CMS adds templates for RADs, PAPs and vents

Of the three, RADs top the improper payment rate at 63%
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Friday, April 20, 2018

WASHINGTON – CMS unveiled the first drafts of clinical templates for respiratory-related items at a Special Open Door Forum April 19.

The templates, as well as suggested clinical data elements, are for respiratory assist devices (order, face-to-face encounter and lab results); positive airway pressure devices (order and face-to-face encounter); and ventilators (order and face-to-face encounter).

The templates, which are strictly voluntary, are designed to assist providers with medical documentation requirements and data collection, in an effort to reduce denials.

CMS has targeted RADs, PAPs and vents because of their high improper payment rates. A 2017 report on Comprehensive Error Rate Testing reported PAP has an improper payment rate of 59%, with 88% due to incomplete documentation; RADs have an improper payment rate of 63%, with 98% due to improper or incomplete documentation; and ventilators have an improper payment rate of 57%, with 25% due to incomplete documentation and 58% due to medical necessity.

CMS officials say they welcome feedback on the drafts as they work to fine tune them. Feedback and questions can be sent to clinicaltemplates@cms.hhs.gov.

CMS also continues to develop templates and CDEs for oxygen, which had an improper payment rate of 48% in 2015, with 86.2% due to incomplete documentation. A third draft of the templates and CDEs was discussed at a Special Open Door Forum in January 2017.

The downloadable drafts are available on the CMS.gov website.

 

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