Oxygen cap: Industry clamors for specifics

Tuesday, September 30, 2008

BALTIMORE--HME stakeholders in August continued pressing CMS for answers to questions surrounding the 36-month cap on oxygen reimbursement.

“Most providers just want to understand what will be their responsibilities and what their compensation will be under the cap,” said Joe Lewarski, vice president of Invacare’s Respiratory Products Group.

Beginning Jan. 1, 2009, providers must stop collecting reimbursement for oxygen equipment that has been in use for three years. The Medicare bill passed in July, however, allows providers to retain ownership of equipment.

The industry, meanwhile, is clamoring for specifics.

AAHomecare in August sent a list of providers’ top 22 questions to CMS.

Among them:

- How will CMS develop payment amounts for oxygen equipment maintenance?

- Will CMS pay for one month’s rental of loaner equipment while equipment is repaired?

- How will CMS reimburse for parts and labor after the rental period has expired?

Providers are especially worried that they may get stuck performing service and maintenance without adequate payment, if they get paid at all.

“Nowhere else in the Medicare program do payments cease while services continue,” said Walt Gorski, vice president of government relations for AAHomecare. “Not only is it controversial, but it is likely to cause problems for patients and providers.”

CMS has stated that it plans to pay for maintenance and service. Under the current structure, the monthly reimbursement fee covers all associated costs, including parts, labor, service calls and back-up equipment.

One CMS official told callers during a July Open Door Forum: “I don’t think the maintenance and servicing payments are going to be changing in any significant way. We’re paying it now, so we’ll continue to pay it.”

That’s small comfort, said Bob McCoy, the current homecare section chair for the American Association for Respiratory Care.

“I don’t know how adequate their payment’s going to be,” said McCoy. “The current reimbursement isn’t adequate to cover the clinical services. Medicare is not recognizing this is an expensive service.

Everyone else can raise their prices, but Medicare wants to pay less.”