Medicare program: special payment limits for home oxygen--HCFA. Proposed notice.
This notice would establish special payment limits for home oxygen. Currently, payment under the Medicare program for home oxygen and other items of durable medical equipment is equal to 80 percent of the lesser of the actual charge for the item or the fee schedule amount for the item. Based on our experience and after consulting with representative of home oxygen suppliers, we have determined that the Medicare fee schedule amounts for home oxygen are grossly excessive and are not inherently reasonable because they are excessively high relative to the payment and amount for similar services by the Department of Veterans Affairs which uses a true competitive payment methodology. This notice would replace the use of fee schedule amount and proposes that payment for home oxygen be equal to 80 percent of the lesser of the actual charge or a special payment limit set by HCFA, which would vary by locality. It is intended to prevent continuation of excessive payment. The special limit would be based on the average payment amount for home oxygen services by the Department of Veterans Affairs.
D014487:Centers for Medicare and Medicaid Services, U.S.; D004389:Durable Medical Equipment / Q000191:economics*; D005245:Fee Schedules / Q000331:legislation & jurisprudence*; D006699:Home Care Services / Q000191:economics* / Q000331:legislation & jurisprudence / Q000592:standards; D006801:Humans; D007349:Insurance, Health, Reimbursement; D006278:Medicare / Q000331:legislation & jurisprudence*; D010102:Oxygen Inhalation Therapy / Q000191:economics* / Q000295:instrumentation; D014481:United States