July 8, 2009
New Medicare Oxygen rules have unintended consequences
The Center for Medicare has recently seen issues regarding new rules for Medicare coverage of home oxygen equipment. (See our Medicare Changes for Oxygen Equipment Payment and Maintenance, April 9, 2009). Because, under the new rules, providers are paid for 5 years, but payments are spread over the first three years of use, there have been instances of providers taking back equipment after three years, or attempting to entice beneficiaries into new contracts so that the supplier doesn’t have to honor its commitment under the old one to service the equipment for the required 5 years.An article in the Cleveland Plain Dealer illustrates some of the problems that advocates and beneficiaries are beginning to see:
One company wrote to patients "to inform you that over the next six weeks, [the company] will have to pick up the oxygen equipment you have been using." [They went on to say:] Because of a decision by Medicare, the government's health insurance program for seniors, "you will probably not be able to obtain this type of equipment from any other company." [1]
The threat is misleading, to say the least. While the company does still own the equipment after payments have stopped, they must continue to provide it to the same patients for another two years if medically necessary without additional payment from the beneficiary. Medicare will, however, pay a service fee, no more often than every six-months. See Medicare Changes for Oxygen Equipment Payment and Maintenance.
Another issue, according
to the Plain Dealer article, is that:
Patients who want to change providers, or who have moved, cannot find companies willing to take them. That's because Medicare has already paid one provider for 36 months, so a new provider would not get paid for the remaining two years. [2]
This again, is misleading, and clearly against the rules of the program. The provider who was paid for the first 36 months of service remains responsible for the maintenance and service functions for which the supplier has been paid for the next two years as well. The provider got 36 monthly payments, paying for five years worth of service, and is legally obligated to help find new service - even if it means contracting with and paying another provider.
Any individuals who are refused service should contact the Centers for Medicare & Medicaid Services immediately at 1-800-633-4227.
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[1] Koff, Stephen, "Home oxygen industry trying to change way government pays to provide service to seniors," Cleveland Palin Dealer, July 08, 2009. http://www.cleveland.com/medical/index.ssf/2009/07/home_oxygen_industry_trying_to.html
[2] Id.
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