WASHINGTON (November 11, 2022)—The Council for Quality Respiratory Care (CQRC), a coalition of the nation's leading home oxygen therapy providers and manufacturing companies, recently submitted its response to the Centers for Medicare & Medicaid Services’ (CMS) Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs Request For Information (RFI) seeking public input on accessing health care and related challenges. 

CQRC recommended the agency adopt clear, objective oxygen clinical data elements consistent with existing CMS-developed “templates” to ensure that access to care for home respiratory patients is not unnecessarily placed at risk. Currently, an outdated documentation system, high backlogs, high reimbursement denial rates, and post-pandemic uncertainty present unique barriers to providing high-quality oxygen therapy care. CQRC also urges CMS to issue clear guidelines about what to expect after the COVID-19 Public Health Emergency (PHE) ends so that patients continue to receive these services based on their existing documentation order.

CQRC’s RFI response also urges CMS to provide clear guidelines about what home respiratory patients and suppliers should expect after the COVID-19 public health emergency expires. 

Because the pandemic placed such importance on assuring patients’ access to respiratory supplies and equipment, CQRC believes that CMS "appropriately created flexibility" to expedite patients receiving care, benefiting an overcommitted health system. About 1 million patients who began services during the PHE will require assistance after it ends, but without clear guidance about how certain flexibilities and waivers may end, these patients may be forced to be recertified for care, which would threaten to seriously overwhelm the nation’s healthcare system.

"Currently, CMS has yet to issue guidance as to how it plans to address these patients regarding the documentation and audit processes. Requiring all these patients to return to their doctors, be tested again, receive a new prescription, and submit new documentation will overload the already stressed healthcare system,” CQRC warns.  

Ultimately, CQRC calls upon CMS to outline guidelines before the end of the year in order to support providers in this changing healthcare climate. Such guidelines should ensure patients are able to continue receiving home respiratory services based on their existing documentation order and not be subject to additional documentation requirements.

Responding to RFI questions about challenges for healthcare workers and provider well-being, CQRC responded that Medicare contractors’ reliance on outdated, paper medical record reviews leads 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. 

“Suppliers simply cannot provide medically necessary services when they are not reimbursed because contractors determine that physician notes do not meet a standard that has not been shared with the physicians making those notes,” CQRC wrote to CMS.

CQRC proposes the agency instruct contractors to streamline the process by using CMS digital “templates” with standardized clinical data elements instead of paper records. 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, which may or may not include the subjective “magic words” that the contractor requires for reimbursement.

“Doing so will reduce burden, set the agency on a clear path to the use of digital health technology that will reduce burdens on providers and suppliers, and protect access to a medically necessary therapy that allows individuals to remain in their homes and communities, and reduce hospitalizations and the need for institutional-based care,” said the CQRC response.