Repercussions sink in
Shell-shocked providers spent the first days of November picking through the rubble of what is left of Medicare oxygen reimbursement.
Providers had been waiting for guidance on the 36-month oxygen cap for most of the year, but even those who said they were prepared for the worst were stunned.
“We are expected to take care of these patients whenever they want us to for free,” said Joan Cross, co-owner of Bradenton, Fla.-based C&C Medical Services, who estimates about 50% of her patients will cap out Jan. 1. “I can’t afford to do that.”
Providers must stop billing Medicare for oxygen patients who cap out Jan. 1, but they must continue providing supplies, accessories and repairs, as well as emergency services. Medicare will continue paying for oxygen contents (liquid or gas) and for routine, in-home service and maintenance once every six months. It will not pay for supplies, such as tubing, cannulas and water bottles.
Provider Julie Weidemann says she typically changes tubing every month and cannulas every week, which costs her $5 to $7 per month, not including labor or travel. After the cap, Wiedemann says she may have to cut back-a bad thing for patients.
“You’ll see increased infections and ER visits,” said Weidemann, director of Palmer Home Medical Equipment in West Union, Iowa, who estimates about 20% of her oxygen patients will cap out Jan. 1.
Repairs to oxygen equipment are infrequent, but when they’re necessary, they’re usually expensive, says provider Gary Sheehan.
“It never breaks at noon on Wednesday,” said Sheehan, owner of Cape Medical Supply in Sandwich, Mass. “It breaks at 3 a.m. on Sunday. Forget my cost to repair it. It’s about paying (the technician) time-and-a-half Equipment in West Union, Iowa, says they typically change tubing every month and cannulas every week, at a cost of $5 to $7 per month-that’s her acquisition cost and doesn’t include any labor or travel. Wiedmann, who says about 20% of her oxygen patients will cap out next month, says she may have to cut back-a bad thing for the patient.
“If we’ve got to provide that for free, you’ll see increased infections and ER visits,” she said.
The lack of payment for repairs is frustrating, but most providers say oxygen equipment is pretty sturdy. The time involved for repairs-and false alarms from anxious patients-is far more costly.
“Repairs are infrequent, but it never breaks at noon on Wednesday,” aid Gary Sheehan, owner of Cape Medical Supply in Sandwich, Mass. “It breaks at 3 a.m. on Sunday. Forget my cost to repair it. It’s about paying (the technician) time-and-a-half and the cost of gas.”
Providers can bill for a 30-minute routine maintenance visit every six months, but many providers say they do more. Unanswered is how to handle it when a beneficiary requests more frequent maintenance.
“Can we legally bill for that?” asks Weidemann.
One of the biggest concerns for providers is CMS’s stance that it is the original provider’s responsibility to arrange for service when a patient moves from their service area. In the months leading up to the cap, many have encountered difficulty finding providers willing to accept patients with less than a year left on their benefit.
That policy discriminates against the patients of local providers, says provider Scott Lloyd, president of Norcross, Ga.-based Extracare.
“If a beneficiary is the patient of a national and moves from Atlanta to Albuquerque, there’s a good chance the national can still service them,” he said. “It’s challenging for smaller providers to arrange that. It’s the patient who is the loser.”
Overall, the new rules highlight the continuing disconnect between the value providers say they offer and how CMS views them, says Anthony Ellis, president of Ellis Home Oxygen in Pulaski, West Virginia.
“I think they think it’s like walking outside and breathing the air,” he said. “They don’t understand it’s a machine along with our services.”