AMARILLO, Texas — With all the confusion surrounding CMS' new post-cap oxygen payment rules, it's time for some answers. In a special series for HomeCare Monday, Lisa K. Smith, Esq., an attorney with the Health Care Group at Brown & Fortunato, P.C., a law firm based in Amarillo, Texas, responds to several of home medical equipment providers' most common questions about the new rules.
Question: Does a portable unit take on the exact start date of the stationary system or can the two be unique? The situation is the physician may initially order a stationary system and a few months later the portable is added. Does the portable unit have a unique oxygen cap start/end date (36-month period), or do I start billing for portable contents once the stationary system caps?
Answer: The 36-month cap period for the portable unit will be different from the 36-month cap period for the stationary system if the portable equipment is added at a later date. Once the stationary system caps, the supplier will continue to bill the portable unit as a rental until it reaches the 36-month cap, after which portable contents may be billed if the supplier delivers oxygen content for the portable unit.
Question: CMS states that a portable unit is a regulator, cart, tank, contents and cannulas. How many tanks are reimbursable during a month and what is the reimbursement for the contents?
Answer: The fee schedule amount for portable contents (gas or liquid) is $77.45. The HCPCS codes for oxygen contents are for one month's supply. When billing Medicare for oxygen contents, the quantity to be billed is one unit (one month's supply), and not the number of tanks actually provided. Therefore, Medicare pays $77.45 for all portable contents provided for a one-month period, regardless of the number of tanks provided.
Question: Can the supplier contract with the patient for a 24/7 on-call/emergency service?
Answer: No. In the CMS transmittal issued December 23rd (CR 6297), CMS states: "Following the 36-month cap, the supplier is responsible for furnishing all of the same necessary services associated with furnishing oxygen equipment that were furnished during the 36-month rental period. For example, as required by the Medicare quality standards for respiratory equipment, supplies, and services established in accordance with 1834(a)(20) of the Social Security Act, the supplier shall provide services 24 hours a day, 7 days a week as needed by the beneficiary. Suppliers may not bill beneficiaries separately for these services."
Appendix A to the DMEPOS Quality Standards contains the additional quality standards applicable to respiratory equipment, supplies and services. It states: "The supplier shall provide respiratory services 24 hours a day, 7 days a week as needed by the beneficiary and/or caregiver(s)." Respiratory services are defined as "the provision of home medical equipment and supplies that require technical and professional services" and include oxygen equipment, CPAPs, RADs, IPPBs, home invasive mechanical ventilators and nebulizers.
Lisa K. Smith, who is Board Certified in Health Law by the Texas Board of Legal Specialization, represents HME companies, pharmacies, hospitals and other health care providers throughout the United States. She can be contacted at lsmith@bf-law.com.
