Ask Mark

Fran from Colorado asks Mark to explain how Medicare pays for her oxygen.

Mark explains, There are a lot of misconceptions about what Medicare will or will not pay, how much they pay and to whom they pay what and what happens to your equipment at the end of the 5-year (60-month) cycle.

First, $320 is the Medicare “allowable” for monthly billing and is the required-by-law amount your oxygen provider must submit when they bill. Medicare then discounts according to the prevailing reimbursement rate for the region. For those who have an Advantage Plan, the payment from Medicare is based upon a negotiated rate.

For those on regular Medicare, the 20 percent you will be required to pay can be as much as $64 on that $320, as the co-pay is based upon the allowable – not the Medicare reimbursement amount. In those instances, it is entirely possible for a beneficiary to pay more co-pay than Medicare did for the 80 percent portion.

No one who receives Medicare reim- bursed oxygen will ever own their equipment. Oxygen users are “eligible” to enter a new 60-month cycle at the end of each 60-month cycle. When Medicare begins a 60-month cycle, they pay the provider for 36 consecutive months and require the next 24 months be service without payment.

You can continue on with your provider’s equipment without a new cycle. The company still must provide you cannulas, humidifiers, etc. They must also be available for emergency service, especially if your concentrator breaks down and needs to be replaced. If they do initiate another cycle, they are supposed to provide new equipment. Used equipment is not supposed to be provided, much less a simple switch of equipment from one individual to another.

How do you tell if your equipment is new or old? Concentrators have time meters that tell you how many hours of service that device has provided. If you have more than a hundred hours, your equipment is not brand new!

Mark Mangus RRT, BSRC, is a member of the Medical Board of EFFORTS (the

online support group, Emphysema Foundation For Our Right To Survive, www.emphysema. net). He generously donates his time to answer members’ questions.

Roger from EFFORTS asks if taking one’s Albuterol by a nebulizer is better than

taking it by an inhaler.

Mark writes, Whether or not nebulizers versus single inhalation devices are better than the other really depends upon the individual. There are many medical professionals who hold strong views on this subject. Much research has pushed many to extol the virtues of only inhalers – damn the nebulizers. Other studies have used math to argue in favor of nebulized medications. Emergency medicine journals have pretty much argued that inhalers present the better/easier/ quicker effective intervention when we need to get bronchodilators fast! To achieve the same results in emergencies, multiple inhalations of up to ten or more are taken – not the usual one or two we use. In my opinion, this does not apply to peo- ple who simply need maintenance medication and occasional rescue dosing of short-acting medi- cations to adequately manage their symptoms.

For folks with very low flow rates, inhalers become increasingly difficult to use effectively. Nebulizers end up providing an improvement in effective- ness of their medications. Inhalers do provide a very convenient and easily portable option as you venture away from home base. Medicare Part B pays for both the nebulized medications and equipment – a big benefit for people on fixed and limited income. Inhalers can still be pre- scribed and used for times when one is away from home and the nebulizer simply is not an option.

If you think you want to try the nebulizer, ask your doctor. You can try it for a couple of months and see if it works better for you than an inhaler. If it doesn’t provide a significant difference in benefit and effectiveness, you can always return the compressor and change back to inhalers. Medicare pays for the nebulizer for 15 months on a rental basis before it is considered completely purchased and becomes “yours”. So you have a window of time to conduct a trial without com mitment.

Barbara from Texas says she appreciated the tip of using hard candies for dry

mouth but wonders if Mark knows of any sugar-free versions?

Mark replies, There are sugar-free versions of lemon and peppermint candies that you can get online or in local stores. Be careful with how much sugar-free candy you ingest. They usually are sweetened with sorbital, a rather powerful laxative. My Dad used to consume a large bag of M&Ms while sitting in front of the TV. When he switched to sugar-free candies, he continued eating a whole bag. He then told me about this horrible problem of diarrhea and couldn’t figure out why he was having it. When we reviewed what he was eating and found the candy change, I checked the ingredients to find it had sorbital in it. A simple reduction in how much he consumed solved the issue!