New Medicare Laws May Affect Your Access to Home Oxygen Equipment
My 96-year-old father has had pneumonia 7 times! That is just one of the medical conditions that can result in the pulmonary fibrosis he suffers from now. Because of the condition of his lungs, Dad requires supplemental oxygen 24/7. He has a concentrator that provides oxygen in his room, and he must take a portable oxygen bottle with him whenever he goes more than 50 feet from the concentrator. The refillable bottles must be constantly rotated on to and off of the self-fill portion of the system.
Pulmonary fibrosis is just one lung disease that can require constant or occasional oxygen therapy. One you might hear more about is COPD, a group of lung diseases that includes emphysema, chronic bronchitis, and in some cases asthma. In older people, especially those with memory problems, oxygen use must be closely monitored. Many patients strenuously resist being tethered to an oxygen supply, and loved ones and caregivers sometime have an uphill battle just to keep the oxygen on the patient. If your loved one is able to move around on his own, remembering to change from home to portable oxygen and then back again can be a struggle. As many lung diseases are progressive, the flow of oxygen must be adjusted from time to time. This should only be done under a doctor’s supervision.
Dakota Travel Nurse Home Care serves clients that are on oxygen. They do competency checks with their caregivers to ensure that they know when and how to adjust the oxygen and how to manage the equipment to ensure that there is a steady supply. Family caregivers must also ensure that oxygen equipment is being used correctly and consistently.
2016 Changes to Medicare Laws
A new challenge with my dad’s oxygen needs occurred when I received a letter from his supplier on May 17, 2016, stating: “This is to notify you that changes in the law have altered the way Medicare pays for your oxygen equipment and supplies. The new rules become effective July 1, 2016.” The “bottom line” said in bold, “You have two options: you can continue service with [us] and pay out of pocket for the equipment or you will need to find another supplier….If we do not hear from you, we will be picking up your oxygen equipment on June 30, 2016.”
When I told Dad’s doctor about the letter, his first response was, “Oh, no!” Apparently, he knew something about the difficulties facing us in finding a new “Medicare Competitive Bid” supplier in the ZIP Code where Dad resides. Yes! Your ZIP Code makes a difference. Because the changes are so new, one of the difficulties we encountered was that not everyone at every company knew what equipment they could provide under the new law. The two-page list of suppliers on the Medicare Website was at least 75 percent inaccurate, and when I called Medicare’s direct line, I was read the same list over the phone. On a first call to one company, I was assured that they did provide the Medicare-covered equipment we needed. During a follow-up call, a second person told me that the first person was wrong—that they did not cover Dad’s ZIP Code. We had already sent paperwork from the doctor.
From start to finish, it took more than 6 weeks of continuous effort with 3 different suppliers and many failed attempts to get Dad set up with the prescribed equipment. Even when we got to the point of delivery, the first truck brought the wrong equipment and the next one brought a low-flow concentrator that did not have adequate capacity to also fill portable tanks. I had to accept this one, because the original equipment had already been picked up, and I was desperate. The third supplier I found would not accept the documentation the doctor had provided to the first two, and so we began the whole process again. When all of the documentation had finally arrived and been approved, the company said we had exceeded the 30-day limit from when Dad recertified by the doctor as qualified to received oxygen so we would have to begin again!
With Dad limping along on less oxygen than prescribed and portable tanks we were unable to keep full, I began looking into renting or buying equipment on a self-pay basis. At this point, the low-flow concentrator ceased to function! The supplier reluctantly—because we were trying to replace them—agreed to schedule a next-day delivery of another low-flow system. They told me after the first delivery that they didn’t carry the type of high-flow concentrator Dad needed.
Dad went without any oxygen for more than 24 hours, but when the truck finally arrived, miraculously the high-flow concentrator we’d been searching for was on it! I don’t know where it came from, and I didn’t ask. I was able to tell supplier #3 that we wouldn’t be starting the documentation process again, and we have able to meet Dad’s oxygen needs once again!
If you have a loved one or a client who is on oxygen that is currently covered by Medicare, and you receive a letter like I did, consider these things that I had to find out the hard way:
- The list of medical equipment suppliers who provide oxygen equipment on a Competitive Bid basis, if required in your area, might be short. Don’t wait to start looking for one.
- Save time by first telling the companies you call what the delivery/use Zip Code is and by asking if they service Medicare patients in that area.
- The documentation suppliers require from the doctor is extensive, but they might not tell you exactly what that documentation needs to be until you’ve failed to provide all of it more than once.
- The documentation must contain the exact wording required by Medicare for such things as the type of equipment and the reasons why it is needed. One of my forms was rejected because I left out the word “system.”
- Anything handwritten, such as a date, must be deemed legible by the supplier. I had one document returned as illegible because the bottom part of a 6 was not completely closed.
- The doctor’s oximeter test and the resulting report and all other documentation must be returned to the supplier and approved by Medicare within 30 days of the required testing.
- You may think your doctor and the suppliers you talk to will know everything they need to know about what to provide and how, but because of the recent changes to the law, they might not.
There is some very detailed information online about Medicare requirements that you might not want to read but you probably should. Some links you can follow are at the bottom of this blog. If you know a professional who can help you wade through all of this bureaucracy, take advantage of their expertise!
We all need the right amount of oxygen for our minds and bodies to function at their full capacity. The difficulty of getting that oxygen from a mechanical source that is covered by Medicare just might take Your breath away!
by Marti Lythgoe, Writer/Editor