Your Post-Cap O2 Questions Asked and Answered (Part 3)

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 [email protected].