Testing, Testing

While everyone focused on wheelchairs and “Operation Wheeler Dealer” in September, the Centers for Medicare and Medicaid Services nonchalantly slipped the long-awaited oxygen policy into its latest round of updates.

The final policy included a few big changes and several smaller nuances that raise more questions than answers. The changes and their impact on your operations are detailed below:

• For patients who qualify for oxygen based only on a sleep study, the test results must show a qualifying test value present for at least five minutes. This does not mean that it has to be five continuous minutes. Rather, the patient must have a qualifying test value for a total of five minutes during a night's sleep. Currently no minimum length of sleep is specified for oxygen.

  Impact: The operational impact should not result in much change to the number of qualified patients.

• Retesting and recertification for oxygen is required at three months of use. The proposed draft policy changes the recertification of Group I patients from the current 12 months to three months and requires retesting prior to recertification. Medicare says that, due to “technical considerations” relating to implementation,” this has not yet been included in the policy revisions. Some in the industry are breathing a short sigh of relief.

“Perhaps postponing this requirement is caused in part by the insufficient number of qualified [independent] testing facilities available due to the low reimbursement rates,” speculates Kim Brummett, vice president of contracting and reimbursement for Advanced Home Care in Greensboro, N.C.

“Physicians are not interested in purchasing or renting equipment for which they will not be adequately reimbursed,” Brummett adds.

Many companies require a complete overnight respiratory assessment by an IDTF to get the patient tested. Even then, the companies available to conduct such studies are few and far between. The delay in getting qualifying tests can be weeks.

Impact: While waiting for this change, find an IDTF to handle your cases. In addition, educate your physician community, which perhaps can shoulder some of the burden by testing in their offices, even if it is financially limiting.

A few of the many nuances addressed in the policy include: