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Printed Date: 9/22/2015
A supplier exiting the Medicare oxygen business with oxygen patients who they are unable to transfer to new suppliers are in violation of their regulatory and statutory obligations. Section 1834(a)(5)(F)(ii)(I) of the Social Security Act, and regulation at 42 Code of Federal Regulations Section 414.226(f)(1), requires that an oxygen supplier that received the 36th month rental payment continue furnishing the oxygen equipment they were furnishing in month 36 for any period of medical need for the remainder of the equipment’s five-year reasonable useful lifetime. In accordance with the regulation at 42 Code of Federal Regulations Section 414.226(f)(2), if the supplier furnished gaseous or liquid oxygen equipment (stationary and/or portable) in month 36, they must continue furnishing the gaseous or liquid oxygen contents for this equipment for any period of medical need for the remainder of the equipment’s five-year reasonable useful lifetime. If the beneficiary relocates outside the normal service area of the supplier, the supplier is still responsible for furnishing the oxygen and oxygen equipment in accordance with the statute and regulations. They may make arrangements with another supplier to meet this responsibility and would likely need to reimburse the other supplier under such an arrangement. Under no circumstances can a beneficiary be charged for oxygen equipment furnished after the 36th paid rental month and before the end of the equipment’s five-year reasonable useful lifetime. If there are breaks in need or breaks in service after month 36, the supplier must continue providing the oxygen and oxygen equipment as soon as the break is over, regardless of the length of the break, if the break ends before the end of the equipment’s five-year reasonable useful lifetime.
Further, the regulation at 42 Code of Federal Regulations Section 414.226(g)(1) requires, barring a few exceptions, that the supplier that furnishes oxygen equipment in the first month during which payment is made must continue to furnish the equipment for the entire 36-month period of continuous use, unless medical necessity ends. In addition, the regulation at 42 Code of Federal Regulations Section 414.226(g)(2) prohibits the supplier from changing the modality of stationary oxygen equipment initially furnished (liquid, gaseous, or concentrator), or from changing the modality of portable oxygen equipment initially furnished (liquid, gaseous, portable concentrator, gaseous transfilling system, or liquid transfilling system), unless the physician orders new equipment, the beneficiary chooses to upgrade to newer technology equipment, or CMS or a Medicare Administrative Contractor determines that an exception should apply in an individual case.
Failure to comply with the regulations cited will be considered a violation of 42 Code of Federal Regulations Section 424.57(c)(i) and can therefore be grounds for revocation of your billing number.
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Last Updated: 08/05/2016