Oxygen Users and Suppliers Have Many Questions

January 1, 2009 has come and gone and the 36-month cap is here. If you were using an oxygen concentra- tor on January 1, 2006, your oxygen provider is no longer getting reimbursed by Centers for Medicare and Medicaid Services (CMS) for the equipment. Both oxygen users and suppliers have a lot of questions! Because providers own the equipment, they are expected to service it. CMS will not pay for parts or for non-routine service calls.

Shirley from New Mexico writes, “My company tells me that they will no longer make weekly deliveries of oxygen tanks, only monthly. They will not provide any more tanks than are already in our possession (which, generally, is a week’s supply.) If more are needed, we will need to drive to their office. It is hard to see how some will manage it. Suppliers give all kinds of reasons why they can’t (or won’t) supply the liquid oxygen the doctor ordered. We are looking to organizations such as yours to present the facts carefully and understand- ably to us so that we know what we can reasonably ask for or expect regarding oxygen service.”

For answers, we turned to Wayne Knewasser, Vice President Public Relations/Government Affairs at Premier Home Care Inc. in Louisville, KY. Wayne sent us the following questions and answers straight from CMM. He explains, “Suppliers can not switch out equipment without a doctor’s order or a signed form by the patient that they no longer want to have that type of equipment in their home. The suppliers have to main- tain the current level of services they provided prior to the 36-month cap. This includes portable systems and quantity used. CMS will pay suppliers approximately $77/month, regardless of quantity used. CMS is still answering our questions. This causes confusion with the suppliers as to how to answer their customers’ questions and comply with the new rules.

The supplier was paid approximately $160/month by CMS for an oxygen concentrator (80% of $200). On January 1, 2009, there was a scheduled 9.5% cut, so that figure is now lower. When deciding payment, CMS did not take into consideration, the service, education and other supplies that go into oxygen therapy. The oxygen equipment is only a part of the big picture.”

Just when you think you could not be more confused! Wayne tells us that oxygen suppliers will be checking each of their client’s history. On January 1, 2009, if they have been on oxygen therapy with their company, not just three but for five years, which is what CMS has determined to be the equipment’s useful life, the 36- month cap starts anew. The oxygen user will receive another concentrator – not necessarily a brand new concentrator – just one that they have never had before. At this time, the oxygen user will have to sign on again with their oxygen supplier.