[flamingo909]

hi , i need clarification when a patient is hmo, then changes to medicare, my oxygen patient set up 051910 and kaiser billed. medicare effective 060110. the guidelines state to treat as if new patient, so does this mean he has to be evaluated by physician or would he eval in may prior to initial set up be compliant, would the initial for cmn then be 061910?. i need to know where to find this specifically in supplier manual. this happens when my cpap patient also, with the re eval and compliance it gets very messy and confusing. any help would be appreciated

[Regina]

From Region A LCD- Testing and Visit Requirements: Initial CMN for situations 1 and 2 • The blood gas study must be the most recent study obtained within 30 days prior to the Initial Date. o For situation 1, there is an exception to the 30-day test requirement for patients who were started on oxygen while enrolled in a Medicare HMO and transition to fee-for-service Medicare. For those patients, the blood gas study does not have to be obtained 30 days prior to the Initial Date, but must be the most recent qualifying test obtained while in the HMO.

[Liz]

What about cpap patients in the middle of their rental period? Do you start a new rental period? Does the pt have to re-qualify all over; even if you treat all your HMO pt's as if they are fee-for-service medicare patients and have all the documentation to adhering to cpap policy?