New Medicare Oxygen Rules Hurting Patients

Posted in Health Insurance

November 25th, 2009

New payment rules have been implemented to help reduce waste and fraud in medical-equipment reimbursements, the only problem is that they are driving some home oxygen suppliers out of business and leaving patients in search of new providers. The rules, which are set to take effect Jan. 1, 2010, could affect more than one million people who rely on Medicare to pay for their oxygen services.

The New Payment Rules

Under the new rules, Medicare will pay suppliers 80 percent of an average of $200 a month in reimbursements for the first three years after a patient begins coverage. Patients are responsible for 20 percent. Afterward, suppliers will be required to continue providing oxygen services to patients for an additional two years, but at a sharply reduced payment rate. After the additional two years, when patients are entitled to new equipment, Medicare will resume paying suppliers at a higher rate.

The Effect on Patients

Because of the new rules, smaller suppliers fear they won’t be able to maintain services to patients, which could end up costing tens of thousands of dollars a year to comply. Many suppliers have decided to exit the business rather than succumb to the excessive costs. As a result, dependent patients are now in a position to find new oxygen servicers to help manage chronic symptoms deriving from conditions like emphysema and chronic obstructive pulmonary disease.

There have been many critics of the new payment plan, including hospitals that have complained that the new rules could result in patients ending up in the hospital from a lack of care. However, with the new rules already set to take effect, it looks like this could be another Medicare solution that causes more problems than it actually solves.