CQRC on CMN: ‘It has been an anchor’

WASHINGTON – The Council for Quality Respiratory Care in a statement today encouraged CMS to reconsider eliminating the CMN for home oxygen therapy.

The CQRC, a coalition of the nation’s largest respiratory providers and manufacturers, says doing that would replace “objective testing ordered by a patient’s physician for the subjective decision-making of Medicare contractors.”

“We are highly supportive of allowing acute patients to receive oxygen therapy outside the institutional or hospital setting; however, we are concerned CMS’s proposal would create ambiguity in the system when it comes to demonstrating patient need,” said Crispin Teufel, chairman of the CQRC. “While there have been difficulties with the objective CMN that established medical necessity, it has been an anchor during the appeals process when suppliers defend patients’ access to these devices after a contractor has denied their claims. It is essential that, if the CMN is removed, CMS adopts an objective template or prior authorization to make sure Medicare approves the patient access. A subjective review process and Medicare Administrative Contractor discretion, which, according to historic CMS CERT data, could result in 80% of claims being denied, (puts) patient access at risk.”

CMS published a proposed decision memo earlier this month outlining the changes it wants to make to the NCD for home oxygen therapy.

The CQRC is troubled by a more subjective approach because it could mean a supplier fills the physician’s prescription and delivers the equipment to the patient only for the Medicare contractor to deny the claim if the documentation does not meet their subjective view. The situation forces the supplier to try to remove the equipment from the patient’s home, even if the physician still believes, in their medical judgement, the equipment is necessary.

“There is no reason to ‘hide the ball’ and make physicians, patients and suppliers guess at what documentation is required before contractors allow patients to use a device their physicians have prescribed for them,” Teufel said. “All stakeholders must have access to the objective data used to ensure the delivery of timely, quality patient care.”

The CQRC plans to submit comments on the proposed changes before an Aug. 1 deadline.