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Understanding Medicare Oxygen changes eff April 1st!

 

Understanding the layers of changes being made by CMS to Oxygen Billing for Medicare Beneficiaries is no easy task. We've broken down the important changes we think you need to know below. The primary change is that all of this below is controlled by Modifiers, but we've sorted them into three topics:

 

TOPIC 1: Changes to High & Low Supply

Effective April 1st, Medicare reimbursement will be impacted by a patient's liter flow. Specifically, those patient's that need Less than 1 LPM or those that need Greater than 4 LPM and when Portable Oxygen is added, below explains the new standards:

NOTE: the middle situation described above is a setting that has existing in the Payer Types table of HDMS for some time, on the General tab, "Oxygen bill 50% more for LPM > 4.

TOPIC 2: Changes to Daytime Rest vs. Nighttime Liter Flows

Effective April 1st, Medicare will also address with modifiers situations where patient's activity levels require different liter flow. They indicate the following will be true:

 

TOPIC 3: Coping with multiple liter flows & Question 5

There are many cases where patients are prescribed different liter flows for different activity levels, but the DMERC CMN does not allow for this information, nor will CMN pay for varying rates. Below is how CMS has instructed Providers to prescribe & report on these situations.

There is also a large movement in the industry questioning CMS because they feel to advise a physician on how to answer Question 5 of the DMERC CMN, or potentially put an average or lesser liter flow would tantamount to falsifying the document. Be on the look out for our partners AAHomecare to continue sharing updates with the community as they rally on The Hill next week.

 

We recommend you continue as you currently have, adding Oxygen modifiers to your Oxygen CMN's with Payer Type settings to apply CMN Modifiers to claims.

I'd like to thank our contributors & supports both in our Clients & Partners like PGI, HCRS, EBS, andĀ  AAHomecare!

Resources:

DMD Response - Buhrmester_Oxygen CMN Q5 - 3-16-18 MLN Matters NumberĀ  MN10158