CMS avoids oxygen details

Wednesday, December 31, 2008

BALTIMORE--An Open Door Forum Dec. 9 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,” said Kaiser.