Providers, CMS officials debate new maintenance rules for oxygen

Wednesday, April 14, 2010

BALTIMORE - Providers feel that if they're required to go to a patient's house in the first month to check on oxygen equipment, they should be able to bill Medicare for maintenance and service. But CMS officials say, not so fast.

"In the regulations now for many years, there has been a prohibition that it's not reasonable and necessary to pay for maintenance and service of DME that's covered under a manufacturer's warranty," said CMS official Joel Kaiser during an April 14 Open Door Forum. " To the extent that there's a warranty, Medicare would not pay for that and the supplier should not bill for that."

The debate stems over Change Request 6792, which states that on or after July 1, 2010, providers can bill CMS a maintenance and service fee of $66 every six months, starting either six months after the 36-month rental period or when the item is no longer covered under the manufacturer's warranty. It also states that providers must make an initial visit in the first month of the six-month period.

But provider Laraine Forry wants to know: What do warranties have to do with anything?

"The intent of the warranty is typically parts--labor is not covered," she said. "This is a requirement that the provider sees the patient in the first month of the six month period to check the equipment and that's not normally a warranty (item). I don't understand why you can't bill for the maintenance and service fee if you are required to be there."

Also during the forum, CMS officials discussed bundling payments for certain DME supplies for patients who are currently under the care of a home health agency (HHA). For those patients, Medicare pays the home health agency a "bundled fee" and the DME provider must seek payment from the HHA. DME providers can access an electronic inquiry system to obtain information about patients having a "home health episode."

CMS officials stated that all parties bear some responsibility: DME providers should ask patients if they are currently under an HHA's care and HHAs should inquire about where the patient has obtained supplies.