HME News Staff

Updated 9:22 AM CDT, Mon April 29, 2024

WASHINGTON – The Council for Quality Respiratory Care submitted a statement highlighting the need for Medcare to standardize the process for determining medical necessity for home oxygen therapy as part of a recent congressional hearing on “Examining How Improper Payments Cost Taxpayers Billions and Weaken Medicare and Medicaid.” 

In the statement, the CQRC recommends CMS require Medicare contractors to use the clinical data element templates already created by the agency to establish beneficiary medical necessity, rather than relying solely on subjective notes written by a patient’s doctor in their medical record, which has led to “alarming” claims denials. 

“To address the problem of improper payments in supplemental oxygen therapy, we strongly urge the committee to instruct CMS to require Medicare contractors to use the CMS created clinical data element templates to establish beneficiary medical necessity,” the council stated. “This one step would create a comprehensive set of information for meaningful audit review and would address the problems created by contractors relying solely on physician notes.” 

The hearing was held by the Energy & Commerce Committee Subcommittee on Oversight and Investigations in the House of Representatives. 

The CQRC’s statement also urged lawmakers to support the Supplemental Oxygen Access Reform (SOAR) Act, H.R. 7829 and S. 3821, which would mandate the use of a template for documentation, remove supplemental oxygen from Medicare’s competitive bidding program and permanently extend Medicare’s blended reimbursement rates, among other things.