Tag: National coverage determination

WASHINGTON – CMS has opened the National Coverage Determination for seat elevation systems used with power wheelchairs, but the agency is not reconsidering coverage for power standing systems at this time.  CMS said in May it would commit to re-opening the NCD, nearly two years after the ITEM Coalition submitted a formal request to reconsider the NCD for mobility assistive equipment to include coverage for these systems.   “Now is the time for Medicare – the...

WASHINGTON – Twenty two members of the House of Representatives have asked CMS to streamline documentation for home oxygen therapy, AAHomecare reports. A sign-on letter spearheaded by Reps. Terri Sewell, D-Ala., and Larry Bucshon, R-Ind., requests that CMS: “Use the opportunity of expanding the current National Coverage Determination for oxygen to establish a clear set of criteria to support medical necessity and instruct the contractors to rely solely on the Standard Written Order...

WASHINGTON – Sen. Tammy Duckworth, D-Ill., and Rep. Jim Langevin, R-R.I., each had calls with CMS officials this month to stress the need for the agency to take the next step in reconsidering the national coverage determination for mobility assistive equipment to include seat elevation and standing systems.  Last fall, Duckworth and Langevin orchestrated letters in the Senate and House, respectively, asking CMS to seek public comment on the ITEM Coalition’s request to reconsider...

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,...