Medicare Compliance & Reimbursement

Previously paid claims will not be retro-adjusted.

Oxygen suppliers who were holding their breath while waiting for the new Medicare rates can exhale now.

Though many suppliers will be paid less for their oxygen wares, the cuts won't be as drastic as some durable medical equipment industry insiders had feared.

The HHS Office of Inspector General has released its long-awaited report comparing Medicare and Federal Employee Health Benefit Plan rates for home oxygen equipment. The OIG concluded that FEHBPs' median payment rates are 12.4 percent lower than Medicare for stationary equipment and 10.8 percent lower for portable equipment.

The greatest disparity in payment rates was for oxygen concentrators, with Medicare paying on median 12.6 percent more than FEHBPs. The Centers for Medicare and Medicaid Services will now bring the Medicare rates in line with FEHBP rates.

Minus: At press time, Medicare contractors planned to implement the cuts by April 8. All claims for oxygen and oxygen equipment furnished on or after Jan. 1, 2005 that contractors receive after CMS implements the new fees will be paid using the 2005 fee schedule amounts, according to CMS.

Plus: Contractors will not retroactively adjust claims with dates of service on or after Jan. 1 that were previously paid using the 2004 fee schedule amounts.

The same day that the OIG released its report, CMS published a state-by-state listing of new fee schedule amounts calculated based on the information in the OIG report. The new monthly payment amounts for stationary oxygen equipment in the states range from $194.48 to $200.41 and from $30.57 to $32.08 for portable equipment. Providers in states with the highest Medicare fees will suffer the sharpest cuts. Hawaii, for example, faces a 25 percent cut for stationary oxygen and a 28 percent cut for portable systems, while New York got a 12 percent cut on stationary systems and a 10 percent cut for portables.

Payment reductions are smaller in states where current fees are closer to the FEHBP median, while states with fees already at or below the FEHBP median price will see no changes.