[Mardi]

Over the past couple of years that I have been involved in DME, we have had a few patients who will up their 02 tank usage drastically to the point where we know they are using tanks and a concentrator at home (and usually at the same time.) What do other companies do in these circumstances? How do you decide how many tanks a patient can have in a week, month, etc.? It can't be unlimited, can it? At some point can someone be charged for extra 02 tanks? We are following up with the Dr. as to complying with orders, but that may not solve the problem. This particlular circumstance is a patient that is virtually homebound, other than Dr. appts. and has started using 14 E tanks in 1 week and has admitted to using a tank and the concentrator at the same time, virtually doubling his current 02 order. How do others handle this? Thanks for any input!

[HEATHER]

If you are billing Medicare Assigned for the portable oxygen system - the
tanks ARE umlimited and you cannot charge for excessive tanks, delivery,
etc. However, if you haven't yet reached the 36th month, you can tell them
that you will have to start billing the portable oxygen Unassigned. For a
change in assignment you need the patient's "permission" so put it in
writing and have them sign. If you have passed the 36 month cap you have
little, if any, recourse. Also not sure what the physician can do to help
you other than trying to talk sense into them - but compliance with a dr
order has nothing to do with use of tanks vs. concentrator.

[Mardi]

Thanks for the info. (The patient is putting tubing hooked up to a tank in his mouth at 4 liters and a nasal cannula hooked up to his concentrator in his nose at four liters, thus putting himself on 8 liters. His order is for 4lpm. That was the reason for following up with the doctor.) Thanks again! Mardi

[HEATHER]

lol I was wondering how he was using both at the same time! That's a new
one!!

[lsologuren]

One clarification on not accepting assignment, you do not need the patient's permission to bill unassigned. That is a decision made by the provider. However, you do need to put the patient on written notice of your decision. This protects the provider and allows the patient the choice to pay for his habits, change his habits or find another provider.

[HEATHER]

I interpreted the following to mean that you cannot enter into an assigned
rental agreement for a piece of equipment and then switch that agreement to
a non-assigned one with out the consent of the patient. I agree that at the
time of delivery, the decision of assigned or non-assigned rests solely with
the non-participating provider.

Supplier Manual - Ch 6 - Sec 2 Assignment Agreement

"Once entered into, the assignment agreement may not be rescinded by
nonparticipating suppliers unless done so by mutual written agreement of the
supplier and beneficiary. This agreement must be communicated to the DME MAC
before the DME MAC has made, and sent notice of, the claim determination.
Participating suppliers may not rescind the assignment agreement during the
period of their participation contract."

[SimplyLori]

We put our heavy tank users on Homefill if they can tolerate a conserver. You can get them with continuous flow now too but we haven't done that yet.

[fakeplant]

For my money, I think that oxygen concentrators are much than its bottled oxygen counter-part. The concentrator actually creates the oxygen you need without the risk of leaks, explosions, or fires