CQRC Disappointed Latest LCD on Supplemental Oxygen Fails to Adopt Clear, Objective Oxygen Template


WASHINGTON — The Council for Quality Respiratory Care (CQRC) – a coalition of the nation’s leading home oxygen therapy providers and manufacturing companies – today expressed disappointment that the latest Local Coverage Determination (LCD) for oxygen and oxygen equipment issued by the Centers for Medicare & Medicaid Services (CMS) on November 18, does not call for the use of a data-driven oxygen template when documenting medical need. Instead, it continues to rely on the use of patients’ subjective and inconsistent medical records, which are known to lead to a high rate of oxygen claims denials.

CQRC has consistently urged CMS to support the adoption of clear, objective clinical data elements that are consistent with existing CMS-developed standardized “clinical data element templates” to ensure that access to supplemental oxygen in the home is not interrupted or jeopardized. Currently, Medicare’s outdated documentation system creates significant burdens and risks for providers delivering high-quality oxygen therapy care to more than one million American seniors and other Medicare beneficiaries.

“It is concerning that CMS missed another opportunity to streamline the claims review process by failing to adopt the use of oxygen templates with standardized clinical data elements instead of paper records,” said Crispin Teufel, Chair of CQRC. “By requiring the use of oxygen templates, CMS could protect access to a medically necessary therapy that allows individuals to remain independent in the home, reduces burdens on providers and suppliers, and cuts costs.”

Medicare contractors currently rely on outdated, paper medical record reviews, which lead to high denial rates as a result of inconsistent document standards. According to Comprehensive Error Rate Testing (CERT) data, contractors deny “between 70 and 90 percent of oxygen claims” due to a failure to match paper documents. These denials, along with the resulting backlog of appeals, represent a serious access issue for an exceptionally vulnerable patient population.

“CMS currently maintains such a template on its website that could be easily adapted by Medicare contractors instead of requiring home oxygen suppliers to provide a patient’s medical record,” added Teufel.

While CQRC members continue to review the new coverage materials, the new LCD also raises concerns that Medicare contractors could now deny patients’ access to supplemental home oxygen if their healthcare providers cannot prove that “[t]he provision of oxygen and oxygen equipment in the home setting will improve the beneficiary’s condition.” While healthcare providers may seek to improve the lives of patients with certain treatments, the long history of supplemental oxygen, especially when used for patients battling chronic respiratory diseases, has shown that oxygen is needed to maintain the patient’s current status so that it does not worsen. Requiring “improvement” as a condition of maintaining supplemental oxygen could result in hundreds of thousands of patients who, prior to the new coverage requirements, met Medicare’s compliance rules no longer being able to receive it.

“This added language, unfortunately, does not recognize that each patient is unique and the important role that supplemental oxygen plays in preventing these individuals from experiencing worsening symptoms,” noted Teufel. “We hope that CMS will work with patients, providers, and suppliers to make sure that the new coverage rules do not result in patients losing access to medically necessary oxygen.”


About the Council for Quality Respiratory Care

The CQRC is a coalition of the nation’s seven leading home oxygen therapy provider and manufacturing companies. To learn more, visit cqrc.org and follow CQRC on Twitter at @TheCQRC.