Confusion over contents
YARMOUTH, Maine – HME providers need to be more diligent about making sure oxygen contents, which are now subject to the face-to-face requirement, are included on original orders, say industry stakeholders.
If they’re not, a new exam and a new order are needed if providers want to bill for contents after the equipment caps, between months 37 and 60, says AAHomcare’s Kim Brummett.
“Providers have been giving the content to the patient all along and now suddenly the equipment caps and they have to bill for the contents, and we typically don’t have contents on the order,” said Brummett, senior director of regulatory affairs for AAHomecare.
This is why AAHomecare last week recommended to CMS that it carve out the content codes from the face-to-face requirement. CMS implemented the requirement in 2013, but it hasn’t started enforcing it yet.
Providers that have orders with the content codes on them, even before they were able to bill for them, are in the clear, says MiraVista’s Andrea Stark.
“It varies from provider to provider—some providers are proactive at getting an order for anything the patient will need; others only for what they are specifically billing for at that time,” said Stark, a reimbursement consultant.
One bright spot: If the patient has had an office visit within the previous six months, that would satisfy the requirement, Stark says.
Provider Ron Evans says, historically, Medicare hasn’t been great at paying for contents in general.
“We’ve never had much success,” said Evans, owner of Phoenix-based Valley Respiratory Services.“You bill it correctly and Medicare still doesn’t want to pay it.”