Solving the Oxygen Qualification Crisis

For the past several years, providers have searched endlessly for a solution to qualifying their oxygen patients. No solution seemed possible until this year, when the Centers for Medicare and Medicaid Services (CMS) approved the use of a home testing system for oxygen.

The system, called Power-Ox, allows the DME provider to deliver an overnight pulse oximetry device to the patient's home and instruct the patient on its use. The following day, the provider returns to retrieve the device, downloads the results into a Palm Pilot-based system, and has the patient sign an Assignment of Benefit form located on the Palm device. This sends the results, which are encrypted for HIPAA security and to prevent tampering, over the Internet directly to a Medicare-approved Independent Diagnostic Testing Facility (IDTF).

After returning to the office, the provider can access the results from the IDTF's Web site. The results can be printed immediately and, assuming the patient meets all Medicare requirements, may be used to meet the IDTF requirements to bill Medicare for oxygen.

Of course, the physician must review these results and complete sections B and D of the CMN (certificate of medical necessity). A provider may not bill Medicare until he receives a completed, signed CMN back from the treating physician. The IDTF bills Medicare directly, and the patient is responsible for only the Medicare co-payment.

The testing system was developed by Michigan-based Newco Holdings and is marketed by The Letco Companies. Earlier this year, the two companies demonstrated the product for CMS, after which the agency issued the following statement: “The Power-Ox system does not violate any portion of the Local Medical Review Policy or National Coverage Determination for home oxygen therapy. Test results obtained using Power-Ox are acceptable for qualifying patients for home oxygen therapy.” While The Letco Companies has received three letters from CMS that address various concerns, DME providers should consult with their health care attorney on use of the device.

According to some providers taking advantage of home oxygen testing, their prescriptions for overnight pulse oximetry tests have doubled within their existing physician base. The system allows a 24-hour turnaround from initial testing of an oxygen patient to full set-up and Medicare billing for that same patient — and that is something that none of their competitors offer.