Article Detail - JA DME

Original Effective Date: 01/01/2001
Revision Effective Date: 11/07/2013

A surprising number of oxygen claims have recently been submitted with "PRN" on the physician order. While physicians are accustomed to including this "as needed" descriptor for certain items and services, Medicare guidelines specifically prohibit payment for oxygen used and ordered only on a PRN basis.

Oxygen therapy is a major expenditure under Part B Medicare totaling over $1.5 billion annually. And that's just the equipment. Not included in this total are the cost of physician evaluations, laboratory tests and respiratory therapy services. To insure their patients have ready access to and payment for necessary oxygen requirements, physicians are reminded to:

• Review any test results with a critical eye and determine if and when the patient requires the oxygen supplementation.
• Write orders that detail oxygen use for a specific activity or time period and not PRN.
• Consider the length of need for oxygen very carefully when prescribing for Medicare beneficiaries.
• Be careful when relying on outside agencies to express a patient's oxygen needs accurately.
• Be aware of the potential conflicts of interest inherent in a DME supplier of oxygen performing qualifying oximetry or arterial blood gas testing. Medicare regulations prohibit DME suppliers from performing the qualifying test.

Diligent attention to details when ordering oxygen therapy will help prevent delays in patients receiving the Medicare benefits they need and deserve.