Straight Talk Tuesday

Tuesdays in the month of June, I’d like to have some straight talk about a few of the MANY ways in which payment for hyperbaric oxygen therapy is going to change and FAST.  All payers, commercial and Medicare/Medicaid are establishing specific criteria for hyperbaric medicine credentialing, without which they will not pay for HBOT treatment supervision. Many payers are requiring sub-specialty Board certification in undersea and hyperbaric medicine (UHM), although some allow leeway for a certificate of added qualification (CAQ). These payer credentialing requirements may mandate a certain number of HBOT treatments  to be proctored by another credentialed physician for new hyperbaric practitioners. Some specify the number of documented HBOT SPECIFIC CMEs needed to maintain credentials, and many mandate ACLS certification.

For example, for Independent Blue Cross (IBC) to reimburse HBOT therapy in the non-hospital-affiliated setting, the following criteria must be met: Direct supervision is provided by a physician certified in Undersea and Hyperbaric Medicine by the American Board of Emergency Medicine (ABEM), the American Board of Preventive Medicine (ABPM), or the American Osteopathic Conjoint Committee of Undersea and Hyperbaric Medicine (AOCUHM); or by a physician who has successfully completed a minimum 40-hour in-person accredited training program such as one approved by the American College of Hyperbaric Medicine (ACHM) or the Undersea and Hyperbaric Medical Society (UHMS), and has supervised at least 300 HBO treatments. The supervising provider must be ACLS trained and certified. If the supervising provider response time to the chamber may be expected to exceed five minutes, the personnel that is chamber side during HBO therapy must be ACLS trained and certified.

The recent Novitas LCD for HBOT requires that an emergency response team is available on site. “No payment will be allowed for HBO without documentation that a trained emergency response team is available and that the setting provides the required availability of ICU services that could be needed to ensure the patient’s safety if a complication occurred.” I am pretty sure that “calling 911” does not meet this requirement. The ACHM and UHMS have both issued white papers on physician credentialing.

2 comments

  1. Read your post and am curious what district your comment was about ? I am from Pennsylvania and have not found any LCD from Novitas. What time frame if any would these supposed criteria would go into effect. It seems obvious that they are trying to exclude free standing HBOT centers which we are a part of. I am just trying to be proactive

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    1. Here is the link to the pre-authorization announcement: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Prior-Authorization-of-Non-emergent-Hyperbaric-Oxygen.html

      Preauthorization for non emergent HBOT will be required in Illinois, Michigan, and New Jersey. This means that 3 different MACs are involved. However, only one state in each MAC is involved and Pennsylvania is not one of them.

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