CMS sunsets CMN for home oxygen

WASHINGTON – CMS on Sept. 27 posted a final national coverage determination for home oxygen, but now industry stakeholders must “wait and see” what the DME Medicare Administrative Contractors do with the changes. 

While the effective date of the NCD is technically Sept. 27, it won’t be implemented until a later date, when the DME MACs update their local coverage determinations. 

“There are a lot of positives here, and we will wait and see,” says Kim Brummett, vice president of regulatory affairs for AAHomecare. “There’s a lot that is at the discretion of the MACs.” 

CMS in July issued a proposed NCD for home oxygen therapy that, among other things, removed the CMN requirement and expanded access for acute conditions.  

Dropping the CMN requirement has been widely applauded by stakeholders as a sensible way to reduce an unnecessary step in getting patients on therapy. 

“The CMN is a claims processing tool,” Brummett said. “Providers would be stuck waiting to have the prescriber fill it out and it had no bearing on anything at all.” 

Still, without the CMN, stakeholders acknowledge there may be more gray areas, including around requalification. 

“Some suppliers feel the CMN still gave direction to the physician as to what they needed in the medical records,” said Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. “There’s still some concern when you read the NCD that some of the requirements are up to the MAC’s discretion. (For example), allowing or accepting acute conditions for oxygen – what will the requalifying look like?” 

One change that CMS made in the final NCD should provide a little breathing room, stakeholders say: Patients can get requalified at any time within the first 120 days, rather than 60 to 90 days. 

“If the physician feels like the patient would benefit by staying on oxygen, we shouldn’t be tied to the 60 to 90 days,” Brummett said. “It can be difficult to get into the physician and if they see the physician on day 45, why should they have to go back again (to get requalified)?”  

It could take six months or longer for the DME MACs to issue LCDs because the 21st Century Cures Act requires comment and notice periods. In the meantime, providers are still under the cover of a public health emergency that provides flexibility, stakeholders say. 

“We’re still under a pandemic, which is almost helpful for suppliers to make decisions,” Buhrmester said. “When you get an order from the doctor, be sure the medical record indicates medical need related to the reason oxygen is necessary for treatment and append the CR modifier to the claim related to the pandemic.”