Monday, May 11, 2009

ATLANTA — On Thursday, the DME MACs issued an article on travel oxygen related to short-term travel (days or weeks) and temporary relocation, such as for snowbirds.

Under a new payment policy for oxygen effective Jan. 1, the article notes, if a beneficiary travels or relocates outside the provider's service area, "then for the remainder of the rental month for which it billed, the home supplier is required to provide the oxygen itself or arrange for a temporary supplier (non-billing) to provide the oxygen."

"Historically, providers weren't responsible for providing travel oxygen, and the patient had to make arrangements for that or pay on their own," according to Lisa Smith, a health care attorney with Brown & Fortunato, Amarillo, Texas. "This is definitely changing that picture.

"If you have provided oxygen for a patient during a month Medicare pays for it, then you're going to be required to provide travel oxygen as well."

Additional requirements for home providers:


  • For subsequent rental months that the beneficiary is outside the service area, the home supplier is encouraged to either provide or arrange for the oxygen itself or assist the beneficiary in finding a temporary supplier (billing) in the new location.
  • If the home supplier provides oxygen to the patient for use out-of-area or arranges for a temporary supplier (non-billing) to provide the oxygen, the home supplier bills for whatever system the patient is using on the anniversary date/billing date. The supplier may provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
  • The home supplier may not bill for or be reimbursed by Medicare if it is not providing oxygen or has not arranged for a temporary supplier (non-billing) to provide the oxygen on the anniversary billing date.

Requirements for temporary providers:

  • If it is during a month in which the home supplier has not billed Medicare, claims from the temporary supplier (billing) would be paid, if all coverage criteria and payment rules are met.
  • If it is during a month in which the home supplier has billed Medicare and it is not provided under an arrangement with the home supplier, then the claim from the temporary supplier (billing) will be denied as not medically necessary, if it bills Medicare.
  • If the beneficiary returns home before the end of a rental month for which the temporary supplier (billing) has billed, it must provide oxygen itself for the entirety of that month or make arrangements with the home supplier to provide the oxygen.
  • The temporary supplier (billing) must provide a copy of a valid CMN, an order (if the order information was not included on the CMN), a report of the qualifying blood gas study, and documentation of any required physician visit, if requested.

The article also gives instructions for providing oxygen in months 37 through 60:

  • The supplier providing oxygen to the patient during the 36th month is required to provide oxygen to the patient either directly or under arrangements with a temporary supplier (non-billing) for beneficiary use out-of-area.
  • The home supplier could provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
  • The supplier would not submit a claim for that equipment (because it is required to continue to provide equipment after the 36 month cap).
  • If the beneficiary had a gaseous or liquid system during the 36th month and the supplier was providing contents to the patient during months 37-60, it may only bill and will only be reimbursed for contents if the patient was using contents at some time during the billed month. It may not bill for contents if, for example, the beneficiary was using a portable concentrator during the entire month.

Smith, who recently authored a Q&A series on the 36-month oxygen cap and post-cap payment rules for HomeCare Monday, said she is asking CMS for clarification on billing for travel oxygen and other points in the MACs' new instruction.

But one frustrated oxygen provider said the gist of the article is all too familiar: "It's one more thing that doesn't fix anything," said Bill Baker, RRT, of RxO2 in Tucson, Ariz. "It makes it worse. Nobody is going to touch a traveler. It's too much trouble."

Read the full travel oxygen article on the Jurisdiction C (Cigna) Web site.