LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2011-03 Widespread Documentation Compliance Prepayment Review for Oxygen and Oxygen Equipment

March 14, 2011

Widespread Documentation Compliance Prepayment Review for Oxygen and Oxygen Equipment
  • NHIC, the DME MAC for Jurisdiction A, will be initiating a widespread documentation compliance prepayment review of claims for Oxygen and Oxygen Equipment. This review is being initiated due to a high volume of claim errors identified by the Comprehensive Error Rate Testing (CERT) Contractor for missing and/or incomplete documentation.
  • Suppliers will be sent a documentation request for information listed below. The requested information must be returned within 30 days from the date of the letter to avoid claim denials.
  • The request will include the following:
    1. The detailed written order
    2. Certificate of Medical Necessity (CMN)
    3. Copy of the laboratory result for the arterial blood gas PO2 and/or oxygen saturation test value reported on the CMN
    4. Documentation of a physician office visit prior to the initial date of service
    5. Proof of delivery
  • It is important for suppliers to be familiar with the documentation requirements as outlined in the LCD and Policy article. Suppliers can review the LCD on the NHIC DME MAC A Web site at:
    http://www.medicarenhic.com/dme/medical_review/mr_lcd_current.shtml
  • A common finding in these reviews is missing or incomplete records. To ensure compliance, please submit the requested information within the timeframe requested.