Medicare Compliance & Reimbursement

Still no details on oxygen maintenance and service payments.

New rules for home medical equipment rentals in the Deficit Reduction Act raise more questions than they answer, some suppliers criticize.

The legislation, which President Bush signed into law on Feb. 8, shortens by two months the length of time Medicare will make rental payments on items already in the capped rental category. The law also introduces a 36-month cap on oxygen equipment rentals.

But the Centers for Medicare & Medicaid Services has yet to define exactly how it will implement these changes. For example, Medicare will pay for maintenance and service that CMS determines to be "reasonable and necessary," reports the American Association for Homecare on its Web site. Yet CMS hasn't set the details and payment amounts.

The lack of detailed instructions is frustrating, says Lyn Kaman with Fox Medical Equipment Services Inc. in Collinsville, IL. "You're in a place where you want real information and it's difficult to get."

Flushing out all the questions that need answers is going to take time, says Tom Williams of Strategic Dynamics Inc. in Scottsdale, AZ. The best way to get started is to work with national and state HME associations to define the questions before turning to the government for answers, he says.

AAHomecare recently added some questions and answers about the DRA and its impact on capped rental HME and home oxygen to its Web site. Some points to note:

• Beneficiaries no longer have the option to rent HME in the current capped-rental payment category after Medicare stops paying for the rental. Medicare will make rental payments for a period of medical necessity not to exceed 13 months after which the equipment belongs to the beneficiary.

• The monthly fee schedule amount for items in the current capped-rentals payment category remains the same, but the payment period decreased from 15 months to 13 months.

• Benes using capped-rental equipment before Jan. 1 are "grandfathered" under the current capped-rental reimbursement method. The new requirements apply to equipment benes first rented on or after Jan. 1.

• Effective Jan. 1, Medicare payment for oxygen equipment rentals is limited to 36 months. After 36 months, the equipment belongs to the beneficiary.

• Medicare will continue to pay for oxygen for patients with a medical need, even after their oxygen equipment rentals cap out.

• Medicare will continue to make monthly payments for oxygen equipment for an additional 36 months beginning Jan. 1 for benes who were receiving home oxygen on Dec. 31, 2005 or before.

To view the complete Q&A, go to www.aahomecare.org/displaycommon.cfm?an=1&subarticlenbr=230.