Talk with your doctor. Ask what type of delivery system is best for you. Talk about your needs not only at home, but also what you need when you're exercising or otherwise exerting yourself. Your doctor will provide a certificate of medical necessity, saying that you require supplemental oxygen. Make sure this certificate of medical necessity includes exactly what your doctor told you that you need.
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Next, find an oxygen supplier that can provide what is in the certificate of medical necessity. Know that your oxygen supplier is not your doctor and cannot make decisions about the type of equipment you require. Only you and your doctor may do this!
Once you have your equipment, you cannot, in most cases, change the type of equipment or type of delivery system for a term of five (5) years. This is why it's important to choose the type of equipment and delivery system that will work best for your lifestyle! Note: If your oxygen requirements change or your doctor feels you require different equipment or delivery system, your certificate of medical necessity should be changed. With a new certificate of medical necessity your oxygen supplier must provide equipment that fits that need.
There are two main types of supplemental oxygen, also called 'modalities:' gaseous and liquid. These systems work differently. There are pros and cons with each system.
In the past, many oxygen users were given both a home concentrator (for use while at home) and an 'E' tank (for going out). One problem with this arrangement was that a user had to pull the tank on a cart when going outside their home. Inside the home a user could move only as far as the tubing would go.
A newer type of oxygen system is the 'trans-fill' unit. In this system gaseous oxygen can be produced in the home by a concentrator and stored in a refillable tank. These 'M' tanks are small and light. They can be easily carried in a shoulder case. The length of time these smaller tanks last varies on your liter flow and the pressure with which the tanks are filled. Note: some trans-fill units will fill at psi (pounds per square inch) while others fill at psi. The higher pressure provides more capacity. This system helps you move around easier outside and inside your home. You don't have to rely on the home care supplier to replace tanks when you need them. This type of system puts you in control of filling your own tanks for increased mobility. The entire system can be moved if you need to leave your home for extended periods like relocating to a summer home.
The other modality is liquid oxygen, a popular option with high liter flow users. In this system the oxygen is stored in liquid form in a home reservoir which must be filled on a regular basis. You can use the reservoir to fill smaller containers. These smaller oxygen containers offer longer use times even at high liter flows. The other advantage of this system is that it does not depend on electricity like a home concentrator. This means that oxygen use will not add to your utility bills and you will continue to have oxygen if the power goes out.
The main disadvantage of liquid oxygen is that the reservoir is not portable with travel (unless your oxygen provider allows you the use of a travel reservoir). You must make arrangements to have a different reservoir in place at your destination.
In some areas it is very difficult to obtain liquid oxygen. Check with suppliers in your area before deciding on liquid oxygen to make sure it is available. Be sure to discuss all of these options with your doctor!
A recent change in Medicare as a result of the new competitive bidding sets new rules and regulations as to how your oxygen provider is paid.
If you have Medicare and use oxygen you will have a five-year contract with Medicare and your home oxygen supplier. The contract begins the first month the oxygen supplier bills Medicare for your oxygen. In the first 36 months of the contract the oxygen supplier is paid for rental of the equipment. In the last 24 months of the contract the oxygen supplier is paid only for providing refilled tanks, hoses and other supplies. The oxygen supplier is responsible for maintaining and repairing the equipment for the entire length of the contract.
Medicare pays 80% of the charges billed by the oxygen supplier and you are responsible for the remaining amount. A supplemental plan provider plan may offset or cover this 20% difference, so check with your supplemental plan provider.
When your five-year contract is about to run out, your oxygen supplier is required to let you know. Your doctor will then need to provide a new letter of medical necessity. This may include an updated evaluation of your oxygen needs. This is the perfect time to talk with your doctor about other types of oxygen systems that might work better for you. You should NEVER enter into a new contract period without first consulting the doctor who writes orders for your oxygen! Also, if for any reason you are not satisfied with your oxygen supplier, now is the time to change to a new supplier.
When beginning a new contract, your oxygen supplier must provide new equipment specified by your doctor in the new letter of medical necessity. Even though your contract period is ending, it is assumed that you are planning to implement a new 5 year contract through your contracted supplier. If they no longer wish to handle your contract, they must help you find another supplier. If they are unable to do this, they must continue to provide your services. If your oxygen supplier renews your contract based on your request to keep the existing equipment in place, this may lower your payment of the 20% billable services, but the supplier will not be able to bill Medicare for rental on your old equipment. If you agree to receive new equipment the oxygen provider will start a new five-year contract with Medicare.
According to the Medicare CMS Supplier Handbook:
'Suppliers voluntarily exiting the Medicare program are reminded that they are in violation of their regulatory and statutory obligations. Section (a)(5)(F)(ii)(I) requires that the supplier that received the 36th month rental payment continue furnishing the oxygen equipment during any period of medical need for the remainder of the equipment's reasonable useful lifetime.
