CQRC Urges Medicare to Streamline and Standardize the Process for Demonstrating Patients’ Need for Supplemental Oxygen  

FOR IMMEDIATE RELEASE

April 25, 2024

CQRC Urges Medicare to Streamline and Standardize the Process for Demonstrating Patients’ Need for Supplemental Oxygen  

Submitting statement to a recent House hearing on improper payments, CQRC highlighted the need for Medicare to standardize the process for determining medical necessity in order to safeguard patients’ access to care and avoid unnecessary delays

Washington, D.C. – The Council for Quality Respiratory Care (CQRC) – a coalition of the nation’s leading home respiratory therapy providers and manufacturing companies – submitted a statement as part of the House Energy & Commerce Committee Subcommittee on Oversight and Investigations’ recent hearing, “Examining How Improper Payments Cost Taxpayers Billions And Weaken Medicare And Medicaid.”

In order to safeguard taxpayer dollars and ensure the timely delivery of care to Medicare beneficiaries who need supplemental oxygen, CQRC submitted a statement recommending the Centers for Medicare & Medicaid Services (CMS) require Medicare contractors to use the clinical data element templates already created by CMS 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 serious delays for this exceptionally vulnerable population.

In the case of supplemental oxygen, improper payments are primarily linked to deficiencies in physician documentation rather than beneficiary needs. The current documentation and review process is flawed and has had an extremely negative impact on Medicare beneficiaries who need supplemental oxygen to manage serious conditions including chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. By relying on physician notes, rather than a standardized clinical data element template to help Medicare contractors determine a beneficiaries’ need for supplemental oxygen, an alarming number of claims have been denied because some information in the patient record may be missing, incomplete, or characterized in a way to help inform their clinical care, not satisfy auditing requirements.

“In the case of supplemental oxygen, the problem of improper payments is directly linked to the Medicare contractors’ sole reliance on physician medical record notes. Since 2016, the CERT has reported that less than one percent of the improper payment rate was due to patients not meeting Medicare’s medically necessity requirements. During the same period, the CERT has also reported that 72 to 99 percent of the oxygen improper payment rate was due to problems with the ordering clinician’s documentation,” CQRC’s statement said.

“To address the problem of improper payments in supplemental oxygen therapy, we strongly urge the Committee to instruct the Centers for Medicare & Medicaid Services (CMS) to require Medicare contractors to use the CMS created clinical data element templates to establish beneficiary medical necessity. 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,” CQRC continued.

Regrettably, Medicare contractors have yet to embrace these reforms, resulting in prolonged improper payments and access barriers for beneficiaries. CQRC implores CMS to mandate the adoption of clinical data element templates, facilitating a more efficient and equitable reimbursement process.

To rectify this issue, CQRC is advocating for the incorporation of CMS-defined clinical data elements into electronic health records, offering clear guidance to prescribing physicians while streamlining the review process. This approach not only ensures accurate reimbursement but also reduces administrative burdens and associated costs.

CQRC also urges Congress to support the Supplemental Oxygen Access Reform (SOAR) Act (S. 3821/H.R. 7829). This critical, bipartisan legislation mandates the use of the oxygen template for documentation, eliminating the need for physicians to disclose their patients’ private medical records. Additionally, the SOAR Act would remove supplemental oxygen from Medicare’s competitive bidding program and permanently extend Medicare’s blended payment rates, ensuring accessibility in rural and less densely populated urban areas. The establishment of a separate payment system for liquid oxygen aims to rectify chronic underfunding issues that have led to documented patient access challenges. Furthermore, the legislation mandates reimbursement for respiratory therapist services in alignment with state laws.

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