MACs ease denial process for oxygen claims

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Friday, May 11, 2018

WASHINGTON – The DME MACs are adding modifiers that will allow HME providers to provide additional information related to the coverage and/or liability when the policy criteria are not met for oxygen patients.

“The benefit of this change is that suppliers can now file an oxygen claim when a patient doesn’t qualify and get an accurate PR (patient responsibility) denial,” AAHomecare wrote in a bulletin.

Effective for claims with dates of service on or after Aug. 1, providers should use:

  • the KX modifier when the requirements specified in the medical policy have been met;
  • GA for a waiver of liability (expected to be denied as not reasonable and necessary, ABN on file);
  • GY for item or service statutorily excluded or does not meet the definition of any Medicare benefit;
  • or GZ for item or service not reasonable or necessary (expected to be denied as not reasonable or necessary, no ABN on file).

AAHomecare says stakeholders have been requesting these changes for “many years.”