By Thomas E. Serena MD, FACS, FACHM, FAPWCA
Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!
