Funding Focus: Perplexing to Providers

Travel Oxygen Programs

• By Kelly Riley
• Oct 01, 2009

Recently, it became mandatory for the Federal Aviation Administration (FAA) and hence, all airlines, to comply with new rules that make for friendlier skies for patients requiring oxygen while in flight. The ruling, passed by the U.S. Department of Transportation (DOT) with an effective date of May 2009, requires airlines to accommodate patients who travel with pre-approved portable oxygen concentrators (POCs). Although the ruling now helps oxygen patients move more freely about the country, the same cannot be said for the suppliers who provide the oxygen and services upon which these patients rely.

During the same month that the DOT ruling went into effect, CMS (via the DME/MACs) posted a transmittal directing providers on how to manage Medicare beneficiaries who travel outside their suppliers’ service areas. The transmittal went so far as to include a “back dated” effective date of January 2009. This was done, CMS explained, to reflect changes due to the MIPPA enactment published in July 2008 with an implementation date of January 2009 for many of its components. The CMS transmittal states in part:

A new payment policy for oxygen became effective on January 1, 2009. This article addresses issues related to short-term travel (e.g., days or weeks) or to temporary relocation (e.g., snowbird) outside of the supplier’s service area.

In this article, the term “oxygen” includes the equipment, contents (if applicable), and all related items and services including, but not limited to accessories, maintenance, and repairs.

The transmittal outlines a provider’s responsibilities based on when in the reimbursement cycle the equipment is being billed. It is divided into provider responsibility during months 1 through 36, and post-36, of Medicare reimbursement. Providers have known for several months the burden they must carry after they receive the final payment at the 36th month. However, this transmittal, as well as other documents released since its issue, has caused quite a stir. The provider responsibility for months 1 through 36 of rental service that is implied by the transmittal indicates that once again, providers have been dealt a blow.

The policy specifies that for those pre cap months the supplier must abide by the following requirements:

• If the beneficiary travels or relocates outside the supplier’s service area, then for the remainder of the rental month for which it billed, the home supplier is required to provide the oxygen itself or arrange for a temporary supplier (non-billing) to provide the oxygen.
• For subsequent rental months that the beneficiary is outside the service area, the home supplier is encouraged to either provide or arrange for the oxygen itself or assist the beneficiary in finding a temporary supplier (billing) in the new location.
• If the home supplier provides oxygen to the patient for use out-of-area or arranges for a temporary supplier (non-billing) to provide the oxygen, the home supplier bills for whatever system the patient is using on the anniversary date/billing date. The supplier may provide the patient with different oxygen equipment (e.g., portable concentrator) for travel, if there is an order from the physician.
• The home supplier may not bill for or be reimbursed by Medicare if it is not providing oxygen or has not arranged for a temporary supplier (non-billing) to provide the oxygen on the anniversary billing date.

Most providers want to support and encourage their patients to maintain active lives, and that often includes travel. However, facilitating travel (especially outside of the supplier’s service area) can be daunting for the provider, both in terms of staff time required to make arrangements as well as added cost for actual product. Current reimbursement by CMS for patients who are ordered to have oxygen provided for ambulation averages a mere $25 to $50, depending on the technology they receive. That amount is quickly depleted, whether by providing cylinders or advanced technology (either a portable oxygen concentrator such as a SeQual, or a transfilling device such as I-fill). Whenever patients travel, company resources are required to:

• Gather and copy or send via fax documents the patient will need
• Ship additional equipment
• Facilitate numerous calls to arrange for another provider willing to provide backup emergency services should equipment failure occur

Many of these processes are required regardless of the size of the HME Company.

“Facilitating travel can be daunting for the provider, both in terms of staff time required to make arrangements as well as added cost for actual product.”

Where We Stand

There is currently an ongoing effort to clarify at least, and eliminate at best, this latest blow to respiratory providers. The American Association for Homecare (AAHC), with input from the associations’ regulatory council, recently sent a letter to the DME/ MAC medical directors and to CMS. The letter states that the policy on travel oxygen imposes an unworkable obligation upon providers, who have no influence or control over beneficiary travel decisions. It further states that the policy represents a significant departure from a longstanding body of policy that holds Medicare beneficiaries responsible for arranging for their oxygen when they travel away from home. The policy is also inconsistent with well-established rules that control billing for “same or similar equipment,” which Medicare does not cover.

As of this writing, the medical directors have responded to AAHC’s letter, and deferred the issue to CMS.

Until this matter is resolved, providers are encouraged to concisely document all conversations with beneficiaries regarding travel, and solidify company policy on this, which includes communicating the policy clearly to all staff.

Given this latest, it remains imperative that all oxygen providers continue to contact their State representatives to garner support for oxygen reform. Removal of the oxygen payment cap would make life easier for patients and providers alike.

This article originally appeared in the Respiratory Management October 2009 issue of HME Business.