Table of Contents
1. Introduction
2. Understanding Oxygen Services & Patient Eligibility
3. Oxygen Equipment Overview
4. Oxygen Prescription & Order Documentation
5. Medicare & Insurance Compliance
6. Portable Oxygen Concentrator (POC) Requirements
7. Hospital Discharge & Home Oxygen Qualification
8. Portability & Mobility Documentation
9. Oxygen Titration and Qualification Process
10. Exercise Testing & Oxygen Qualification
11. Pulsating Dose vs. Continuous Flow Oxygen
12. Pediatric Oxygen Considerations
13. Medicare Guidelines for Oxygen Coverage
14. Billing and Insurance Considerations
15. Appendix: Quick Reference Charts & Contact Information
16. Overview of Oxygen Therapy
17. Portable and Stationary Oxygen Equipment
18. Oxygen Concentrators and Conserving Devices
19. Equipment Setup, Usage, and Maintenance
20. Troubleshooting Common Issues
21. Medicare Qualifications for Oxygen Therapy
22. Oxygen Therapy for Sleep-Related Conditions
23. Billing and Equipment Limitations
24. Battery Information and Charging
25. Equipment Returns and Rentals
26. Patient Purchase Options
27. Frequently Asked Questions (FAQs)
1. Introduction
This training manual serves as a reference for A&R Medical Supply staff handling oxygen
orders, equipment setup, and Medicare compliance. It ensures that proper procedures are
followed, reducing errors and maintaining compliance with insurance requirements.2. Understanding Oxygen Services & Patient Eligibility
Before processing an oxygen order, confirm the following:
●
The patient is an active A&R Medical Supply customer.
●
Patients receiving oxygen services from another provider (e.g., Rotec) cannot be
serviced by A&R.
●
Medicaid plans do not cover Portable Oxygen Concentrators (POCs), requiring patients
to seek alternative options.
●
For transition patients (Presbyterian without secondary insurance):
○
All equipment from the previous provider must be picked up before A&R can
process an order.
3. Oxygen Equipment Overview
A&R Medical Supply provides two primary types of oxygen equipment:
Home Oxygen Equipment:
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Requires a prescription indicating the need for continuous oxygen therapy.
●
Includes oxygen concentrators, stationary tanks, and home fill systems.
Portable Oxygen Equipment:
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Suitable for patients with a documented need for mobility.
●
Includes portable tanks and POCs.
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Patients must have a chronic lung or heart condition to qualify for a POC.
●
A credit card must be kept on file for POCs, even if the patient has dual insurance
coverage (e.g., Presbyterian & United Healthcare).
4. Oxygen Prescription & Order Documentation
To process an order, ensure the following requirements are met:
Doctor’s Prescription Must Include:
●
Printed and signed name with NPI number.●
Flow rate and delivery method (Nasal Cannula or Mask).
●
Duration of use (Lifetime, 3 months, etc.).
●
Oxygen saturation (O2 sat) results:
○
Outpatient: Within the last 30 days.
○
Hospital Discharge: Within 2 days before discharge.
○
If the test is older than 31 days, a new test is required.
●
Confirm the doctor is Medicare-certified via the PECOS system.
5. Medicare & Insurance Compliance
Basic Medicare Requirements:
1. Patient must have a diagnosis of a chronic lung or heart condition.
2. Prescription orders must be for at least three months.
3. Orders must specify:
○
Patient’s name.
○
Type of equipment ordered (e.g., Concentrator & Portable Tank, but not both a
Portable Tank and POC).
○
Flow rate (liters per minute).
○
Delivery method.
○
Duration of use.
4. Oxygen saturation (O2 sat) results must be recent:
○
Within 30 days for outpatient services.
○
Within 2 days before hospital discharge.
5. CGS (Medicare Database) Check:
○
Verify patient is NOT receiving oxygen services from another provider within the
last 36 months.
6. Portable Oxygen Concentrator (POC) Requirements
To qualify for a POC, a patient must meet all of the following criteria:
●
Be an A&R Medical Supply customer.
