PST, Medicare has cut DME benefits every year since I started on 02 and PAP therapy.PST wrote:... I do have a question about your O2 experience, though. I am honestly not aware of any 2010 Medicare cuts affecting DMEs. There is an ongoing issue involving physician reimbursement rates, but that shouldn't affect DMEs. Have their been cuts this year? If not, then the problems you encountered had a different cause.
In 2006 Medicare allowed $ $232.48 a month for a 5L concentrator and portable tanks, regulator, tubing, etc. of which they paid $185.98; and $99.95 a month for the 13 month capped rental of a CPAP. At that time the concentrator was a lifetime rental.
In 2007 Medicare dropped the monthly CPAP capped rental allowed amount to $74.96 a month for which they paid $59.97 and the 02 equipment to an allowed $230.19 of which they paid $184.15.
In 2008 Medicare allowed $218.11 a month for a 13 month capped rental of a bi-level PAP of which they paid $174.49. Mid year bi-level PAP reimbursement dropped to $163.58 allowed and paid $130.86.
This was also the year that the controversy surrounding 02 concentrators being switched from lifetime to a 3 or 5 year rental. From January to July Medicare allowed $1,585.70 and paid $1,268.56 for 02 equipment. For August thru October Medicare allowed $725.00 and paid $580.00 for the 02 equipment. November and December 2008 Medicare allowed $231.07 and paid $184.86 for the 02 equipment. Keep in mind that Medicare pays 80% of the allowed amount and the patient or their secondary insurance pays an additional 20% copay.
In 2009 Medicare dropped the bi-level PAPs to $148.04 allowed of which they paid $118.43 monthly for a 13 month capped rental. 02 dropped to $204.56 allowed and $163.65 reimbursed. I think it was this year that the billing for the concentrator and the portable equipment were separated instead of one combined billing.
My bi-level PAP was paid off in 2009 so I have no idea of 2010 Medicare reimbursement rates for them. And there has been quite a bit of confusion regarding the rental/ownership/maintenance of the 02 concentrators. There was talk of a 3 year rental, conversion to patient ownership; 5 year rental no conversion to patient ownership w/ownership remaining w/the DME provider ..... I still don't know the situation - except that I started on 02 in April 2006. 2010 doesn't fit the 3 year or the 5 year rental controversy. I was just for the first time billed $13.20 for a 6 month maintenance on the concentrator (which was WELL-USED when it was provided, died earlier this year and was replaced by another USED concentrator). And as near as I can determine Medicare is now just paying for the monthly portable equipment and necessary supplies such as tubing, etc. plus a 6 month concentrator maintenance that I haven't gotten an EOB for yet.
