CareCentrix requires repeat authorizations for oxygen

Friday, February 24, 2017

HARTFORD, Conn. – A recently announced change to CareCentrix’s authorization process for oxygen patients covered under a Medicare Advantage plan has stakeholders scratching their heads.

The change, issued earlier this month, states that an initial request for oxygen will be approved for only one month, with subsequent months requiring additional authorization.

“I’m trying to get to see why they are doing what they are doing and talk them out of it," said Laura Williard, senior director of payer relations for AAHomecare, who reached out to the health plan manager to seek clarification. "A one-month authorization is crazy.”

It’s unclear from the "Provider Newsflash," stakeholders say, whether additional authorization would be needed on a monthly basis for subsequent months, or just a second time.

Jennifer Russo, vice president of marketing at CareCentrix, said the initial request is an "expedited process so patients can get their oxygen without delay."

"Re-authorizations for acute patients are for two months," she added. "Re-authorizations for chronic conditions can be what the prescriber indicates for up to 11 months."

Russo said CareCentrix plans to issue a clarification to its providers.

CareCentrix, which supports and coordinates homecare for more than 23 million lives, says in its “Provider Newsflash” that “these changes are being implemented as a result of recent CMS publications noting the high utilization of oxygen.” Russo pointed to the "Medicare Fee-for-Service 2016 Improper Payments Report" issued in December.

Most patients who require oxygen—like those with COPD or congestive heart failure—truly need it, often for the rest of their lives, stakeholders point out.

“They don’t do it just to have an oxygen tank in their home and not use it,” said Williard.

With the change effective April 10,  provider Tyler Riddle is keeping an eye out for that clarification.

“We are watching it closely,” said Riddle, vice president of Albany, Ga.-based MRS Homecare.