Monday, December 27, 2010

FARGO, N.D. — A Dec. 23 notice from Noridian Administrative Services, the Jurisdiction D DME MAC, said the Comprehensive Error Rate Testing (CERT) contractor has been identifying "a significant number of errors on claims for oxygen with the most recent error rate at 71.17 percent."

According to NAS, oxygen is the highest source of errors in the jurisdiction, with most due to insufficient documentation to support medical necessity.

NAS said that based on reports it has received, documentation the CERT contractor is looking for includes:

  • Copy of the qualifying blood gas study to support the results noted on the Certificate of Medical Necessity (CMN);
  • Clinical records documenting the patient has severe lung disease or hypoxia related symptoms that are expected to improve with oxygen;
  • Clinical records showing medical management/oversight;
  • Clinical records showing continued need; and
  • Patient evaluation
    • Within 30 days of initial CMN and/or
    • Within 90 days of recertification.

See the notice on the NAS website.