Health Information Management

Tip: Learn your contractor?s rules for hyperbaric oxygen therapy

APCs Insider, June 18, 2010

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Hyperbaric oxygen (HBO) therapy is a relatively new service, so the various MACs and FIs interpret the rules differently. Private payers also may have different rules regarding payment for HBO.

In addition to CMS’ national coverage determination, your MAC or FI may have a related local coverage determination (LCD) or article. Review these for any documentation requirements. Also, carefully examine the LCD to ensure that information you request from providers will result in payment(s) that you are able to retain in the event of an audit.

You can eliminate some denials by instructing clinical staff members to use a prequalification checklist before they start patients on HBO. Include the common outpatient conditions your facility treats with HBO on the form. Customize the form to include the procedures your particular MAC or FI cover.

A prequalification statement will assist providers in determining whether HBO therapy is appropriate. It also gives HIM professionals a starting place to determine whether HBO therapy is covered.

You also can use the prequalification statement to help practitioners remember the necessary documentation for each diagnosis. Physicians then can work through that checklist before starting a patient on HBO therapy.

This tip is adapted from “Check off requirements for hyperbaric oxygen therapy before treatment” in the June issue of Briefings on APCs.

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