Oxygen: Provision gives hope; AAH details reform; CMS answers questions

Sunday, November 30, 2008

WASHINGTON - Recently released guidance on the 36-month oxygen cap may contain a silver lining for providers, at least those with long-term patients.

On pages 846 and 847 of the guidance, Medicare states that, after five years from the day of set up, providers can supply oxygen patients with new equipment and bill Medicare for another three years.

That's music to the ears of Lee Guay, a coordinator for Apex of St. Peters in Helena, Mont. Thanks to the provision, 40 oxygen patients who he thought were capping out Jan. 1 are eligible for new equipment. The patients have been on oxygen for at least six years.

"This is pulling some providers out of the fire," Guay said.

Per the cap, providers can bill only for contents and, twice a year, for routine service and maintenance for patients who have been on oxygen for three years.

Even though the provision is a boost for some providers, it doesn't appear its impact will be far-reaching. Only between 2% to 7% of patients remain on oxygen for five years, industry sources say.

Additionally, there are several caveats to the provision. First of all, providers must still go two years without billing Medicare--the time between the 36-month cap kicking in and the five-year useful lifetime of the equipment ending.

Secondly, beneficiaries must want new equipment.

"People are saying, 'Oh, the provider can do it automatically,'" said Cara Bachenheimer, senior vice president of government relations for Invacare. "But beneficiaries have to make the decision, because they're going to have to start paying a 20% co-pay again."

Lastly, the provision may not be as straightforward as it seems. For example, providers may have to prove equipment is irreparable before supplying new equipment.

"We're telling people to proceed cautiously," said Kelly Riley, director of The MED Group's National Respiratory Network.

At the end of the day, the provision doesn't save the cap from being "a complete mess," industry sources say.

"It continues to be an equipment-based discussion, but that's not what we do," said Gary Sheehan, president and CEO of Cape Medical Supply in Sandwich, Mass. "Do we base the cost of surgery on the tools a surgeon uses to replace a knee? No we don't."

AAHomecare details reform effort
ALEXANDRIA, Va. - AAHomecare sent an update to members last week outlining the type of oxygen reform it will propose to members of Congress early next year. The reform includes eliminating the 36-month oxygen cap and paying for therapy during the entire period of medical need; basing payments on a patient-focused not equipment-focused model; and removing oxygen from national competitive bidding. "To be successful, oxygen reform will require broad support from patients, physicians, providers and Congress," the association stated. "It will require a strong legislative push and enactment into law by the president. The resulting statute will require regulations and the homecare community will need to work with CMS to ensure that the intent of Congress is affirmed in the follow-up regulatory guidance. All of this can happen and will happen if oxygen providers make oxygen reform a priority."

CMS answers questions
BALTIMORE - CMS has posted answers to frequently asked questions about the 36-month oxygen cap. Find the FAQ on the front page of AAHomecare's Web site, www.aahomecare.org, and at www.medicare.gov.