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: We are becoming a non-participating provider effective 01/01/09. We have operated under an assigned status for many years. Are we required to honor our assignment status to any existing patients on our service prior to 2009?
Answer: As a participating provider, you are required to accept assignment on all Medicare claims. As a non-participating provider, you can choose whether or not to accept assignment on a claim-by-claim basis. You are not obligated to continue accepting assignment on claims for all your existing Medicare patients. We believe the supplier should give the Medicare beneficiary at least 30 days prior written notice that it will no longer accept assignment on the beneficiary's claims for the specified items or services, in order to allow the beneficiary the opportunity to find another supplier that will accept assignment.
Question: Is there any limit to what a supplier can charge for Medicare-covered items on a non-assigned basis?
Answer: No. The "limiting charge" provisions that prohibit charges in excess of 115% of the Medicare fee schedule do not apply to DMEPOS items provided by a supplier.
Question: After the 36-month cap, can we supply some oxygen contents assigned and some non-assigned during the same month?
Answer: A supplier can choose to accept assignment on oxygen contents for some beneficiaries and not accept assignment for contents on other beneficiaries during the same month. However, if the supplier accepts assignment on oxygen contents for a beneficiary, we believe it is prohibited from billing the patient non-assigned for additional oxygen contents provided during that same month. In other words, if you have accepted assignment for contents for a patient, you have agreed to provide all oxygen contents needed by that patient for the Medicare allowable amount.
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.