January 29, 2010
Widespread Prepayment Probe for Oxygen and Oxygen Equipment LCD (L11486)
DME MAC A will be initiating a widespread prepayment Probe of claims for “Oxygen concentrator, single delivery port, capable of delivering 85% or greater oxygen concentration at the prescribed flow rate” (E1390), “Portable gaseous oxygen system, rental: includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing” (E0431), and “Stationary liquid oxygen system, rental includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask and tubing” (E0439). This review is being initiated due to a high volume of claim errors found by the Comprehensive Error Rate Testing (CERT) contractor.
Suppliers will be sent a documentation request for information listed below. The requested documentation must be returned within 30 days from the date of the letter to avoid claim denials.
- Documentation should include the following per LCD L11468 – Oxygen and Oxygen Equipment:
- 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
A common problem in these reviews is missing or incomplete records. Please ensure when submitting documentation requests that all requested information is included with your file and respond in a timely manner.
It is important for suppliers to be familiar with the coverage criteria and documentation requirements as outlined in the LCD and Policy article. Suppliers can review the Oxygen and Oxygen Equipment LCD on the DME MAC A Web site at: SEE Current LCDs