.CMS’s phrase “non-enforcement of clinical indications,” introduced in coronavirus-response guidance, doesn’t say much. After wrestling with the publications and various exchanges, I have boiled it down to this:
Medicare will reimburse services during the public health emergency when medical records meet the spirit of the longstanding policies, even if the records do not meet every nit-picky detail.
Said another way, CMS is not waiving long standing policy to allow any patient to access services regardless of need. Instead, the CMS instructions temporarily relax some of the formal documentation requirements. The medical records still have to demonstrate a baseline medical need for the equipment or supplies as a condition of Medicare payment
CMS addressed the concept of non-enforcement in two interim final rules: IFRs 1744 and 5531 posted on April 6 and May 8, 2020, respectively. Here, we look at RAD specifically.
The baseline for RAD therapy generally starts with symptoms characteristic of sleep-associated hypoventilation, such as:
If routinely required testing is not feasible during the PHE, we advise suppliers to ensure the medical record estimates how and when further testing will be coordinated. For continued use beyond the trial period, the medical record must document timely compliance using downloads from the machine and subjective evidence of improvement, via telehealth when an in-person visit is not feasible.
Potentially Permissible Deficiencies for RAD Setups
Under the relaxed guidelines, patients may or may not have lab-performed testing results to confirm a suspected diagnosis per the LCD requirements because practitioners may not be able to:
SOURCE LINKS
https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf
https://www.govinfo.gov/content/pkg/FR-2020-05-08/pdf/2020-09608.pdf
https://cgsmedicare.com/jc/pubs/news/2020/05/cope17333.html
Medicare will reimburse services during the public health emergency when medical records meet the spirit of the longstanding policies, even if the records do not meet every nit-picky detail.
Said another way, CMS is not waiving long standing policy to allow any patient to access services regardless of need. Instead, the CMS instructions temporarily relax some of the formal documentation requirements. The medical records still have to demonstrate a baseline medical need for the equipment or supplies as a condition of Medicare payment
CMS addressed the concept of non-enforcement in two interim final rules: IFRs 1744 and 5531 posted on April 6 and May 8, 2020, respectively. Here, we look at RAD specifically.
The baseline for RAD therapy generally starts with symptoms characteristic of sleep-associated hypoventilation, such as:
- Daytime hypersomnolence.
- Excessive fatigue.
- Morning headaches.
- Cognitive dysfunction.
- Dyspnea.
If routinely required testing is not feasible during the PHE, we advise suppliers to ensure the medical record estimates how and when further testing will be coordinated. For continued use beyond the trial period, the medical record must document timely compliance using downloads from the machine and subjective evidence of improvement, via telehealth when an in-person visit is not feasible.
Potentially Permissible Deficiencies for RAD Setups
Under the relaxed guidelines, patients may or may not have lab-performed testing results to confirm a suspected diagnosis per the LCD requirements because practitioners may not be able to:
- Access a lab.
- Perform routine tests required in the LCD that measure:
- Arterial blood gas.
- Forced vital capacity and expired volume.
- Carbon dioxide retention.
SOURCE LINKS
https://www.govinfo.gov/content/pkg/FR-2020-04-06/pdf/2020-06990.pdf
https://www.govinfo.gov/content/pkg/FR-2020-05-08/pdf/2020-09608.pdf
https://cgsmedicare.com/jc/pubs/news/2020/05/cope17333.html
RSS Feed