Your Post-Cap O2 Questions Asked and Answered (Part 2)

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 [email protected].