CQRC Commends Bipartisan Senate Lawmakers for Urging CMS to Ensure Patient Access to Supplemental Oxygen Therapy

February 8, 2024

Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH) spearhead letter calling on CMS to adopt a standardized template to streamline home respiratory patients’ access to supplemental oxygen and prevent unnecessary denials

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 applauded lawmakers in the U.S. Senate for signing a letter calling on the Center for Medicare & Medicaid Services (CMS) to adopt the standardized template instead of the medical record review, which has historically caused serious patient access issues. CQRC applauds the letter and urges CMS to take the Senators’ recommendations into account to ensure access to supplemental oxygen for one of America’s most vulnerable patient populations.

Current CMS policy creates significant challenges for patients’ dependent on supplemental oxygen therapy, as well as the physicians they rely on for treatment. The policy of Medical Record Review for oxygen outlined in the National Coverage Determination (NCD) and the Local Coverage Determination (LCD) enables contractors to rely ONLY on physicians’ medical record notes, which are not standardized. As a result, Medicare contractors are forced to comb through each doctor’s notes—which are written to support clinical care, not auditors’ requirements—to determine if a patient’s prescribed supplemental oxygen can be covered under Medicare. Not only does this create unnecessary administrative burden for everyone involved, but it also jeopardizes timely access to treatment if contractors fail to find the “magic words” in the patient’s medical record. Ultimately, the lack of a standardized format is a major reason why some patients have had their claims denied, creating severe access issues for Medicare beneficiaries who need supplemental oxygen.

The letter, led by Senators Bill Cassidy (R-LA) and Maggie Hassan (D-NH), calls on CMS to adopt the standardized template instead of the medical record review to ensure access to supplemental oxygen for patients. Other Senators on the letter to CMS include Sens. Marsha Blackburn (R-TN), James Lankford (R-OK), and Tim Scott (R-SC).

“We ask that the Centers for Medicare & Medicaid Services (CMS) remove barriers for patient access to supplemental oxygen by establishing clear requirements for determining the medical necessity of prescribed supplemental oxygen therapy. Establishing a requirement for Medicare contractors to use consistent clinical data element template, aligned with the National Coverage Determination for supplemental oxygen, would allow CMS to avoid claims being denied based on physician’s medical record notes,” the senators wrote to CMS.

CQRC supports and thanks the bipartisan lawmakers for urging CMS to require contractors to adopt a standardized template and the standard written order. By providing these clear questions for physicians or prescribers to answer, rather than relying on the highly detailed clinical notes, contractors can more efficiently find critical claims-related information. This approach will streamline the documentation process by eliminating potential discrepancies between what the clinical notes contain and what contractors expect to see for the claims process.

CQRC applauds lawmakers for recognizing this significant administrative strain and the threat it poses to patients’ vital medical support. Looking ahead, CQRC encourages CMS to require a standardized template for supplemental oxygen to better ensure patient access.

###

Media Contact:
Ellen Almond
ealmond@schmidtpa.com
202-271-0234