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

      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.

      Suggested stories:
    • In brief: Industry must keep pushing Meek bill

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      HME News Info Center
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      CALENDAR

      February 2010
      One of the key success factors associated with effective lean healthcare organizations is that they get their employees to think and act like owners - learn how they do it in this timely and highly relevant live webinar with Chris Calderone. This innovative webinar-based learning opportunity is specifically geared towards the unique challenges facing today's HME providers.
      FMI: http://www.chriscalderone.com/feb3.html

      The HITECH Act takes effect Feb 17th, 2010. The HITECH act expands HIPAA privacy and security obligations increases compliance obligations and strengthens enforcement penalties. Sweeping changes will affect every business that is involved in or works for Healthcare Organizations. This 90 minute Webinar will give you an understanding of HIPAA and HITECH, risks and key requirements of these laws, the impact on business associates and the covered entity.
      One hour of your time today could save you thousands tomorrow.
      1:00 PM - 2:30 PM EST
      Space is limited.
      Reserve your Webinar seat now at:
      https://www2.gotomeeting.com/register/207314795

      AMEPA and CAMPS are hosting a rally to support HR 3790, the bill to repeal competitive bidding. The bill needs 219 co-sponsors. Southern California is home to 25 of California's 53 Congressmen. Local representatives, the media and patients will be invited to attend.
      Holiday Inn and Conference Center, Buena Park (just outside Anaheim)
      10 a.m. to 12 p.m. RSVP to info@amepa.us

      2:00pm - 3:00pm EST
      Join Andrea Stark for this first in a special three-part billing series, where you’ll learn how to reduce rejections and denials by knowing:
      What needs to be included in patient charts to ensure compliance with Medicare rules and policies.
      What questions to ask before agreeing to take on a patient.
      Basic documentation and signature requirements for general DME, including when CMNs, DIFs and WOPDs should be used.
      How to determine if and when you will need to utilize an ABN, obtain a renewal ABN, and ensure that they are compliant.
      This webinar will help reduce your chances of failing an audit by teaching you what to look for before submitting a claim.

      February 23-26 (dates include optional, stand-alone Billing Boot Camp on 23rd; there is also an optional driver/delivery tech certification program on 26th, concurrent with general sessions)
      Includes general sessions on legislative updates; HR law; consignment closet rules; staying accredited and changing accreditors; alternative revenue sources; patients traveling with oxygen; evaluating, selling and buying an HME; and a panel with CMS, CIGNA, the RAC and CBIC.
      The St. Anthony Hotel, San Antonio, TX
      Conference Index Page:
      http://www.mesanet.org/index.php?src=gendocs&ref=10conference_index&category=MESA_conference


      March 2010
      The American Association for Homecare will host the Washington Legislative Conference, March 1-3, 2010 ,at the Capital Hilton, Washington, D.C.
      It is impossible to have a strong impact on home medical equipment policy without more involvement on Capitol Hill. In 2010, the home medical equipment community faces continued challenges: competitive bidding, complex mobility policy, the oxygen cap, and other regulatory and legislative concerns.
      So we are asking HME stakeholders to make their voice heard. AAHomecare will provide background materials for this key annual lobbying event for the HME sector. Speakers during the conference will include members of Congress and officials from CMS.
      For more information, please visit www.aahomecare.org

      Attend the CAMPS Convention for only $125 (member pricing) and attend as many of the various sessions. The schedule is divided into tracks to help you determine the best sessions for your interest. This year's line-up includes sessions such as: Business Management, Operations / Reimbursement, Exemptee Training, Respiratory CE*, RESNA RT Prep Test. Earn 6 units of continuing education with the American Association for Respiratory Care (AARC). Do not hesitate, register by February 1, 2010 to take advantage of the $50 savings. Register here: http://member.campsone.org/cgi-shl/TWServer.exe?EREG:OrderEvent:2010AM

      2:00pm - 3:00pm EST
      Join Andrea Stark for the second installation in a special three-part billing series, where you’ll learn how to:
      Prescreen your claims for potential denials.
      Utilize technology to submit claims electronically, reduce the burden on your AR department, and decrease your risk of getting denied.
      dentify potential same or similar, medical necessity, or other eligibility issues (i.e. SNF stays).
      Establish an AR Strategy and ensure that reporting tools effectively capture the vulnerabilities of claim processing to include analysis of claim rejections, days sales outstanding and denials.
      This webinar will provide you with the tips and tools you need to be sure you are properly submitting claims to Medicare, the first time around.

      AMEPA and FAHCS present the third annual Florida Home Care Conference. Scheduled to appear: Walt Gorski (Washington update), Jeff Baird (Legal), Mark Higley (Audits), Sean Schwinghammer (Tallahassee update), Sylvia Toscano (Billing) and Ty Bello (Referrals).
      FMI: visit www.amepa.us or e-mail info@amepa.us


      April 2010
      Annual event features manufacturer exhibits, networking and educational sessions for womens health providers. Louisville, Ky.
      FMI: call 800-988-4484, visit www.essentiallywomen.com or email melissa@essentiallywomen.com

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