FEHBP Fee for Service Payment Rates for Oxygen are Virtually the Same as Medicare Rates

Main Category: Caregivers / Homecare
Article Date: 14 Sep 2004 - 0:00 PDT


A comprehensive study of home oxygen pricing found virtually no difference between Federal Employees Health Benefits Program (FEHBP) fee-for-service plans and Medicare.

Anticipating an adjustment to Medicare reimbursement for the home oxygen benefit based on FEHBP pricing, the American Association for Homecare (AAHomecare) commissioned a nationwide, comprehensive statistical survey of FEHBP pricing. During July and August, Morrison Informatics, Inc. collected data about 107 FEHBP plans and determined that among the fee-for-service plans there is virtually no difference between the median FEHBP price and the median Medicare payment rates for home oxygen.

The study found a difference of less than one percent (0.6%) between the $227.50 median monthly FEHBP fee-for-service payment for stationary oxygen systems and the $228.80 median Medicare payment for stationary oxygen (HCPCS codes E0424, E0439, and E1390). Likewise, the study found a difference of less than one percent (0.3%) between the $36.08 median monthly FEHBP fee-for-service payment for portable oxygen systems and the $35.97 median Medicare payment for portable systems (HCPCS codes E0434 and E0431).

The comprehensive survey captured not only FEHBP plan payments for oxygen equipment, but also separate FEHBP plan payments for oxygen contents included with stationary and portable oxygen units. Inclusion of these oxygen content payments is critical to the accuracy of any survey of median FEHBP prices.

Under the Medicare Prescription Drug, Improvement and Modernization Act of 2003, CMS was directed to reduce reimbursement for home oxygen based on a study prepared by the Department of Health and Human Services' Office of Inspector General (OIG), which will report on median FEHBP pricing. That OIG report is expected to be released today.

"AAHomecare looks forward to working with CMS to ensure it considers all appropriate data on median FEHBP pricing for home oxygen to ensure equitable pricing and continued access to this critical homecare therapy for Medicare beneficiaries," said Kay Cox, President and CEO of the American Association for Homecare. "Later this week, AAHomecare will release the full Morrison Informatics study with detailed, comprehensive, and accurate median FEHBP pricing information."

Homecare provides tremendous value for Americans' healthcare dollar. AAHomecare is the only national association representing every line of service in the homecare community, including home health and home medical equipment providers, respiratory and infusion therapy, telemedicine, and rehab and assistive technology. Representing 3,000 member locations nationwide, AAHomecare advances the value and practice of quality, cost-effective health care services where patients prefer them - at home.

Michael Reinemer
Director, Communications
American Association for Homecare
625 Slaters Lane, Suite 200
Alexandria, VA 22314-1171
703-535-1881
http;//www.aahomecare.org

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