CMS releases oxygen guidance

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Sunday, May 10, 2009

WASHINGTON - An article was published last week on providing home oxygen therapy to patients who are traveling for a short period of time and snowbirds.

The article, published by the DME MAC for Jurisdiction A, outlines requirements for home providers and temporary providers. It also provides instructions for providing oxygen in months 37 through 60.

Requirements for the home provider:

*    If the beneficiary travels or relocates outside the provider's service area, then for the remainder of the rental month for which it billed, the home provider is required to provide the oxygen itself or arrange for a temporary provider (non-billing) to provide the oxygen.

*    For subsequent rental months that the beneficiary is outside the service area, the home provider is encouraged to either provide or arrange for the oxygen itself or assist the beneficiary in finding a temporary provider (billing) in the new location.

*    If the home provider provides oxygen to the patient for use out-of-area or arranges for a temporary provider (non-billing) to provide the oxygen, the home provider bills for whatever system the patient is using on the anniversary date/billing date. The provider may provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.

*    The home provider may not bill for or be reimbursed by Medicare if it is not providing oxygen or has not arranged for a temporary provider (non-billing) to provide the oxygen on the anniversary billing date.

Requirements for the temporary provider:

*    If it is during a month in which the home provider has not billed Medicare, claims from the temporary provider (billing) would be paid, if all coverage criteria and payment rules are met.

*    If it is during a month in which the home provider has billed Medicare and it is not provided under an arrangement with the home provider, then the claim from the temporary provider (billing) will be denied as not medically necessary, if it bills Medicare.

*    If the beneficiary returns home before the end of a rental month for which the temporary provider (billing) has billed, it must provide oxygen itself for the entirety of that month or make arrangements with the home provider to provide the oxygen.

*    The temporary provider (billing) must provide a copy of a valid CMN, an order (if the order information was not included on the CMN), a report of the qualifying blood gas study, and documentation of any required physician visit, if requested.

Months 37-60:

*    The provider providing oxygen to the patient during the 36th month is required to provide oxygen to the patient either directly or under arrangements with a temporary provider (non-billing) for beneficiary use out-of-area.

*    The home provider could provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.

*    The provider would not submit a claim for that equipment (because it is required to continue to provide equipment after the 36 month cap).

*    If the beneficiary had a gaseous or liquid system during the 36th month and the provider was providing contents to the patient during months 37-60, it may only bill and will only be reimbursed for contents if the patient was using contents at some time during the billed month. It may not bill for contents if, for example, the beneficiary was using a portable concentrator during the entire month.

Read the complete article at: http://www.medicarenhic.com/dme/dme_whats_new.shtml.

 

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