Questions linger as cap kick starts

Saturday, January 31, 2009

WASHINGTON--CMS released additional guidance on the 36-month oxygen cap on Dec. 23, but it did little to assuage providers, particularly about how to bill for contents.

Lingering questions left providers like Lee Guay worried about their ability to comply with the cap, even as it kicked in Jan. 1.

“With competitive bidding delayed, I feel like this is their new way of wiping some of us out,” said Guay, a coordinator for Apex of St. Peter’s Home Medical in Helena, Mont. “I would have thought we would have had more of this resolved by now.”

Transmittal R421OTN and MLN Matters article MM6297 were more notable for the information they lacked than the information they included, providers and industry stakeholders said. In general, they provided an overview of codes and modifiers, as well as payment rates.

The week before the cap kicked in, providers grumbled loudest about a section in the documents about oxygen contents. Post-cap, providers can bill monthly for contents (liquid or gas). The transmittal and MLN article advise providers to use codes E0441 through E0444.

The problem: Contents aren’t always provided monthly, providers and industry stakeholders said. For example, a provider may provide a two-month supply of contents on the 29th of month 1 and not provide them again until the 2nd of month 3. If the provider doesn’t have proof of delivery for month 2, can he still bill for months 1 through 3?

Adding insult to injury, the MLN Matters article goes on to state: “Instructions regarding claims for oxygen contents will be provided in a separate transmittal/change request (CR 6296) that will be issued as part of the April 2009 release.”

“When you see a statement like that, you wonder, ‘What could possibly be in store next?’” said Walt Gorski, vice president of government affairs for AAHomecare.

In late December, providers also griped about the five-year useful lifetime provision. CMS officials have indicated that providers can start a new 36-month cycle after five years if patients elect to get new equipment, but providers aren’t sure about the “mechanics” of restarting a cycle, stakeholders said.