[HMEFRIENDS]

I would like to hear what other interpret as the correct way to bill for oxygen when a patient has a Medicare Replacement Plan. Do you cap it out at 36th months just like traditional Medicare your do you bill and continue to accept payments from the HMO payer even though it is beyond the 36 month cap.

[ylbms]

As far as I know even though they are a Medicare replacement plan I believe they go by Medicare guidelines. Best thing to do is contact that insurance plan and verify. I know that if a patient has Medicare, switches to a replacement and then back to Medicare within the 36 mths, Medicare does not count those mths paid by the other insurance and the supplier will have to bill Medicare until they show 36 mths paid.

[DwayneThomas]

Most Medicare Advantage plans follow traditional Medicare guidelines, or are in the process of converting to coverage criteria that is in line with the current guidelines. You can contact the provider services department with most plans where they will either confirm the parallel with Medicare or provide specific links to their current policy.

Dwayne Thomas
Healthcare Management Solutions
866-505-8866 ext 149