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Elizabeth M. Whitehorn, Director

Provider Notice Issued 05/18/2017

Provider Enrollment Changes for Nursing Facilities Billing for Oxygen

 

Date:  May 18, 2017                                                  

 

To:     Long Term Care Facilities – Nursing Facilities only  

 

Re:     Provider Enrollment Changes for Nursing Facilities Billing for Oxygen

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This notice details new provider enrollment instructions for Nursing Facilities (NF) billing Healthcare and Family Services (HFS) directly for oxygen provided to residents. This new enrollment option allows NF’s billing for oxygen to be classified as low or “limited” risk.

 

In the Program Advanced Cloud Technology (IMPACT) system, a NF enrolled as a Durable Medical Equipment (DME) provider is currently designated as a “high categorical risk.” Long Term Care (LTC) providers, conversely, are designated as “limited categorical risk” in the IMPACT system. To streamline the enrollment process, while maintaining adequate safeguards and protections, LTC providers that bill for oxygen only, may now submit a separate enrollment in IMPACT. Facilities enrolling to bill for oxygen only will not be subject to the same Office of Inspector General (OIG) requirements as a DME provider because of the new “limited categorical risk” designation.

 

NFs directly billing for oxygen must have a National Provider Identifier (NPI) number that is separate from the NPI used to bill for institutional room and board services. To become eligible to bill for oxygen, the NF must enroll in IMPACT with a separate NPI as follows:

Provider Type: LTC Facility

Specialty:        Nursing Facility

Subspecialty:   LTC Oxygen

 

NFs that have a pending (“in-review” status) enrollment request in IMPACT with the Provider Type “Durable Medical Equipment/Medical Supplies” may choose to do one of the following:

 

·       Process the enrollment request ‘as is’; or

·       Submit an enrollment using “LTC Facility” as the Provider Type.

 

If the NF has an enrollment that is still “In Review” status, the provider should submit a new request to IMPACT.Help@illinois.gov to put the enrollment back “In Process.” The Subject Line should state, “LTC DME back in process request.” The provider name and NPI must also be included with the request. Once the application is back in process, the provider can delete the DME Specialty and add the Nursing Facility Specialty and LTC Oxygen Subspecialty.  

 

NFs already approved and enrolled as a DME provider may submit a modification request in IMPACT allowing the provider to change the Provider Type, Specialty and Subspecialty as outlined above.  

 

Once enrolled, the claim submittal process and reimbursement rates found on the DME fee schedule remain the same. The NF may bill for oxygen and no other DME claims using the NPI number specifically assigned for oxygen billing. Instructions for oxygen billing by LTC facilities may be found in the Handbook for Providers of Medical Equipment and Supplies.

 

To obtain a new NPI, follow instructions on the National Plan & Provider Enumeration System (NPPES) website.

 

Questions may be directed to the Bureau of Long Term Care at: 844-528-8444.

 

Felicia F. Norwood

Director