Providers Question Oxygen Maintenance Rules, HHA Payments Collection

BALTIMORE — The thrust of CMS’ Open Door Call April 14 might have been hospice and home health agencies, but officials were peppered with questions regarding home oxygen, competitive bidding financial standards and how to get HHAs to pay for home medical equipment.

Why won’t CMS pay for maintenance and service for home oxygen equipment that is under warranty, asked two callers from HME companies.

“This is a long, long-standing regulation,” replied Joel Kaiser, DMEPOS policy director. “We can pay for reasonable maintenance and servicing to the extent that it is not covered by warranty.”

“Typically, the manufacturer warranties … for parts and service is not covered,” caller Laraine Forry of Pennsylvania pointed out, adding that CMS regulations stipulate that providers must visit a patient during the first month of the six-month billing period. “If you are required to be there, why can’t you bill for maintenance or service done during that visit?”

Responded Kaiser, “I’ve been told by oxygen suppliers in the past that they don’t do any repairs on oxygen equipment. They send it to the manufacturer and they do the repairs … That leads me to think that there are manufacturers out there that do offer a full warranty.”

Under a final rule that takes effect July 1, CMS will make a single maintenance and servicing payment of $66 once every six months. The rule also requires the provider to visit the beneficiary’s home during the first month of each six-month period, but Forry also questioned the reasonableness of that requirement. Snowstorms, patients who go into the hospital and other situations can prevent providers from seeing those patients, she said.

“One of the things we wanted to ensure was that suppliers were going out routinely,” Kaiser responded. “We wanted to ensure there was a regular check on the equipment; that’s why there is a first-month requirement for a visit … All I can tell you is that this is the policy.”

However, he added, others have brought up the question to CMS, and the agency is “working to develop the policy guidelines to address those situations.”

HME providers also questioned how to get HHAs to pay them for medical equipment, as they are mandated by law to do when a home health agency steps into the care picture.

Officials emphasized repeatedly on the call that for beneficiaries receiving home health services, CMS can only make a “bundled payment” for furnishing all home health services, including for medical supplies.

“The HHA has the responsibility for coordinating the care,” a CMS representative said. “But the provider needs to ask the right questions and properly notify the beneficiary.”

The “right questions” include whether the patient is receiving home health services. HME providers can also check to see if a patient has had a “home health episode” through an electronic inquiry system.

But one HME provider pointed out that none of this guarantees the HME provider won’t be left holding the bag for payment.
“This is fine, but it is after the fact of our care. So we’re out on a limb,” said a caller. “Isn’t there something that can be put into place to protect the DME supplier up front?”

“It certainly points to the fact that better communication needs to occur,” the CMS official responded.

Another caller’s question supported that notion.

“We have trouble with HHAs who do not think things are bundled service,” reported a Minnesota provider.

“We’ll try to communicate that this is the HHA’s responsibility,” said the CMS official.

In a throwback to an Open Door call March 10, Bruce Levinson of the Center for Regulatory Effectiveness, a watchdog organization based in Washington, called in again to gain some information from CMS on financial standards for bidders in the DMEPOS competitive bidding project.

“I asked when CMS would specify the financial standards for competitive bidding,” Levinson said, referencing his question on the previous call. “On that call, I was told to email my questions to CMS, which I did that afternoon … When will my question from last month be answered?”

Kaiser said CMS has released information on financial standards for competitive bidding. He said bidders were required to submit financial documents to CMS when they entered their bids and that CMS will also obtain a credit report on each bidder.

“A lot has been released on that,” he said, noting that the first scoring threshold based on that information would be “to determine if [the bidder] can be awarded a contract at all and the second is whether they can accept it.”

However, at least one aspect of the financial standards remains a secret.

“One thing we haven’t revealed is the release of the various scoring thresholds which could be manipulated by bidders and threaten the integrity of the program,” Kaiser said.