Oxygen cap: Reimbursement void frustrates providers
WASHINGTON - With only seven months until the clock stops ticking on the 36-month oxygen cap, providers still have no clue how much they'll be reimbursed for ongoing service and maintenance. That's made planning problematic, to say the least.
"I'm trying to look at my expenses vs. reimbursement to figure out if I can continue servicing these patients, but I don't know what the reimbursement's going to be, so I can't," said Mark Ehlers, owner of Ehlers Health Supply in Stockton, Calif. "I've never seen this much lack of information on an industry issue before."
On Jan. 1, 2009, providers must begin transferring ownership of oxygen concentrators to Medicare beneficiaries and forgo collecting monthly reimbursement.
Providers' frustration is well deserved, industry leaders say. Medicare's last update on the oxygen cap was a final rule published in 2006 stating it would pay a six-month maintenance fee, starting with the 42nd month, and a one-time tank pick-up fee.
"That's all we know," said Cara Bachenheimer, senior vice president of government relations for Invacare. "We don't have the critical details--how much they're going to pay and what the criteria are going to be."
Industry leaders expect CMS to issue additional guidance in July, after it has kicked off Round 1 of national competitive bidding.
Provider Daniel Heckman says he can't put preparations for dealing with the oxygen cap on hold any longer.
"Whatever CMS pays, we know it's not going to have any relation to our actual costs, anyway, when you consider back-up tanks, emergency services, etc.," said Heckman, general manager of Heckman Healthcare in Decatur, Ill. "So we think we're going to give them options on an a la carte, out-of-pocket basis."
Legally, provider Tom Inman wonders whether providers will be able to continue servicing concentrators at all after the cap. He, for one, has no plans to go to the trouble and expense of keeping prescriptions on file for capped concentrators, and state laws prohibit him from providing oxygen without prescriptions.
"When a patient calls me on a Friday night to tell me her concentrator is broken, I'm going to have to tell her, 'Have your doc fax me a script on Monday, and enjoy your weekend in the hospital,'" said Inman, president of Virginia Home Medical in Newport News, Va. "The cap forces me to disconnect from patients."