Tag: National coverage determination

WASHINGTON – CMS’s plan to discontinue CMNs on Jan. 1, 2023, may cause problems for HME providers trying to comply with a new national coverage determination for home oxygen therapy that went into effect Sept. 27, say industry stakeholders.   Following the release of the NCD, CMS issued change requests to push new language to the decision manual and to trigger claims processing edits to align with the new guidelines, but nothing related to eliminating the CMN for oxygen specifically....

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...

WASHINGTON – The Council for Quality Respiratory Care is asking industry stakeholders to contact CMS Administrator Chiquita Brooks-LaSure to standardize the paperwork requirements for home oxygen coverage.  The CQRC says requiring physicians to provide medical records could result in “the vast majority of claims being denied.”  “CMS has indicated that physicians will be required to provide their medical records instead of using a form with the information...

YARMOUTH, Maine – Outdated, redundant and confusing is the common refrain from HME Newspoll respondents who overwhelmingly support CMS’s decision to eliminate the CMN requirement for home oxygen therapy.  “The CMN is an outdated tool that simply seems to supply Medicare with another means to deny claims on technicalities,” wrote Josh Turner, billing manager at McAbee Medical in Decatur, Ala. “Everything on the CMN is in the medical record, so there is no reason...

WASHINGTON – CMS has posted a final national coverage determination and decision memo on “Home Use of Oxygen and Home Oxygen Use to Treat Cluster Headaches.” The agency says of its decision to stick with removing the CMN requirement for home oxygen: “CMNs are claim attachment forms developed in the 1990s to augment medical review. At that time, the CMS DME claims systems had very limited editing capabilities and only basic information was included on the claim form....

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...

These were some of the reactions of industry stakeholders to the news of CMS’s proposed national coverage determination for home oxygen therapy: “Groundbreaking.” “We haven’t seen something this major happen in a long time.” “This obliterates everything that we’ve held to be immovable ground for oxygen coverage.”  If you’re like me, when you first saw the news on that Friday before a long holiday weekend (classic CMS move,...

WASHINGTON – CMS’s proposed national coverage determination for home oxygen therapy – its first revision since 1993 – makes “groundbreaking” changes, including expanding access for acute conditions and removing the CMN requirement.  Industry stakeholders say the agency is proposing the changes largely as a result of the COVID-19 pandemic, which significantly increased the number of people needing oxygen and exposed issues with the current NCD.  “We...

WASHINGTON – CMS wants to modify the national coverage determination (NCD) for home use of oxygen to expand patient access to oxygen and oxygen equipment and permit the Medicare Administrative Contractors (MACs) to cover their use to treat cluster headaches and other acute conditions, according to a proposed decision memo.  The agency also wants to remove the NCD for home oxygen use to treat cluster headache, ending coverage with evidence development.  The scope of the decision...