House Dear Colleague letter on protecting patient access to home oxygen
Action is needed from the HME community. Representatives Terri Sewell (D—AL) and Larry Bucshon (R—IN) are spearheading a Congressional letter to CMS asking the agency to streamline medical necessity documentation to protect patient access for home oxygen therapy. This will have a large impact on the HME Industry and those we serve.
You can view the Dear Colleague letter and Congressional letter here.
Please reach out to your federal House legislators to encourage them to sign onto the letter. The deadline for signatures is Friday, July 29.
- Per CERT data, less than 1% of Medicare home oxygen therapy claims are improperly paid are due to failing to meet medical necessity requirements.
- Suppliers are caught in the middle when claims aren’t paid because they are required to provide equipment since it meets Medicare’s medical necessity requirements, yet the contractors deny claims for the clinicians’ notes not meeting the contractor’s standards.
- The solution is to remove the ambiguity by creating clear rules and forms that facilitate beneficiary access while protecting against fraud and abuse.
- The letter requests CMS to:
- Establish a clear set of objective criteria to support medical necessity
- Require contractors to rely solely on the Standard Written Order to establish medical need
- Eliminate the medical record review
- Precedence has already been set with success! Pandemic flexibilities temporarily removed the requirement for medical record notes to be used to document medical necessity and instead use the prescription and standard written order.
- Endorsing stakeholders include several leading clinical and consumer organizations as well as AAHomecare, VGM, and CQRC.
Please e-mail the staffer that deals with health care issues for your federal House legislator, and ask that they sign the Congressional letter to CMS. If you need contact information, please contact Ashley Plauché, firstname.lastname@example.org, or Gordon Barnes, email@example.com.