WASHINGTON--HHS' Office of Inspector General has begun surveying providers to help determine the costs of inhalation drug therapy services. The results could be significant, according to the American Association of Homecare, because they may factor into future decisions about Medicare's Part B inhalation drug dispensing fees.

That fact concerns the association because it says the survey is not thorough enough and could lead to some inaccurate conclusions.

Earlier this month, the OIG sent the survey to a random sample of inhalation drug therapy providers, requesting that they complete a form for each service they provided in 2003. According to AAHomecare, not all dispensing fee service categories--after-hours and weekend services, for example--are listed on the questionnaire. Providers will have to complete additional pages on these unlisted services.

"It is critical that you capture and record all services provided to and contact made with the identified patients in order to provide support for the extensive costs incurred by pharmacies in dispensing inhalation drugs to Medicare beneficiaries," AAHomecare advised providers in a mid-week bulletin.

The organization said it has requested a meeting with the OIG to discuss its concerns about the accuracy of the survey.

Responses are due on Wednesday, but AAHomecare is asking that providers request a deadline extension to June 20, which would allow time for responding companies to gather the necessary documentation.

Last year, the association commissioned a study of 109 pharmacies and found that the Medicare 2005 reimbursement formula--based on average sales price plus 6 percent--would under-reimburse the actual cost of providing and dispensing albuterol sulfate and ipratropium bromide by $68.10 per monthly supply. And after some of the nation's largest providers--including Apria and Lincare--threatened to leave the respiratory drug business without adequate reimbursement, CMS announced in November it would add a $57 monthly or $80 quarterly dispensing fee for inhalation drugs in the 2005 fee schedule.

Since the new reimbursement formula took effect Jan. 1, there have been some glitches with claims for the dispensing fee. Last month, Lincare and other providers reported having dispensing fees denied during the five-day grace period that allows time for patients to receive refills before their prescriptions run out at the end of the billing cycle.

Some also have had dispensing-fee trouble for patients who get medication from more than one pharmacy. Only the pharmacy that bills Medicare first within the 30- or 90-day cycle receives the dispensing fee.

Medicare policy for the new dispensing fee states "per patient per month--not per provider," said Mickey Letson, president of drug wholesaler The Letco Cos., Decatur, Ala. "It's first come, first serve," he said, "and that has created problems for a few."