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This is a guest blog from Dr. Helen Gelly, who is a tireless hyperbaric coverage and reimbursement watchdog.
Noridian (a CMS Medicare contractor) has started making requests for additional hyperbaric oxygen therapy (HBOT) documentation prior to payment. This process is known as a prepayment review. Only one provider that we know of has received this request. It’s not clear why he/she was singled out because at this particular facility, multiple doctors provide hyperbaric chamber supervision. Although Noridian is demanding a lot of specific documents as part of this prepayment review, one in particular is baffling: “Documentation to support credentialing of the provider performing the HBO service.”
Since the Centers for Medicare and Medicaid Services (CMS) does not have any credentialing requirements in the National Coverage Determination that defines the coverage policy for HBO (NCD 20.29), we are curious exactly what documentation for physician credentialing that they are looking for.
Has anyone else received this request from Noridian (or any other Medicare Administrative Contractor)? If so, can you provide insight as to exactly what credentials they are looking for? Are they looking for subspecialty board certification in Undersea and Hyperbaric Medicine (UHM)? Or will they accept an accredited 40-hour introductory course? Did they expect to see the claim submitted by a provider using the Undersea and Hyperbaric Medicine taxonomy code?
If there are super-secret requirements that Noridian has now decided to impose prior to paying for hyperbaric chamber supervision, then they should be enshrined in a public document somewhere. Whatever it is they are looking for, any hyperbaric practitioner in the Noridian jurisdiction could be affected and that includes the following states: Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming.
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