Solving the Oxygen Qualification Crisis

For the past several years, providers have searched endlessly for a solution to qualifying their oxygen patients. No solution seemed possible until this year, when the Centers for Medicare and Medicaid Services (CMS) approved the use of a home testing system for oxygen.

The system, called Power-Ox, allows the DME provider to deliver an overnight pulse oximetry device to the patient’s home and instruct the patient on its use. The following day, the provider returns to retrieve the device, downloads the results into a Palm Pilot-based system, and has the patient sign an Assignment of Benefit form located on the Palm device. This sends the results, which are encrypted for HIPAA security and to prevent tampering, over the Internet directly to a Medicare-approved Independent Diagnostic Testing Facility (IDTF).

After returning to the office, the provider can access the results from the IDTF’s Web site. The results can be printed immediately and, assuming the patient meets all Medicare requirements, may be used to meet the IDTF requirements to bill Medicare for oxygen.

Of course, the physician must review these results and complete sections B and D of the CMN (certificate of medical necessity). A provider may not bill Medicare until he receives a completed, signed CMN back from the treating physician. The IDTF bills Medicare directly, and the patient is responsible for only the Medicare co-payment.

The testing system was developed by Michigan-based Newco Holdings and is marketed by The Letco Companies. Earlier this year, the two companies demonstrated the product for CMS, after which the agency issued the following statement: “The Power-Ox system does not violate any portion of the Local Medical Review Policy or National Coverage Determination for home oxygen therapy. Test results obtained using Power-Ox are acceptable for qualifying patients for home oxygen therapy.” While The Letco Companies has received three letters from CMS that address various concerns, DME providers should consult with their health care attorney on use of the device.

According to some providers taking advantage of home oxygen testing, their prescriptions for overnight pulse oximetry tests have doubled within their existing physician base. The system allows a 24-hour turnaround from initial testing of an oxygen patient to full set-up and Medicare billing for that same patient — and that is something that none of their competitors offer.

This program, however, may carry both good and bad for the provider. Oxygen therapy has been under CMS scrutiny for some time. The agency would love a method to require quarterly testing for Group I Medicare patients to ensure that only qualified patients receive home oxygen therapy.

In the past, it would have been virtually impossible for CMS to require quarterly testing of patients and for providers to have their patients qualify as requested. However, widespread use of home oxygen testing might just make it easy for CMS to implement such a statute.

Regardless, this system does solve a long-standing problem for all providers of oxygen therapy. Most DME providers experience long waits for a local IDTF — if there is one left — to qualify their patients, and also experience lost revenues since they are unable to bill Medicare until they receive IDTF qualification. Medicare-approved home oxygen testing may be an answer to what has been a seemingly unsolvable problem.

Jane Bunch is president of DMEs of America, a Miami-based holding company, and CEO of Kennesaw, Ga.-based JB&CS, a division of DMEA. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans and serves as a consultant for fraud and abuse cases. She can be reached at 678/445-1221 or via e-mail at [email protected].