Further, 42 CFR 414.226(g)(1) requires, barring a few exceptions, that the supplier that furnishes oxygen equipment in the first month during which payment is made must continue to furnish the equipment for the entire 36-month period of continuous use, unless medical necessity ends. S
Suppliers leaving the program must give you a ninety-day notice, in writing, that they can no longer provide oxygen therapy services. This notice must be in one of two forms:
In the case of number one above, work with your supplier to find a new oxygen supplier in your area and request that they send a letter to the new supplier on your behalf. This will ensure no interruption in service and a transfer of your medical records to the new supplier within that 90 day period.
Medicare regulations state:
'Providing different oxygen equipment/modalities (e.g., concentrator [stationary or portable], gaseous, liquid, trans-filling equipment) is not permitted unless one of the following requirements is met:
Since liquid oxygen is very different from compressed or gaseous oxygen, the supplier cannot provide a 'same or equivalent' system when changing modalities. Changing from one brand of liquid system to another is considered 'same or equivalent.'
The Medicare CMS Handbook also states: 'The supplier must have a prescription and/or CMN (certificate of medical necessity) to change modalities.'
Contact us to discuss your requirements of oxygen dewar. Our experienced sales team can help you identify the options that best suit your needs.
If you are told that your oxygen supplier will no longer provide your prescribed therapy (liquid) and you have NOT completed your five-year contract, you should do the following:
If your oxygen provider states they are no longer providing the specific equipment/modality you are prescribed, your oxygen provider must find another contractor that does provide what you require, and if unable, they must continue to provide those services.
How do I choose the right oxygen equipment for me?
You, your health care provider and your oxygen supplier should all work together to choose the oxygen system that is right for you ' one that takes into account your lifestyle and activities, as well as the amount of oxygen you need. The goal is to have oxygen equipment that you can and will wear, so you can keep enjoying your usual activities.
Some of the factors to consider when choosing your system and equipment are listed below:
What type of equipment is available?
The three types of oxygen systems currently available are:
The compressed gas system consists of a stationary concentrator, to be used in the home, and a small oxygen tank, to be used outside the home. The liquid oxygen system consists of a stationary concentrator or reservoir to use while you are in your home and an ambulatory tank to use when you go out. The portable oxygen concentrator can serve as both the ambulatory device and the stationary concentrator in certain circumstances.
Type of system Ambulatory component Stationary component Compressed gas system Small, pre-filled tanks delivered to you on a weekly basis, depending on how much oxygen you are using, or tanks that fill overnight at home (aka a home-fill system) from your concentrator.These small tanks must be used in conjunction with an oxygen conserving device or regulator (OCD) that delivers the oxygen in pulses, so that the oxygen supply lasts longer.
Oxygen concentrator with 50-foot tubing Liquid oxygen system Small, refillable tank that you fill from the reservoir as needed Oxygen reservoir with 50-foot tubing Portable oxygen concentrator (POC) A small electric device that can be worn on the back or wheeled around, runs on regular electricity or a battery, is easily recharged even in a car, and requires no tanks or filling. The maximum tubing length for proper delivery of oxygen is 7 feet. These units can be taken onto airplanes.While the terms portable and ambulatory oxygen equipment are often used interchangeably, there is an important difference. In , the 5th Oxygen Consensus Conference differentiated between portable and ambulatory oxygen systems.
Portables are defined as easily moved devices that are not designed to be carried and weigh more than 10 pounds. Ambulatory devices are defined as weighing less than 10 pounds, available for daily use, designed to be carried by the patient, and lasting four to six hours at a setting of 2 liters per minute. They are normally small aluminum cylinders or liquid oxygen containers equipped with oxygen conserving devices (OCDs).
E tanks are the larger, older metal tanks that are wheeled around. They can be the right choice for some people and situations, but are generally not considered to be ambulatory devices. They are often used as back-up systems in the home, should the electric power in the home fail.
The oxygen conserving device (OCD) is the device on your small compressed gas tank that makes the oxygen supply last longer. It causes the oxygen to be delivered only when you take a breath. Not all OCDs deliver the same amount of oxygen as a continuous flow would, so it is important that your oxygen saturation be tested at rest and with activity while you are using the OCD, to make sure you are getting enough oxygen.
Several accessories come with your oxygen equipment. In addition, there are other accessories to make wearing or carrying your oxygen more comfortable. Below are examples of a few basic accessories.
Rates of 4 liters/minute or greater are considered higher oxygen flow.
Where do I get my oxygen and equipment?
Your provider can help you choose an oxygen company, or you may choose any company you want. Some insurance policies dictate which oxygen company you must use.
Who will pay for my oxygen and equipment?
Most insurance policies cover supplemental oxygen when the medical necessity for oxygen is demonstrated. This necessity is based on the oxygen saturation or the arterial blood gas measurements.
Generally, if your O2 saturation falls below 89 percent, or your paO2 falls below 60 mm Hg ' whether at rest, with activity or during sleep ' then you qualify for supplemental oxygen. For more information, see The Need for Supplemental Oxygen.
How do I maintain my equipment?
Your oxygen supply company will give you instructions for cleaning your equipment. Some basics are listed below:
For more information about setting up, using and maintaining your oxygen equipment, see this educational guide created by UCSF experts.
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