Home Oxygen Therapy Guidelines
The purpose of this bulletin is to define oxygen guidelines for Paramount Elite members. As of 1/1/11
Paramount will follow Medicare’s current guidelines for oxygen therapy for Paramount Elite
members. Once a member qualifies for home oxygen therapy, the provider and the member enter into a
five year relationship at the beginning of the rental period. It is up to the provider to fully disclose this
relationship to the member. This five year period will begin 1/1/11 for your current Paramount Elite
patients.
THE FOLLOWING GUIDELINES APPLY:
•
The oxygen equipment may only be billed for 36 months.
o
o
BILLING
for the
OXYGEN EQUIPMENT
•
In the first 36 months, the monthly rental includes the oxygen equipment, the oxygen
contents, and all supplies and accessories.
•
In the last 24 months, only the oxygen contents may be reported.
•
During the last 24 months, maintenance should be completed and billed every 6
months.
•
The supplies and accessories are included in the monthly rental, so they are never
separately reported.
•
The provider arranges the member’s oxygen equipment needs with some exceptions.
PROVIDER
RESPONSIBILITIES
o
o
FIVE YEAR
CONTRACT
and
AFTER
When the member is out of state, an agreement is established with another provider by the
current contracted provider.
Oxygen equipment is not arranged when the member is in the hospital, this is referred to as
“break in coverage”.
•
The member remains with the provider for a 5 year contract.
•
After the completion of a 5 year contract:
o
o
o
o
•
•
•
PAYMENT INCLUSIVE
of the FOLLOWING
COMPONENTS
Copay applies to the equipment during the first 36 months.
In the next 24 months, no copay/ coinsurance applies to the equipment.
•
•
•
•
Member may select new provider or remain with the same provide to begin a new five year
contract.
Provider may choose not to contract or re-contract with a member.
The process outlined above, repeats once a five year contact has been signed between the
member and provider.
In order for the process to begin again, the provider will need to call Paramount Inquiry to
arrange approval for an additional 5 years or services will deny. The member will only be
allowed the benefit for the first five years and must have the benefit renewed.
Set up and instructions.
Equipment (including concentrator) and supplies.
Maintenance and repairs to include any supplies or attachments that are integral to the
operation of the oxygen system being supplied.
Transportation and/or delivery charges.
Emergency services (to include the supply of backup oxygen supplies) or
subsequent/interim visits.
Oxygen consumed (when applicable).
Equipment monitoring visits.
FOR QUESTIONS, CALL PROVIDER INQUIRY AT:
419-887-2564 or 1-888-891-2564
AUDIENCE: DME Providers
CLAIMS PROCESSING CONNECTION
www.paramounthealthcare.com
Volume 9 ▪ Bulletin 7
December 20, 2010