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.