Watch Those Emails: Oxygen Info Could Come This Week

MIAMI–According to CMS’ Joel Kaiser, deputy director of
DMEPOS policy, the agency may begin providing guidance on capped
oxygen service, maintenance and replacement by Oct. 31.

In preparation for a Medtrade session on the oxygen rule changes
he will conduct at Medtrade this week, Rob Brant, president of the
Accredited Medical Equipment Providers of America, contacted Kaiser
to ask when providers could expect answers to questions surrounding
the impending cap.

Kaiser’s response in an Oct. 21 email: “We fully expect to begin
providing guidance by the end of the month. I cannot make any
guarantees or provide further details at this time.”

For months, oxygen stakeholders have asked CMS to address
providers’ concerns about the 36-month oxygen rental cap,
which is scheduled to take effect Jan. 1.

The cap was imposed by the Deficit Reduction Act of 2005, which
also required that ownership of oxygen equipment transfer to
beneficiaries after 36 months of rental. The title transfer was
eliminated by the Medicare Improvements for Patients and Providers
Act of 2008, but the rental cap remains. Under the new law,
providers will maintain ownership of the equipment for its useful
lifetime (five years), but CMS has yet to address how service and
maintenance will be paid after the equipment has capped. Numerous
other questions also remain.

According to Brant, general manager of Miami-based City Medical
Services, some have speculated that not releasing guidance until
the last day of the month “may be a way to lock in companies
to provide maintenance and service after the oxygen caps out at 36
months.

“Prior to 2006, if a patient chose the rental option for
capping equipment, the provider who accepted the final three months
of reimbursement would be locked into providing maintenance and
service to the beneficiary. The provider would receive a single
monthly reimbursement payment for continued maintenance, seven
months after the equipment caps out and once every six months
thereafter.

“If guidance is released on Oct. 31,” Brant
explained, “most providers would have already finished
billing for the equipment on that 34th month, one of the final
three months of the cap rental. Unfortunately, Mr. Kaiser could not
address this scenario as the rules have not been
finalized.”

One thing Kaiser did address, however, is the issue of changing
beneficiaries’ assignment.

“One of the worst fears providers have is taking
tremendous losses on patients who demand frequent visits for
service and oxygen refills,” Brant said. “I discussed a
scenario with Mr. Kaiser in which a non-participating provider has
been billing Medicare on behalf of the patient continuously for
months and then decides to tell the patient that they are no longer
accepting Medicare assignment for that individual.

“In other words, can you tell the patient that although we
are about to begin the 35th month of billing, we are no longer
accepting Medicare assignment on your equipment. The patient would
then have the option to pay out of pocket for the equipment and if
the patient refuses the provider could pick-up the
equipment.”

In a separate email, Kaiser confirmed that Medicare assignment
is decided on a claim-by-claim basis.

“He was also kind enough to send chapter and verse of the
rule,” Brant said, noting Kaiser directed him to Section
30.3.2 of Chapter 1 of the Medicare Claims Processing Manual (Pub.
100-4). Section 1842(b)(3)(B)(i) and (ii) of the Act and 42 CFR
424.55 of CMS’ regulations are the legal citations for
assignment.

Brant said the same scenario could also apply to refills of
oxygen tanks and liquid oxygen when the portable oxygen systems cap
in 2009.

Brant will expand on his conversation with Kaiser and lead a
panel discussion examining other issues regarding breaks in
service, changes in payer source, beneficiary travel and more about
the cap in a Medtrade session called “Help, I Can’t
Breathe–Surviving the Oxygen Cap” on Wednesday from 7:30 to
8:30 a.m. at the Georgia World Congress Center.

For information, visit www.medtrade.com.