●
Have a documented chronic lung or heart condition.
●
Require 3 liters per minute or less.
●
Be tested and titrated by a respiratory therapist.
●
Have a credit card on file for loss or damage coverage.7. Hospital Discharge & Home Oxygen Qualification
●
Patients must have two oxygen saturation tests within 2 days of discharge.
●
If discharge occurs more than 2 days after testing, a new test must be performed.
●
The oxygen prescription should align with the most recent O2 saturation results.
8. Portability & Mobility Documentation
Eligibility for Portable Oxygen:
✅ Doctor must document the patient’s mobility status.
✅ If the patient is bed-bound or house-bound, they do not qualify for portability.
✅ A concentrator may be provided, but not a portable unit.
9. Oxygen Titration and Qualification Process
●
Before prescribing a conserving device, a titration test is conducted to ensure
compatibility.
●
If patients qualify for portable oxygen pumps, retesting is not required.
●
Patients with conserving devices should have been titrated previously.
10. Exercise Testing & Oxygen Qualification
●
Patients qualify for oxygen therapy if their O2 saturation drops below 89% during
exercise.
Exercise Testing Steps:
1. Measure Room Air Saturation while sitting.
2. Conduct an Exercise Test (Walking or exertion).
3. Conduct a Recovery Test (Oxygen use, verifying improvement).11. Pulsating Dose vs. Continuous Flow Oxygen
Pulsating Dose Oxygen:
●
Oxygen is delivered only upon inhalation, making it more efficient and conserving
oxygen usage.
●
Suitable for patients who can tolerate intermittent flow.
Continuous Flow Oxygen:
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Oxygen flows at a constant rate, regardless of inhalation.
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Necessary for patients with more severe oxygen needs.
12. Pediatric Oxygen Considerations
●
Pediatric Regulators: Support fractional oxygen flow (¼, ½, ¾ liters).
●
Adult Regulators: Only support whole-number flow settings (1, 2, 3, etc.).
●
Flow Meters: Required for infants needing fractional flow rates.
●
Billing Considerations: Flow meters and cannulas are part of the oxygen package and
not separately billed.
13. Medicare Guidelines for Oxygen Coverage
●
Medicare covers oxygen therapy for 36 months (3 years).
●
After the 3-year rental period, equipment enters a maintenance phase for 2 additional
years without reimbursement.
●
After 5 years, a new rental cycle begins.
●
During maintenance periods, Medicare does not reimburse for new equipment.
Billing Notes:
●
If a patient is in the maintenance phase, new equipment should not be provided.
●
Patients who received a conserving device after 1 year receive Medicare compensation
for only 2 more years.
14. Billing and Insurance Considerations●
Portable Oxygen Code: EO-431.
●
Stationary Oxygen Code: EO-424.
●
Insurance Updates: Ensure accurate documentation when switching between portable
and stationary equipment.
●
Important: Do not remove a stationary code if only the portable unit is returned.
15. Appendix: Quick Reference Charts & Contact
Information
●
Oxygen Qualification Quick Chart.
●
Medicare Coverage Breakdown.
●
Key Contact Information.
16. Overview of Oxygen Therapy
Oxygen therapy is prescribed to patients with respiratory conditions that require supplemental
oxygen. It is used to manage conditions such as Chronic Obstructive Pulmonary Disease
(COPD), sleep apnea, and other chronic or acute respiratory issues.
Types of Oxygen Therapy:
●
Continuous Oxygen Therapy: Requires both portable and stationary systems.
●
Nocturnal Oxygen Therapy: Used only during sleep, typically with a stationary unit.
●
Portable Oxygen Therapy: Utilizes portable concentrators or tanks for mobile use.
17. Portable and Stationary Oxygen Equipment
Portable Oxygen Concentrators (POCs):
●
Designed for mobility, operating on battery or AC/DC power.
●
Typically use pulse dose technology to conserve oxygen.
●
Equipped with carrying bags allowing proper airflow.
Stationary Oxygen Concentrators:
●
Provide continuous oxygen at home.
