All Things Respiratory
Avoiding Oxygen Audits
Not too long ago, taking referrals and billing for oxygen products and services was something most of us felt we could do in our sleep. But that was before the “audit atrocities of 2012.” These audits are a combination of pre-payment and post-payment audits by the DME/MACs as well as the CERT contractors. Many HMEs report they have had to add a significant number of staff hours to be able to respond to the requests in a timely manner and, of course, to keep revenue coming in the door. The following areas are still the most problematic:
- Patient testing does not meet intent of the LCD;
- Having language from the medical record that demonstrates other methods that have been tried and failed;
- Documentation lacking from the medical record of patient use and need within CMS timeframe;
- Evidence of prescriber evaluation that is specific to addressing the need for oxygen.
This column will focus on the two areas that, in my experience, have caused the most strife for HME providers: evidence of prescriber evaluation that is specific to addressing the need for oxygen, and having language from the medical record that demonstrates other methods that have been tried and failed.
When a patient is referred to an HME provider following discharge from a hospital, many providers “assume” that the patient has certainly been evaluated for medical necessity for providing oxygen therapy by the prescriber. That assumption is where the problems begin. It is recommended you ask—preferably before you provide the oxygen product to the patient—to see documentation to prove that the evaluation is contained in the record.