Regulatory update: DME MACs notified, RACs limited 

WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy. 

CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021: 

• expansion of oxygen coverage for acute and chronic conditions; 
• expansion of coverage for short and long-term need (when hypoxemia exhibited); 
• the ability of the MACs to determine if oxygen and equipment are reasonable and necessary; 
• and the ability of the MACs to make coverage determinations for patients with cluster headaches. 

“This is the first guidance CMS has published publicly to the DME MACs regarding the updated oxygen NCD,” AAHomecare stated. 

Limits set for RAC reviews 

The Recovery Audit Contractor (RAC) starting April 1 will limit additional documentation requests (ADRs) based on the number of paid Medicare claims a provider has in a given product category, AAHomecare reports. 

Currently, the RAC bases reviews on the total claim number by NPI, without consideration for the number of claims in a category, resulting in the possibility of a provider receiving large volumes of audits for categories in which they do minimal business. 

“This new change will allow the RAC to account for volume of claims by product category, which should improve the RAC’s program integrity efforts,” AAHomecare stated. 

The new guidance states: “Limits will be set at 10% of all paid claims, by policy group, paid within a previous 12-month period, divided into eight periods (45 days). Although a RAC may go more than 45 days between record requests, in no case shall a RAC make requests more frequently than every 45 days.”