●
Require access to a power source.●
Have higher oxygen output than portable systems.
Conserving Devices:
●
Extend oxygen supply by releasing oxygen only during inhalation.
18. Oxygen Concentrators and Conserving Devices
Portable Concentrators:
●
Require a warm-up period and may be loud initially.
●
Display screens show: flow settings, battery life, and operational status.
●
Will alarm if no breath is detected.
Conserving Devices:
●
Reduce oxygen waste by delivering oxygen only when inhaling.
●
Improve tank longevity for portable use.
19. Equipment Setup, Usage, and Maintenance
Setup Guidelines:
1. Secure tubing connection to the unit.
2. Turn on the device and adjust settings per prescription.
3. Ensure patient is receiving oxygen by checking the indicator.
Usage Best Practices:
●
Keep air vents unobstructed.
●
Ensure external filters are cleaned regularly.
●
Replace foam filters every three months or as recommended.
Maintenance Recommendations:
●
Patients should bring in units periodically for servicing.
●
Equipment must be checked for proper functioning.20. Troubleshooting Common Issues
Device Alarms:
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No Breath Detected Alarm: Ensure the nasal cannula is properly connected.
●
Overheating Warning: Check for blocked air vents and remove obstructions.
●
Low Battery Alert: Charge the battery or connect to AC/DC power.
●
Blocked Airflow Alert: Inspect for tubing kinks or clogged filters.
21. Medicare Qualifications for Oxygen Therapy
Non-Chronic Conditions (e.g., Bronchiolitis):
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Requires an oxygen saturation (O2 stats) of 88% or lower.
●
Order must include a diagnosis and cannot exceed three months.
●
If oxygen is needed beyond three months, PCP reevaluation is required.
Chronic Conditions (e.g., COPD, ALS, Cystic Fibrosis):
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Eligible for long-term oxygen therapy.
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Covered under durable medical equipment (DME) guidelines.
22. Oxygen Therapy for Sleep-Related Conditions
Obstructive Sleep Apnea (OSA) & Nocturnal Oxygen:
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Requires a sleep study or overnight oximetry while using a PAP device.
●
The order must state “Nocturnal Oxygen” and include flow rate details.
COPD Patients & Nocturnal Oxygen:
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Overnight oximetry is required for qualification.
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A full sleep study is not necessary.
23. Billing and Equipment Limitations
●
Medicare covers specific oxygen-related equipment under strict guidelines.●
Non-billable supplies (e.g., extra tubing, cannulas) are limited.
●
Equipment billing depends on prescribed therapy (24/7 vs. nocturnal use).
●
Staff can reference CGS.org for up-to-date Medicare policies.
24. Battery Information and Charging
Battery Life:
●
Battery duration varies by usage and charging habits.
●
A fully depleted battery takes approximately six hours to recharge.
Charging Best Practices:
1. Charge immediately upon returning home.
2. Avoid full battery depletion before recharging.
3. Use only approved chargers (AC for wall outlets, DC for cars).
Backup Power Options:
●
Additional batteries available for purchase.
●
Standalone chargers allow for separate battery charging.
●
Larger concentrators require direct AC power.
25. Equipment Returns and Rentals
Returning Equipment:
●
Patients returning rentals must include all components:
○
Main unit, battery, AC and DC chargers.
○
Equipment must retain A&R Medical Supply stickers.
Insurance Rental Guidelines:
●
Medicare follows a five-year rental cycle.
●
Insurance does not cover outright equipment purchases.
26. Patient Purchase Options●
Patients may purchase units outright with a prescription.
●
Warranty Coverage:
○
Equipment: 5 years
○
Batteries: 1 year
○
Internal filtration system: 1 year
●
Used equipment does not carry warranties.
27. Frequently Asked Questions (FAQs)
1. Can a patient charge the unit while using it?
○
Yes, but charging takes longer when in use.
2. Do larger units have backup batteries?
○
No, they require direct AC power.
3. What happens if rental equipment is returned incomplete?
○
Missing components must be replaced before returning to inventory.
