WASHINGTON, D.C. (August 16, 2022—The Council for Quality Respiratory Care (CQRC), a coalition of the nation's leading home respiratory therapy providers and manufacturing companies, commended 22 House lawmakers for urging the Centers for Medicare & Medicaid Services (CMS) to protect patients’ access to home oxygen.
In a letter to Department of Health and Human Services Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure, 22 bipartisan members of Congress wrote in support of reforms to the home oxygen therapy benefit, which supports Medicare beneficiaries with acute respiratory conditions who require supplemental oxygen. The lawmakers asked CMS to ensure that Medicare contractor documentation requirements are consistent and standardized though the use of a clear, objective template. Recognizing the administrative burden and potential access issues caused by the current approach, the bipartisan group called for the template to clearly set forth the required information to demonstrate medical necessity without having to review pages and pages of individual clinician medical records.
“Particularly in the wake of a respiratory disease global pandemic, we have seen just how vital access to supplemental oxygen therapy is to keeping Medicare beneficiaries safe and stable at home. We hope CMS takes action to protect patient access by ensuring every supplier is working from the same standardized template to confirm a patient’s medical necessity, and we thank Congress for their support,” said Crispin Teufel, Chair of CQRC.
The letter, spearheaded by Reps. Terri Sewell (D-Alabama) and Larry Bucshon (R-Indiana), garnered 22 signatures. Over a dozen stakeholder organizations, including CQRC, have also written to CMS in support of adopting the template instead of medical records.
During the pandemic, CMS provided flexibilities that allowed many beneficiaries to remain safely at home and avoid hospitalization, while also helping communities manage their scarce resources. Contractors currently rely upon the Standard Written Order to support the approval of claims, but also require clinicians’ medical record notes before reimbursing suppliers for providing the oxygen equipment and services prescribed to patients. This has not only led to a high level of administrative burden; it has, more importantly, led to the unjustified denial of claims by Medicare contractors.
“Based on the CERT data, medical necessity is not an issue, but how clinicians write their medical records notes may be problematic. Rather than place suppliers and beneficiaries in the middle, CMS should create clear rules and forms that will facilitate beneficiary access while also protecting against fraud and abusive practices,” the letter said.
To read the full letter, click here.