Compliance Resource Guide VirtuOx

Compliance Resource Guide

Procedural Guidelines for CMS qualification for Oxygen

  • Obtain a written Rx for overnight Oximetry and fax it to VirtuOx BEFORE delivering the Oximeter.
  • Print out AOB/Release and patient instructions from the VirtuOx Website and deliver the device and documentation to the patient. Obtain signature for the AOB/Release at this time.
  • Upon return from the delivery fax the AOB/Release to VirtuOx.

You can now upload the device to VirtuOx and view the report provided you have satisfied the 3 conditions referenced below that were extracted verbatim from the 2006 Winter Advisory.

According to the Winter 2006 Region C DMERC Medicare Advisory

  • The program under CMS is for OVERNIGHT QUALIFICATION.
  • The IDTF must have an order from the treating physician BEFORE delivering the oximeter.

The supplier must meet one of the following 3 criteria to receive the report

  • A supplier currently furnishing oxygen or other respiratory services to the beneficiary may receive a copy of the oximetry test results directly from the IDTF to avoid disruptions in the beneficiary's treatment plan.
  • A Supplier with an order to furnish oxygen or other Respiratory services to a beneficiary is a "Covered Entity" that must comply with the HIPAA Privacy Standards. A Covered Entity may receive oximetry test results from a physician or directly from the IDTF for treatment purposes.
  • A Supplier with a release signed by the beneficiary or his/her representative may receive the test results directly from the IDTF. The release must comply with the HIPAA Privacy Standards.

The above text is taken directly from the Winter 2006 Medicare Advisory

Uploading Oximeters to Profox or Nvision

VirtuOx cautions Suppliers not to upload to local software such as Profox or NVision before or after uploading the same data to VirtuOx or any online qualification system. This may subject the data to regulation as a contraindication to section 3 sentence 3 of Article A40135 “In no cases may the DME supplier access or manipulate the test results in any form.” VirtuOx interprets the test results here to mean the raw data on the oximeter. If you upload them to local software the data resides on your “C” drive and then can be accessed and manipulated. When you upload to VirtuOx the data is encrypted and transferred to our server where it is processed. It is never resident on your local system and is safe from access. In Conclusion, if you upload to a local software, the data is not valid for CMS qualification and the patient would need retested pursuant to the proper guidelines.

We at VirtuOx perceive a continued commitment to our customers to help navigate the labyrinth of compliance issues and potential landmines. You can access the latest HME News Brief before continuing to read any further.

The OIG identifies a common practice that is disclosed by a national HME supplier and deems it a potential illegal inducement for current or future business. In this commentary we will outline two common practices regarding Oximetry Testing and offer a solution to remain in good standing with the OIG.

Example-1

A physician requests a Supplier to perform an overnight oximetry screening on a specified patient. The Supplier drops off the oximeter and picks it up the following day. The supplier then uploads it to a local software program such as NVision or Profox. If the patient qualifies they upload to an online lab such as VirtuOx. If the patient does not qualify the Supplier discards the data and carries on. There are 2 major problems to this approach.

  • If you upload data to a local software such as NVision or Profox the data is no longer valid to upload to an online lab such as VirtuOx. The Patient would have to be retested using the proper procedure.
  • If you upload data to a local software such as NVision or Profox and the patient does not qualify and you do not upload the data to an online lab such as VirtuOx, you could be guilty by OIG indications of offering an inducement to the physician and potential beneficiary for current and future business. This is so because the test is not billed for and is considered a "FREEBIE" at the expense of the Supplier.

The solution

All Overnight testing must be uploaded to VirtuOx pursuant to CMS guidelines and appropriately billed for by VirtuOx.

Example-2

A physician calls the Supplier of Oxygen for a patient he currently has on 1 LPM nocturnal. The treating physician requests an overnight on 1 LPM to assess the efficacy of the liter flow and or to consider additional treatment options. The supplier delivers the oximeter to their oxygen patient and retrieves it the following day. The Supplier uploads the data to a local software such as NVision or Profox and forwards the report to the treating physician. If we understand the OIG warning correctly, this test should be processed through an online lab such as VirtuOx and billed to Medicare. It can be construed that the Supplier is giving a free value added service to the beneficiary and is an inducement for the physician and beneficiary to continue current and future business with the supplier.

This practice has been common for quite some time among Suppliers. It only seems to make sense that a Supplier can perform routine oximetry on current patients they have on Long Term Oxygen Therapy (LTOT) in response to an order by the treating physician to determine the efficacy of the liter flow settings or even consider change or discontinuing the current therapeutic approach. If we understand the spirit and the letter of the OIG commentary on this matter these bundled services are considered "FREEBIES" and subject to regulation as inducements for continued and future business. The Supplier does not charge for them nor do they use an Independent Lab such as VirtuOx. The solution is simple.

The solution

All Overnight testing should be uploaded to VirtuOx pursuant to CMS guidelines and appropriately billed for by VirtuOx.

Be proactive not reactive to governmental regulatory mandates

The above is not a legal opinion. It is intended to be a dialogue regarding CMS and Patient Self-Administered Overnight Oximetry Testing. It is critical that the Supplier consult their compliance officer and/or healthcare attorney when developing a Supplier's strategy and policy in conforming to governmental guidelines.

Unlike other Oximetry testing applications, VirtuOx has no contracts to sign, no expensive Palm devices or hardware to purchase and is available at NO CHARGE!