Hey there!
I know there is some confusion around the CMN requirements for Medicare oxygen volume adjustments, so I thought you might benefit from a brief summary of the MAC’s communications and a flow chart we designed to help you and your staff determine how to handle volume adjustment scenarios as they encounter them.
On April 26, the MACs partially reversed instructions from their February 15 communication regarding oxygen CMNs and volume adjustments. According to the new instruction, suppliers are not required to secure a revised CMN to justify high liter flows and comply with changes to when volume adjustments are paid.
To be clear, the MACs did not reverse the revised coverage criteria or calculation protocols for volume adjustments that took effect on April 1, 2018. However, this reversal means suppliers will not have to ask physicians to answer a different Question 5 than what is on the current, OMB approved, oxygen CMN.
Here’s what you need to do:
Per CMS, exertion prescription orders no longer factor into volume adjustment consideration.
To keep it all straight, we posted a flow chart to help you bill consistently using the right calculations and modifiers.
If you have any questions, give us a shout.
Talk soon.
Andrea
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Source Links
https://cgsmedicare.com/jb/pubs/news/2018/04/cope7420.html
https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/billing-instruction-oxygen-cmn-question-5-revised
I know there is some confusion around the CMN requirements for Medicare oxygen volume adjustments, so I thought you might benefit from a brief summary of the MAC’s communications and a flow chart we designed to help you and your staff determine how to handle volume adjustment scenarios as they encounter them.
On April 26, the MACs partially reversed instructions from their February 15 communication regarding oxygen CMNs and volume adjustments. According to the new instruction, suppliers are not required to secure a revised CMN to justify high liter flows and comply with changes to when volume adjustments are paid.
To be clear, the MACs did not reverse the revised coverage criteria or calculation protocols for volume adjustments that took effect on April 1, 2018. However, this reversal means suppliers will not have to ask physicians to answer a different Question 5 than what is on the current, OMB approved, oxygen CMN.
Here’s what you need to do:
- Query from the billing system active orders for high liter flow oxygen claims, designated with modifiers QE, QF or QG. If no existing orders meet the criterion, only new customers that qualify for volume adjustments must comply with CMS instructions.
- Retrieve current O2 prescriptions for each applicable patient billing for a volume adjustment.
- Based on the prescription, log these two values:
- Physician ordered LPM at rest
- Physician ordered LPM at night
Per CMS, exertion prescription orders no longer factor into volume adjustment consideration.
To keep it all straight, we posted a flow chart to help you bill consistently using the right calculations and modifiers.
If you have any questions, give us a shout.
Talk soon.
Andrea
##
Source Links
https://cgsmedicare.com/jb/pubs/news/2018/04/cope7420.html
https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/billing-instruction-oxygen-cmn-question-5-revised
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