DME MAC releases oxygen, CPAP review data

Thursday, May 29, 2014

HINGHAM, Mass. – NHIC found a 44% denial rate for oxygen and oxygen equipment as part of a review of claims filed between Jan. 1, 2014, and March 31, 2014. The Jurisdiction A DME MAC reports responses to additional documentation requests were not received for 59% of the claims. For the same time period, the NHIC found a 64.3% denial rate for CPAP devices. Oxygen claims were most frequently denied for missing documentation; failing to meet written order prior to delivery requirements; and failing to establish medical necessity, according to the statement. CPAP claims were denied primarily for problems with face-to-face documentation, the detailed written order prior to delivery, sleep study documentation, training documentation or deliveries.