Helpful Tips for Oxygen Providers

Helpful Tips for Oxygen Providers

If you are an oxygen provider, you are aware of the audits occurring whether it’s pre-pay, post-pay, RAC, etc., if its oxygen equipment, it’s getting an audit.

I thought it would be beneficial to pull together some helpful tips that should assist in overcoming those audits.  This information has been gathered from the results of various audits.  Here are a few helpful tips that you need to make sure to check when taking on a new oxygen patient.

  1. A 30 day visit prior to the initial certification date with treating practitioner.  The visit must include the following:
    1. Beneficiary name
    2. Medical necessity information including the condition, prognosis, history, and need
    3. Make sure medical records are legibly signed and dated by treating practitioner
    4. Visit must be dated and within 30 days of initial certification date

If the visit occurred within one or two days beyond the required timeframe, it’s not acceptable.  In this case, check with the physician’s office for another visit that occurred within the 30 days or patient needs to get re-qualified and coverage will start over.

  1. If patient qualifies for oxygen with exercise, make sure that you receive all three tests which are:
    1. The oxygen test on room air at rest
    2. The oxygen test with exercise on room air (this would be the qualifying one)
    3. The oxygen test with exercise on oxygen (to show oxygen levels improve)
  2. Patient must have a severe lung disease or hypoxia related symptoms to qualify for oxygen.  Such as COPD, hypoxia secondary to CHF or cardiac issue, etc….
  3. Make sure patient is in a chronic stable state when tested for oxygen.  The ER visits are not considered chronic stable state.
  4. Be sure that the medical records indicate if alternative treatments have been tried and/or considered.  This needs to be in the medical records; this include nebulizer treatments, inhalers, diutretics (for the CHF patient), etc.
  5. For patients using oxygen with PAP device, the only way to qualify for home oxygen is by sending patient for a titration study at a sleep lab facility.  Optimal pressure settings need to be used by the patient.  The oximetry study performed during this titration shows O2 saturation of 88% or less for 5 total minutes (does not have to be continuous).  There has to be a reduction in AHI/RDI reduced to less than or equal to an average of 10 events/hours or if the initial AHI/RDI was less than an average of 10 events per hour, then the titration demonstrates further reduction in AHI/RDI.

 

Remember, a diagnosis and medication list alone are not sufficient to justify medical necessity in the medical records.

Please use this information as a reference for your oxygen referrals.  I have also included a documentation checklist that is very valuable when receiving an oxygen patient.

Oxygen Documentation Checklist Group I

Oxygen Documentation Checklist Group II

Ronda Buhrmester

[email protected]

Phone:  888-665-6518    Fax:  855-262-3821