Oxygen Prepayment Probe in Jurisdiction A

HINGHAM, Mass. — NHIC, the Jurisdiction A DME MAC,
announced Friday it will begin a widespread prepayment probe of
oxygen claims for codes E1390, E0431 and E0439 due to a high volume
of errors found by the CERT contractor.

“A common problem in these reviews is missing or incomplete
records,” according to the MAC notice. “Please ensure when
submitting documentation requests that all requested information is
included with your file and respond in a timely manner.”

Documentation should include the following, the notice said:

• Documentation of dispensing order (if item is dispensed based on
  a verbal order)

• Detailed written order (must include liters per minute)

• Payable diagnosis

• Copy of initial qualifying arterial blood gas (ABG) or pulse
  oximetry report referenced on the CMN

• Initial Certificate of Medical Necessity (CMS Form 484) (CMN may
  act as substitute for written order if it is sufficiently
  detailed)

• Documentation of initial in-person evaluation

• Re-certification CMN if applicable

• Copy of recertification qualifying arterial blood gas (ABG) or
  pulse oximetry report referenced on the CMN (if applicable)

• Documentation of an in-person recertification evaluation (if
  applicable)

• Beneficiary authorization

• Proof of delivery

• Medical record information from treating physician to support
  that beneficiary is continuing to require, use and benefit from
  oxygen therapy equipment