‘Providers have chased their last CMN for oxygen’

BALTIMORE – With a new clarification from CMS and the DME MACs, it’s “crystal clear” that certificates of medical necessity are no longer required for oxygen claims during the public health emergency, say industry experts. 

“The guidance is crystal clear and precise,” said Andrea Stark, a Medicare consultant and reimbursement specialist for MiraVista. “Providers have chased their last CMN for oxygen.” 

CMS in June posted a joint DME MAC publication clarifying that CMNs are not required for oxygen claims during the PHE and instructed providers to use the CR modifier and COVID-19 narrative to reflect claims submitted during that time. 

The agency has been waiving the CMN requirement for oxygen claims during the PHE since 2020, but not in all instances, Stark says. 

“We all knew there were certain instances where the CMN requirement was waived,” she said. “Back in the early days of the pandemic, patients couldn’t get to doctors, and they might not have had perfect testing protocols. So, we used that flexibility, but we relied on it sparingly. For the routine chronic patient who was able to see a doctor and get tested? We were still chasing those CMNs.” 

With the PHE set to extend through mid-October and likely through the end of the year, the clarification also takes care of the gray areas created by having a new NCD for oxygen that is incompatible with CMN requirements as of Sept. 27, 2021, and the full elimination of the CMN on Jan. 1, 2023. 

“I believe it’s unlikely that the PHE will end before CMNs are officially eliminated with the 60-day notice that (the secretary of the Department of Health and Human Services) has committed to,” Stark said. “If, however, the PHE ends before CMNs are eliminated, CMS did commit to us that they will provide a workaround.” 

So, why didn’t CMS just implement the elimination of the CMN requirement sooner? 

“I think this is a very complicated and interwoven protocol that’s baked into a lot of systems, including claim processing and supplier billing platforms,” Stark said. “The MACs took a conservative education posture absent more specific CMS directives, while CMS thought the PHE flexibilities provided cover. The need for more liberal application wasn’t raised with CMS until the NCD revision created an irreconcilable disconnect, and they clarified it as soon as it was brought to their attention.” 

The clarification will serve as “peace of mind” for providers that were confused by all the “uncertainties” surrounding a new NCD and the elimination of the CMN, says Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. 

“Some were using the CR modifier and the COVID-19 narrative, but they weren’t comfortable with it,” she said. “When they learned of this news, it was a like a huge weight off their shoulders.”