in a regulation introduced last year the agency said providers could ship drugs and bill a dispensing fee for the following month, five days before the next date-of-service starts, so that patients could receive their next month's supply before they run out.

Gabos said that some DMERCs--particularly Region B--are not recognizing that five-day grace period. JoAnn Spalding of CMS told Gabos that the agency would work with the DMERCs to resolve the issue.

Mickey Letson, president of drug wholesaler The Letco Companies in Decatur, Ala., told HomeCare Monday that dispensing-fee denials have been occurring throughout the industry. Some providers, he said, have been shipping more doses initially to compensate so that patients would have a few doses left in case the next month's doses don't arrive in time. "That may not be kosher with Medicare, but there's no other way to do it right now," Letson said.

Medicare began paying for a $57 monthly, or $80 quarterly, dispensing fee this year when reimbursement for respiratory meds transitioned to an Average Sales Price-plus-6-percent formula. The fee was added in response to an outcry from respiratory giants like Lincare and Lake Forest, Calif.-based Apria Healthcare, who said that the drastic MMA-mandated cuts would force them out of the inhalation drug business.