Oxygen update: Policy simplifies billing, audits complicate documentation

Thursday, May 5, 2011

BALTIMORE - A change to Medicare's reasonable useful lifetime (RUL) policy for oxygen equipment could turn out to be a good thing for providers, says industry consultant Andrea Stark.

Under the change, effective May 8, in cases where a patient uses both stationery and portable oxygen concentrators, providers will now be able to re-start billing for both once the 60-month RUL for the stationery concentrator is up. That's even though, in many cases, the portable has not yet reached its RUL.

"This allows us to synchronize everything under one administrative document," said Stark, a reimbursement consultant with MiraVista in Columbia, S.C. "(Before this), when we added portable oxygen, we had to go out and get a revised CMN. Under the new rule, once we reach the RUL, we are able to get one CMN and restart both items on the same date."

In other oxygen news, auditors are really hammering down on oxygen claims, says Kelly Riley, director of the MED Group's National Respiratory Network. Medicare wants to see "need and use" clearly documented in the patient's medical record. Riley's advice?

"Have a clinical person go through the medical records and highlight, if you will, all of the cardiopulmonary drugs the patient has been on (and failed) and look at the dates," said Riley. "Pull the dots together for the auditors and actually show them those things are in place."

Riley also advises providers to make sure oxygen is always included in the patient's medication list, just like any other prescribed drug. That, she said, shows continued use, a requirement for payment.