Patient Qualifications Durable Medical Equipment - Home Oxygen - HCCIntelligence™ Premier Resource 2024-Patient Qualifications Durable Medical Equipment - Home Oxygen

Patient Qualifications Durable Medical Equipment - Home Oxygen - 2024

Pdf Summary

The document provides information about home oxygen equipment and the qualifications for coverage. It mentions the types of equipment, supplies, and accessories covered for home use, including oxygen systems, tubing, and storage vessels. The coverage qualifications include having certain lung diseases or experiencing hypoxia-related symptoms or findings. The document also states that the qualifying condition must be expected to improve with the use of home oxygen therapy. The provider must conduct a qualifying blood gas study, and alternative therapies should be tried or considered and found to be ineffective.<br /><br />The document further explains that there are two groups of criteria for initial oxygen certifications. Group 1 criteria include specific oxygen saturation or arterial oxygen pressure levels during rest, exercise, or sleep. Group 2 criteria involve testing during rest, exercise, or sleep and the presence of certain conditions. The coverage for patients meeting Group 1 criteria is limited to 12 months, while the coverage for patients meeting Group 2 criteria is limited to 3 months.<br /><br />Face-to-face encounter documentation requirements are outlined, stating that qualifying providers must perform an in-person visit and document the patient's condition supporting the need for oxygen equipment. Each time a new prescription is ordered, a new face-to-face visit is required. The medical record should include the patient's diagnosis, clinical course, blood gas study results, functional limitations, and past experience with related items.<br /><br />The document also provides information about the written order (prescription) prior to delivery, which should include the patient's and provider's names, dates, item description, provider's signature, and NPI. To complete the order, the provider's office must submit the written order, face-to-face encounter documentation, and completed CMN to the DME supplier.<br /><br />Patient financial responsibilities are mentioned, stating that patients are responsible for 20% of the Medicare-approved amount for oxygen, and their Part B deductible applies. The oxygen certification period is 36 months, after which recertification is required. Suppliers are required to provide oxygen for an additional 24 months if the patient meets medical necessity.<br /><br />The document is a resource created to provide clarity on patient qualifications and documentation requirements for home oxygen equipment.

Keywords

home oxygen equipment

coverage qualifications

lung diseases

oxygen systems

qualifying blood gas study

initial oxygen certifications

face-to-face encounter documentation

written order

patient financial responsibilities

oxygen certification period