Documentation vexes providers

WASHINGTON - More than half of all claims for oxygen concentrators get denied, and providers say they face an uphill battle in improving that.

For one thing, there's a lot of pressure to get oxygen quickly to patients when they are discharged from the hospital.

“Hospitals will promise you'll get the documentation soon, but a lot of times, it doesn't happen,” says Chris Rice, CEO of Diamond Respiratory Care in Riverside, Calif.

For his part, Rice won't fill orders without the required paperwork, even though it means losing business. Better safe than sorry, he says.

“We've seen what happens with audits,” said Rice. “If you don't have the documentation, you'll be out of business really fast.”

Prepay reviews in Jurisdictions C and D earlier this year found error rates of 58% and 74%, respectively.

As to the claims themselves, contractors consistently find the same errors. Among the most common: no blood gas study, no office notes, or lack of documentation that the beneficiary even needs the equipment.

CMS needs to do more to educate providers, and providers need to educate referral sources, they say.

It doesn't help that not all providers are on the same page, says Mike Marnhout, who asks his referral sources for the required documentation.

“They say, 'Mike, you're the only person asking for this,'” said Marnhout, president of Bluegrass Oxygen in Lexington, Ky.

Setting aside all these factors, the error rates still may not be wholly accurate, says provider Peter Czapla. CMS sometimes denies perfectly good claims.

“We ask (CMS) to clarify what's wrong with the claim and they can't,” said Czapla, co-owner of Wetumpka, Ala.-based Quality Home Healthcare. “Then they tell us to take it to the next step in the appeal process.”

What else can providers do? Read through the LCD with a fine-tooth comb and follow it to the letter, says Lori Corey, vice president of finance for Waukesha, Wis.-based Oxygen One.

“If there's room for gray area, we err on the side of caution,” she said. “It's not enough to think you're covered.”