OIG uncovers incomplete CMNs
OIG uncovers incomplete CMNs
Medicare paid $263 million in 1995 for oxygen equipment covered by inaccurate or incomplete certificates of medical necessity (CMNs); 13% of beneficiaries never used the portable oxygen systems, nor could many suppliers document all the services they were paid to provide.
The damaging news was detailed in an Office of Inspector General (OIG) report released in late August, once again putting the spotlight on home oxygen therapy (the largest segment of durable medical equipment paid for by Medicare) and explaining why it’s high on the government’s fraud and abuse priority list. The OIG’s finding was supported by the Health Care Financing Administration (HCFA), which agreed with all of the OIG’s recommendations:
• HCFA perform focused medical reviews of durable medical equipment carriers’ oxygen equipment claims.
• Implement system edits to identify incomplete certificates of medical necessity and allow for suspended payment until complete CMNs are submitted.
• Establish specific service standards for home oxygen equipment suppliers as mandated by the Balanced Budget Act of 1997.
The OIG also reasserted past warnings to physicians about their responsibility in determining medical necessity. It reminded physicians that by signing CMNs, they are attesting to the medical necessity stated in the CMN and the accuracy of the document.
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