When you think the need for oxygen arises, it is important to discuss with your doctor the benefits of oxygen therapy. If you doctor feels that you would benefit from oxygen therapy and writes a prescription for it, the most popular question becomes: Does Medicare pay for it? While you and your family may be experienced when it comes to Medicare and how it works, sometimes receiving services in the Durable Medical Equipment field can be difficult.
Medicare considers Oxygen Therapy a “Capped Rental”. A Capped Rental is an item or service that is rented for a specific amount of time and serviced for an additional amount of time. For oxygen, the Capped Rental process is for a five year period. During the first three years, the Durable Medical Equipment supplier receives payment for their services. During the final two years, the Durable Medical Equipment supplier does not receive payment for their services, but they are still fully responsible for maintenance and supplies. During the capped rental period, you are not able to switch providers.
In the information provided below, it will outline the requirements for oxygen services and how to get Medicare to pay for it:
Step 1: Consult your doctor about your need for Oxygen Therapy
If you are experiencing shortness of breath or difficulty breathing, you should discuss with your doctor the issues you are experiencing.
Step 2: Have your doctor test your oxygen level. If you only need oxygen at night, then an overnight pulse oximetry will need to be completed. If you also need portable oxygen during the day, then you will need a 6 minute walk test.
An overnight pulse oximetry is a test in which you wear a device on your finger that records your oxygen level while you sleep.
A 6 minute walk test is completed in the doctor’s office or as an outpatient at the hospital. The test begins with no oxygen applied. Once you begin walking, if your oxygen saturation drops below 88%, the test will be paused and oxygen will be applied. Once your oxygen saturation returns to normal and the 6 minutes are over, the test is complete. The person administering the test will record your oxygen saturation at the beginning of the test (often called the baseline), when you drop below 88%, and the oxygen saturation at the end of the test with oxygen applied.
If your oxygen saturation drops below 88% during the test, then you qualify for oxygen.
Step 3: The Durable Medical Equipment (DME) provider of your choice will contact you and let you know that you qualified, and that the paperwork required is being sent to your doctor for him/her to complete.
Once the DME provider receives the results of the test, along with a prescription from your doctor, they will begin the paperwork process required by Medicare.
A Certificate of Medical Necessity (CMN) is a form created by Medicare for suppliers and providers to complete. The current form for oxygen services is the CMS-484.
A Detailed Written Order is required prior to delivery for portable oxygen only. It must state the doctor’s name, your name, the date of the order and start date, detailed description of the item or service, and the doctor’s signature and signature date.
Chart notes are required for all oxygen services. The treating doctor must send over a copy of the chart notes from the office visit in which you discussed oxygen therapy (See Step 1).
Step 4: Once the paperwork is complete, the DME provider will contact you and schedule a time to deliver your oxygen equipment and supplies.
Oxygen, along with all other DME products, is billed through Medicare Part B. Remember that this is different from your normal prescriptions, which are billed through Medicare Part D. Medicare pays 80% of the allowed amount for an item with the remaining 20% being the patient’s responsibility. If you have a Secondary Insurance that picks up your co-pays, then you may not owe anything for your oxygen services. Always talk to your DME supplier about any co-pay or financial questions pertaining to your DME services.
After one year of oxygen therapy, you will be required to complete steps 1-4 again, which will demonstrate the continued need for oxygen. Your DME supplier will be in contact with you during this process. After the 5 year period, the entire process will begin again.
NOTE: If you qualify for oxygen while you are in the hospital or nursing home, once you are discharged you have 30 days to complete steps 2-4 in the above process. Medicare requires a recertification within 30 days of discharge that shows the continued need for oxygen services.
For additional information, you may refer to the National Government Services website for more information about oxygen services. National Government Services only represents Jurisdiction B of the Medicare DME Service Area. The states included in Jurisdiction B are: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin. For other states, please refer to the Medicare.gov website.
National Government Services policies for Oxygen Services:
Medicare.gov Website: http://www.medicare.gov
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