Oxygen cap details: They're on the way?

Sunday, October 26, 2008

WASHINGTON - CMS may begin issuing guidance on the 36-month oxygen cap by the end of the month, according to a recent e-mail from a CMS official to a provider.

In an Oct. 21 e-mail to CMS's Joel Kaiser, provider Rob Brant, president of the Accredited Medical Equipment Providers Association, asked: "Is it possible we may not have the oxygen guidance until November or December?"

Kaiser's response: "We fully expect to begin providing guidance by the end of the month. I cannot make any guarantees or provide further details at this time."

Starting Jan. 1, providers must stop billing Medicare for patients who have been on oxygen for 36 months. Without more information from CMS, particularly about service and maintenance, providers have struggled to make decisions about how to continue caring for capped patients.

Provider Tom Inman has mapped out his budget through 2011, with one big hole: reimbursement for service and maintenance.

"I know what I am losing every month on oxygen reimbursement," said Inman, president of Newport News, Va.-based Virginia Home Medical. "But I can't budget any of the reimbursement I'm going to get."

In addition to the service and maintenance fee, the industry wants to know how CMS expects providers to handle emergency services; whether it will allow providers to establish service contracts with beneficiaries; and how it wants providers to handle snowbirds or patients who move.

"This is cutting it very close," said Walt Gorski, vice president of government relations for AAHomecare. "Suppliers need to know how to handle all of these circumstances as quickly as possible."

Adding to the overall stress: In October, there were reports that CMS was telling callers to its beneficiary hotline that equipment transfers to patients after 36 months. The Medicare bill passed in July that delayed national competitive bidding allows providers to retain ownership.

"We had patients telling us we were wrong, that they would own the equipment, not us," said Ed Erickson, general manager of Great Plains Homecare Equipment in North Platte, Neb. "It piqued our curiosity, so we called the hotline pretending to have a parent on oxygen and that's exactly what they told us."