Bipartisan Lawmakers Urge CMS to Protect Patient Access to Supplemental Oxygen and Home Respiratory Care

House lawmakers ask CMS to clarify Medicare documentation requirements and adopt a standardized template for documenting patient need

Washington, D.C. — The Council for Quality Respiratory Care (CQRC) – a coalition of the nation’s leading home respiratory therapy providers and manufacturing companies – today commended 14 House lawmakers for sending a letter to the Centers for Medicare & Medicaid Services (CMS) urging the agency to clarify Medicare documentation requirements for supplemental oxygen and adopt a standardized template for documenting patient need. 

The current process for documenting patient needs is overly complex and wasteful. Medicare contractors rely solely on patient medical records with doctors’ notes to approve claims instead of using a standardized, clear set of objective questions on a single document to collect the information Medicare needs to establish medical need.

In a letter written to Center for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure, 14 bipartisan Members of Congress wrote to urge her to ensure the millions of Americans, especially seniors dependent on home respiratory care, continue to have access to the lifesaving supplemental oxygen therapy without additional physician visits and testing to meet documentation requirements waived during the COVID-19 Public Health Emergency (PHE).

The letter, spearheaded by Reps. Terry Sewell (D-AL) and Adrian Smith (R-NE), asked that the CMS provide an objective set of clinical data elements such as those in the templates on the CMS website, to avoid claims being unfairly denied based on physician’s medical record notes.

“Approximately one million beneficiaries began supplemental oxygen and respiratory therapies during the PHE and will continue to require these services. The reauthorization process would overload the already stressed healthcare system, requiring patients who utilize these services to repeat their therapy qualification process. This would especially place an undue burden on rural patients. We therefore write to request that auditors accept the standard written order (SWO) as the only necessary documentation to establish medical necessity when auditing claims of patients who received home oxygen, sleep therapy, or non-invasive ventilation equipment,” the letter reads.

It appears that the Centers for Medicare & Medicaid Services will not act, so Congress needs to let the agency know that it should promptly adopt a standardized oxygen template for documenting patient need for supplemental oxygen.

“We are also concerned that the policy of medical record review outlined in the oxygen national coverage determination and related local coverage determinations will take full effect.  If CMS allows contractors to rely only upon physicians’ medical record notes, a vast majority of patient claims will be denied, creating access issues for beneficiaries.  CMS already created the oxygen clinical data element templates which are more practical in assessing coverage needs. We therefore urge CMS to require contractors to use these templates, along with the standard written order in lieu of medical record notes when determining medical necessity,” the lawmakers added.

To read the House lawmaker letter to CMS, click here.

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