Medicare and Oxygen
Medicare, oxygen and the 36 month capped rental period
Services and Supplies from RxStat Pharmacy
- Portable Oxygen Concentrators
- Self filling oxygen cylinders
- Quiet oxygen concentrators
- Rental, travel oxygen
- Nebulizer Medications
- Nebulizer Compressors
- Nebulizer Circuits
- Home Oxygen
- CPAP and BiPAP Supplies
- Respiratory Therapists
- Overnight Oximetry Services
- Medicare Compliance Staff
- Portable Oxygen Specialists
Medicare will pay for oxygen equipment for 36months. After the 36th month of continuous rental,the beneficiary will own the oxygen equipment.
Section 5101(b) of the Deficit Reduction Act (DRA) of 2005 establishes a 36 month (3 year) limit or "cap" on monthly oxygen payments for stationary and portable oxygen equipment. This cap applies to monthly payments made for oxygen equipment on or after January 1, 2006.
For beneficiaries that already had oxygen prior to this date, the 36 month rental period began January 1,2006.
After January 1, 2009 or 36 months of continuous rental, ownership of the equipment will transfer to the beneficiary. This is referred to as "capped out".
Medicare will continue to pay for oxygen contents for beneficiary owned portable oxygen systems after the "cap". This applies to portable and stationary oxygen systems that need refills.
Will your current oxygen system meet your needsin the future? Is it small enough? Light enough? Quiet enough?
It is important that you evaluate your current oxygen system to make sure it will meet your needs for a total of 5 years. Medicare's policy is that the expected life of an oxygen system is 5 years.
If your current system is already "old", how old will it be after the 36 months of rental when you become the owner?
Medicare will pay for reasonable and necessary maintenance and servicing of beneficiary owned equipment, however, they have not published how much they will pay.
It will be the equipment owner's responsibility to schedule any service that might be needed, unfortunately, unless the concentrator stops running or alarms, it will be difficult to determine if it is operating properly without the proper testing equipment.
Medicare does not pay for oxygen when you travel. After the ownership transfer, most oxygen providers will not help with your travel needs. You will have to pay for travel oxygen if you cannot take what you own. Will your current oxygen system allow you to travel?
Medicare will pay for "oxygen contents" if you use oxygen cylinders for portability, however, they have not clarified the ownership of the cylinders because they are often exchanged when empty. If you use many portable cylinders, you might have a problem getting refills.
Suggested equipment checks before theownership transfer.
Concentrator
- When was it last serviced?
- Oxygen purity
- Filters, internal and external
- Hours on concentrator.
- Noise level
- General appearance
- Weight for travel
Portable oxygen
- Does it meet your needs now?
- Is it light enough?
- Does it need refills?
- How many cylinders do you use on a monthly basis?
- Can you travel?
Because of uncertainty about payment to an oxygen provider for portable oxygen refills, will you be dependant on someone to fill your empty cylinders or do you have the ability to fill your own portable oxygen cylinders?
If you wait to long before checking your oxygen equipment, you will not be able to change equipment or providers if you need to. The closer you get to the end of your 36 month rental period, the less options you will have for change.
Providers will not be willing to take on a new oxygen patient if they cannot at least cover the cost of the equipment with the remaining rental months from Medicare.
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