Your Post-Cap O2 Questions Asked and Answered (Part 4)

AMARILLO, Texas — With all the confusion surrounding CMS’
new post-cap oxygen payment rules, it’s time for some answers. In a
special series for HomeCare Monday, Lisa K. Smith, Esq.,
an attorney with the Health Care Group at Brown & Fortunato, P.C., a law
firm based in Amarillo, Texas, responds to several of home medical
equipment providers’ most common questions about the new rules.

Question: When billing for oxygen contents after the
36-month cap period, can the supplier bill for a month’s content if
it did not make a delivery in that month? In other words, can a
supplier deliver oxygen contents for multiple months at one time
and then bill for contents for each of those months?

Answer: Yes, the supplier is not required to
deliver oxygen contents during the month in order to bill for
contents for that month, so long as the supplier delivered oxygen
contents for that month at an earlier date. For example, a supplier
can deliver a three months supply of portable tanks on Jan. 15, and
then submit monthly claims for portable contents with dates of
service of Jan. 15, Feb. 15 and March 15.

Question: What are the logistics for providing
replacement equipment after the end of the five-year useful life
period? What documentation is required? Will the patient need to
see the physician, and is a new CMN required?

Answer: Unfortunately, we are still waiting on
guidance from CMS that will provide instructions related to
starting a new 36-month cap period at the expiration of the
five-year useful life. CMS has repeatedly said that the
instructions will be coming out soon. Providers who want to monitor
the release of CMS instructions can view them at www.cms.hhs.gov/Transmittals/2009Trans/list.asp.

Question: If the patient chooses not to obtain
replacement equipment at the end of the five-year useful life, does
the supplier have the option of picking up the oxygen equipment?
Would a DC order or AMA be required?

Answer: Yes. The supplier’s obligation to
provide the oxygen equipment ceases at the expiration of the
equipment’s five-year useful life, but we recommend that a supplier
only pick up oxygen equipment if the patient has made arrangements
for equipment with another supplier, or the supplier has obtained a
DC order signed by the patient’s physician or had the patient sign
a statement acknowledging that the supplier is entitled to pick up
the oxygen equipment and the patient’s choice not to obtain other
oxygen equipment is against medical advice.

Lisa K. Smith, who is Board Certified in Health Law by the
Texas Board of Legal Specialization, represents HME companies,
pharmacies, hospitals and other health care providers throughout
the United States. She can be contacted at [email protected].