Billing and Payment: Oxygen Equipment
Q. If a beneficiary living at home and using a stationary oxygen unit has to be transported to another location, can we pay for any portable oxygen necessary to transport the beneficiary?
A. Yes, payment under Part B can be made.
Q. If electrical power is lost at the home of a beneficiary using stationary oxygen, can portable oxygen be covered?
A. Yes, the temporary use of portable oxygen can be covered.
Home Health Agencies
Q. How will payments be processed for home health agencies (HHAs)?
A. CMS will advise the FI to facilitate payment for home health services for beneficiaries who have been displaced. The FI will work with the HHAs that have transferred or received patients to ensure that claims are processed timely and issues are addressed quickly.
Durable Medical Equipment
Q. Does CMS provide any payments for durable medical equipment damaged during a disruptive event?
A. DME will be repaired or replaced if the DME was damaged in the hurricane.
Billing and Payment: Bad Debt
Q. If providers choose to waive Medicare deductible or coinsurance amounts for victims of the hurricane, may the providers claim these waived amounts on the cost report as bad debt? If so, what documentation will be required in order to satisfy auditors?
A. Providers can waive the coinsurance and deductible amounts and claim bad debt for Medicare patients that they determine to be indigent. The indigence determination must be made on a case by case basis. Documentation requirements stated in Provider Reimbursement Manual I, Chapter 3, Section 312(C) allow that the “provider should take into account any extenuating circumstances that would affect the determination of the patient’s indigence”. When loss of documentation issues arise in the aftermath of Hurricane Katrina, providers can note their observations or whatever documentation they can with a brief signed statement by medical personnel (e.g., evidence the person is residing in a shelter, Medicaid card, etc.).
Billing and Payment: Payment Floor
Q. Can the 14-day payment floor be temporarily suspended to improve the cash flow of Part A providers and Part B providers?
A. Cash flow problems can better be resolved through accelerated (Part A providers) or advance (Part B providers) payments rather than through suspension of the mandatory payment floor. Intermediaries have been asked to process immediately any requests for accelerated payments or increases in PIP for providers affected by the hurricane. The intermediaries are also authorized to increase the rate of the accelerated payment to 100 percent and extend the repayment period to 180 days on a case-by-case basis.
Billing and Payment: Ambulance Services
Q. How will ambulance services be paid when patients are moved from hospital to hospital or other locations?
A. Charges for ambulance transportation will be paid according to the usual Payment guidelines. Ambulance transportation charges for patients who were evacuated from and returned to originating hospitals should be included on the inpatient claims submitted by the originating hospitals. Payment will be included in the DRG Payment amounts made to hospitals paid under the prospective payment system. Outpatient claims may be submitted for ambulance charges incurred by those patients who were transported from the originating hospitals and subsequently discharged by receiving hospitals.
Q. Will Medicare pay for ambulance services during emergency and evacuation situations?
A. The Medicare contractors may make payment for ambulance transportations that evacuated patients from affected locations. The regulatory requirements must be met (i.e. the vehicle must be an ambulance, the crew must be certified, the patient must need an ambulance transport and the transport must be to an eligible destination)
Q. Will Medicare consider such ambulance trips under the consolidated billing requirements for skilled nursing facilities?
A. No, such trips will not be subject to consolidated billing.
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