All oxygen, all the time: CMS avoids details, industry continues push

Sunday, December 14, 2008

BALTIMORE - An Open Door Forum last week offered little relief for providers seeking advice on how to handle oxygen patients who move from their service areas.

Rehashing recently released guidance, CMS official Joel Kaiser said: "If it is less than 36 months, the beneficiary should make arrangements with their supplier to continue receiving oxygen from a new supplier at their new residence. After the cap, if the beneficiary relocates, their supplier is required to continue supplying oxygen equipment."

But the concerns providers have delve more into the nitty-gritty.

"If the beneficiary moves after he caps, I am on the hook to pay another company to take care of them," said Lee Guay, a coordinator for Apex of St. Peters in Helena, Mont. "Is there going to be anything in the rules to prevent another company from charging above the Medicare allowable?"

Kaiser didn't address Guay's question specifically, but he pointed out: "Most of your beneficiaries aren't going to be moving, so it won't be an issue."

Another provider asked whether, if a provider goes out of business, the new provider could begin a new 36-month period? Yes, Kaiser said, if the provider goes out of business for reasons beyond his control and the beneficiary elects to get new equipment.

But providers can't just go out of business to avoid taking care of capped oxygen patients, Kaiser warned.

"You don't have to take on new patients but you are bound to continue furnishing for patients until the reasonable lifetime is met," he said.

CMS officials did go over situations where the agency will pay for replacement equipment and begin a new 36-month period: when equipment is destroyed (by a fire in the home, for example); stolen; or irreparably damaged.

"It must be a specific incident of damage," he said. "That does not mean the item is worn out."

Additionally, a change in the patient's medical condition does not restart the 36-month period, because oxygen concentrators are billed under one general code, Kaiser said.

CMS reminded providers that the current RP modifier used for equipment replacement or repairs will be replaced with two new modifiers on Jan. 1, 2009: RA for outright replacement of equipment and RB for replacement of parts associated with repairing equipment.

Industry continues push
WASHINGTON - Industry stakeholders are encouraging providers to call their legislators and ask them to sign a "dear colleague" letter to delay the 36-month oxygen cap that goes into effect Jan. 1. The letter, written by Reps. Heath Shuler (D-N.C.) and Tom Price (R-Ga.), asks CMS to delay the rule to give Congress time to reform the oxygen benefit. To reach your legislator, call the Capitol switchboard at 202-224-3121.