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Archive for February, 2018


Wednesday, February 28, 2018 @ 02:02 PM  posted by jbuytaert

From: MiraVista

In its recent Quarterly HCPCS Update, CMS instituted changes to oxygen pricing modifiers related to volume adjustment. These changes will impose further rate reductions and likely cause harm to patients and DME suppliers alike.

In a December 7, 1992 Interim Final Rule, CMS found that Section 1834 of the Social Security Act is silent regarding volume adjustments when the prescribed oxygen liter flow varies according to the circumstances of the patient. As a result, CMS added the following regulatory language regarding volume adjustments:

​Although this guidance has been on the books for over two decades, the change in pricing modifiers, effective April 1, 2018, will shift the physician education burden to suppliers.

Here’s what you need to know about the change:

Providers currently use three pricing modifiers for oxygen volume adjustments, based on the highest liter flow prescribed (regardless of modality): Read more

Case Study Involving Compression Fitting for Burn Patients

Tuesday, February 27, 2018 @ 11:02 AM  posted by jbuytaert

A special acknowledgement to Nancy Petrun, Handi Medical’s Custom Compression Specialist for her work in this project.
All of the patients involved are ones that Nancy worked with to get them their compression garments.

CMS upends oxygen CMN

Monday, February 19, 2018 @ 09:02 AM  posted by jbuytaert

by: Liz Beaulieu

- from the HME News

Friday, February 16, 2018

WASHINGTON – CMS has changed the guidelines for reporting a patient’s oxygen flow rate on a CMN, a move that will have two serious implications for providers, particularly those servicing the critically ill, says Andrea Stark.

First, through new modifiers laid out in a Feb. 15 joint DME MAC publication, CMS has instructed that for patients whose oxygen use differs between day and night, the average flow rate, not the highest flow rate, must be reported on question 5 of the CMN.

“They say this is going to simplify the process, but it makes things ten times more complicated,” said Stark, a reimbursement consultant for MiraVista LLC.

CMS has added three new modifiers, set to go into effect April 1: QA (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute); QB (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed); and QR (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute).

Second, by modifying existing modifiers QE, QF and QG, CMS has instructed that patients must now need more than 4 liters of oxygen per minute “at rest,” not at exertion, to qualify for a high-volume adjustment that increases reimbursement from $70.74 per month to about $106 per month.

“This will exclude patients who previously qualified for high-volume adjustments,” Stark said.

The reimbursement difference for a patient considered standard volume and high volume is about $20 to $30, a change that may be hardly worth the savings when you consider the upheaval to the documentation process and the possible threats to patients, Stark says.

“With the existing reimbursement cuts, this is just one more blow,” she said. “These high-liter-flow patients are the most expensive patients to take care of, and providers aren’t going to be paid nearly enough.”