Oxygen is covered for patients who have a chronic respiratory disorder. You might be surprised to learn that acute pneumonia alone does not qualify a patient for oxygen. Patients with hypoxia due to to pneumonia generally have another chronic pulmonary condition. If so, be sure to include it in your order.
Oxygen is only covered "in the home." All documentation needs to be written this way. If the patient needs portable oxygen, then you'll need chart noted explaining that the patient requires it for use in the home.
Order Form (DWO)
Every order requires a written prescription. While prescriptions take many forms, DME prescriptions require several specific elements. Make sure to see the section on "Order Form (DWO)."
Face to Face Examination
For virtually all medical equipment that is used in the home, the patient needs to have a "Face to Face" examination. This simply means that the patient was seen and examined/treated for a condition that is related to the need for the item. Consider a simple example of a hospital admission for a broken leg. there is likely already a history and physical that discusses the examination of the broken leg. If so - this step is done!
Just about every piece of Medical equipment has coverage rules. These rules stem from Federal Law and dictate when an item is covered.
The items mentioned in the coverage rule need to be addressed by a clinician in the patient's chart notes. For example, when a patient needs a wheelchair, the doctor needs to determine that a cane or walker will not work. While he would usually just this mentally - now he needs to chart it.
Medicare requires testing for coverage. This can be either an arterial blood gas (ABG) test or pulse oximetry. The test must be conducted while the patient is stable, and within 48 hours of discharge from the hospital. Test results from an exacerbation episode (in the emergency department for example) would not qualify.
You can test the patient at rest (sitting or laying, but not sleeping). If the patient does not qualify (Spo2=>88%) you can do an "exercise test." See the testing guide.