Home Health & Hospice Week

CMS raises payment rates slightly for labor HCPCS codes.

Significant political support wasn't enough to stave off a change in Medicare's payment meth-odology for oxygen equipment.

The new payment structure reimburses suppliers for 36 months of oxygen equipment use, but makes them responsible for another two years' worth of service with virtually no payment (see Eli's HCW, Vol. XVII, No. 41, p. 325).

Ninety-eight members of the U.S. House of Representatives signed a letter to the Centers for Medicare & Medicaid Services urging a delay of the oxygen rule, reports the American Association for Homecare. The letter sent to CMS detailed the problems with the new policy, including no reimbursement for emergency services and inadequate reimbursement for routine maintenance.

In another letter, seven Republican U.S. senators also urged CMS head Kerry Weems to delay the rule, according to the National Association of Independent Medical Equipment Suppliers. "Home oxygen providers are more than just suppliers of equipment, they are also caregivers," the letter said. "They educate patients on the proper use of their equipment, answer patients' questions, make repairs and adjustments and ensure that patients are receiving the correct amount of oxygen."

"Without the help of Congress, and a delay by the government, oxygen providers will be facing unreasonable requirements and inadequate reimbursement which jeopardizes access to care," warns AAHomecare's Tyler Wilson in a release.

Despite CMS's recent assurances in the press (see Eli's HCW, Vol. 44-45, p. 355), oxygen patients continue to be worried about their access. Abilene, Texas resident Charlotte Felix, who has been using oxygen for 13 years, is one such beneficiary, reports Scripps Howard News Service. Felix is worried she'll lose her benefit under the restrictive new payment methodology.

Patients are "afraid that the quality of service that they receive is going to be affected," Pat McElrath, director at Hendrick Medical Supply, told the newspaper. Hendrick furnishes Felix's oxygen. "And since they depend on the oxygen to breathe, they're afraid they're going to be left in an emergency situation because of the lack of reimbursement for emergency service."

Meanwhile, CMS issued billing details about the payment change at the eleventh hour. CMS will eliminate former DME billing modifier RP and replace it with two new modifiers -- RA for replacement of a DME item and RB for replacement of a DME item part furnished as part of a repair, the agency explains in Dec. 23 CR 6297 (Transmittal No. 421).

"Suppliers should use the new RA modifier on DMEPOS claims to denote instances where an item is furnished as a replacement for the same item which has been lost, stolen or irreparably damaged," CMS instructs in the transmittal. "In contrast, the new RB modifier should be used on a DMEPOS claim to indicate replacement parts of a DMEPOS item (base equipment/device) furnished as part of the service of repairing the DMEPOS item (base equipment/device)."

The transmittal also includes a list of 16 codes for oxygen-related supplies that won't be paid after the 36th rental month. "The supplier who received payment for furnishing the oxygen and oxygen equipment during the 36-month rental period is responsible for continuing to furnish any accessories and supplies necessary for the effective use of the equipment for any period of medical need following the 36-month rental cap for the remainder of the reasonable useful lifetime of the equipment," CMS stresses. CMS has said that lifetime is defined as five years.

Higher rates: CMS has relented a little bit on oxygen labor rates. It has increased rates for E1340, L4205, and L7520 to take into account inflation updates that failed to be applied previously, the agency says in the transmittal. It also brought rates below the national median up to the median level.

CMS sets out each state's rates, in 15-minute units, in a chart in the transmittal online at www.cms.hhs.gov/transmittals/downloads/R421OTN.pdf. A MLN Matters article on the topic is at www.cms.hhs.gov/mlnmattersarticles/downloads/MM6297.pdf.