Thursday, February 6, 2014

Detailed Written Order Requirements

As a requirement of the Affordable Care Act, which went into effect on July 1, 2013, and Medicare began enforcing on January 1, 2014, whenever prescribing specific DME items (see list below) for Medicare patients, you must:
  • Document in progress notes that the patient has had a face-to-face encounter with a practitioner (physician, PA, NP, or CNS) and was evaluated for a condition that supports the DME ordered.
    1. Face-to-face encounters occurring within 6 months prior to the prescription date are admissible IF they document the condition for which the prescription is being written.
    2. If the DME is ordered by a PA, NP, or CNS, a physician must document the occurrence of the face-to-face encounter by co-signing and dating the pertinent portion of the medical record.
  • Write a prescription containing the following elements:
    1. Patient’s name
    2. Physician’s name
    3. Date of the order and the start date, if the start date is different from the signature date
    4. Detailed description of the item(s)
    5. Physician signature and signature date (Signature or date stamps are not allowed)
    6. Prescribing practitioner’s NPI number
    7. Route of administration (nasal cannula, mask, etc.)
    8. Dosage, Concentration, or Liter Flow
    9. Frequency of use (continuous, nocturnal – PRN or as needed are not acceptable)
    10. Diagnosis is not required but highly recommended.

Equipment cannot be delivered until the Face-to-Face and Physician's Detailed Written Order are received by the DME provider as Medicare requires it prior to delivery.   

Please note for oxygen therapy patients, Medicare also requires that a saturation test be taken within 30 days prior to the delivery of the equipment. This test cannot be taken by Skilled Nursing Facility staff. If the test is taken during a hospital stay, it must be within 2 days of discharge.

Procedure Codes that NRS provides that are included in the new requirements:
  • Nebulizers: E0570, e0575, E0580, E0585, K0730
  • Oxygen:  E0424, E0431, E0433, E0434, E0439, E0441-E0444
  • Positive Airway Pressure Devices:  E0601, E0470
  • Respiratory Assist Devices:  E0470-E0472
  • Ventilators: E0450, E0460, E0461, E0463, E0464

Links for further information about the Detailed Written Order and Face-to-Face requirements:

From CMS


Monday, August 12, 2013

Medicare Competitive Bidding Resources

As most of the durable medical equipment (DME) beneficiaries now know, Round 2 of Medicare's Competitive Bidding began July 1st, 2013. This round of bids has caused an industry-wide ripple that has shaken the foundation and left both HME companies and their customers with cause for concern. Companies are struggling with how to remain viable in this new climate, and customers are seeing the effects on companies trickle down to affecting their level and availability of care.

For this post, we're going to focus on some resources for those affected customers. (Click on the following if you'd like to read more about Competitive Bidding and it's effects.) Customers may find that their current DME supplier can no longer serve them depending on their rental status, and be forced to switch to another supplier they do not know and who does not know them. In some cases, DME companies have already or are considering closing their doors if they were not awarded a contract under competitive bidding. Obviously, this leaves Medicare beneficiaries scrambling to find another supplier. All these changes to the companies providing DME, of course, ultimately has an impact on the customers and their care.

So, if you're a Medicare beneficiary looking to get further educated on competitive bidding, want to share your story of how this legislation has affected you and your care, or want to contact officials to call for the repeal of competitive bidding, check out the resources below.

Resources for Medicare Beneficiaries:

How to Act:
  • Medicare Beneficiary Complaint Hotline - Call the Medicare complaint hotline at 1-800-404-8702. The hotline is available for anyone who is having any kind of problem as a result of Round 2 or Round 1.
  • Visit the People for Quality Care Action Center for information on how you can help.
  • AAHomecare - Send an email to telling us what effects the bidding program will have on you, your family, your business or your community. AAHomecare is collecting stories to let Congress, Medicare, CMS, and the media know just how bad the bidding program really is.
  • Meet with your representative face to face when they are home in your district.

Tuesday, July 31, 2012

New NRS Website Launched

Northwest Respiratory Services is pleased to announce the launch of their new website on July, 27th 2012. The site is completely redesigned and revised to include instruction manuals, resources, product manuals, and troubleshooting information to help guide and inform our customers. Our new website also brings together our new branding strategy unifying NRS' online presence across media and social networking platforms. We hope our customers find this to be a more user friendly and informative experience up-to-date with the latest advantages of online resources. Check it out and let us know what you think!

Northwest Respiratory Services New Website

Northwest Respiratory Services

Thursday, July 19, 2012

Infection Control

After a brief absence, well maybe not so brief, we're back with another Tip of the Month. Infection Control is one of the most important things to keep an eye on both for us, as providers of durable medical equipment (DME), and for you our customers. We all need to limit the possibilities and avenues that can spread infections, viruses, and diseases. So, read on to find out some of our recommendations for practicing infection control.

Infection Control
If you have COPD, or any other respiratory ailment, you can avoid infection by staying away from people that have the flu or upper respiratory infections. (Flu or pneumonia shots have become much more readily available in recent years as well.) Changes in your cough, wheezing, or mucus color and production can signal the onset of an infection. If you do get an infection, contact your physician so that treatment may begin right away.

Keeping your equipment clean is also a necessary step in infection control. You can wash your mask or cannula with liquid soap 1-2 times a week, being sure to rinse it well. At a minimum, change your cannula every week and tubing or humidifier bottle every month. If you do use humidity, you can also follow these steps to clean the humidifier bottle:

  • Soak all parts in warm soapy water for 15 minutes. Use a brush to remove any remaining particles.
  • Rinse all parts in warm water and shake dry.
  • To disinfect, soak the parts in a basin of one part white vinegar to three parts water for 20 minutes.
  • Rinse all parts and let air dry.
Foam Filter on PB540
For equipment, be sure to wipe the gauges, concentrator, or liquid unit with a clean damp cloth. For concentrators with an external foam filter, brush clean or rinse with warm water and let air dry before putting them back on the machine. Our service technicians can show you where these filters are located.

Though not an all-encompassing guide to infection control, the above steps and suggestions should help you decrease your risks and chances for infection and maintain your personal health. Thanks for reading, and as always we welcome your comments and suggestions.

Northwest Respiratory Services

(Images from, NRS)

Wednesday, December 21, 2011

Season's Greetings 2011

Northwest Respiratory Services would like to
wish everyone a safe and Happy Holiday!

Tuesday, December 6, 2011

Oxygen System Troubleshooting

As the weather turns colder, especially here in the Midwest, oxygen equipment can sometimes be prone to some issues. For instance, as with any electronics, concentrators included, you want to do your best to keep them warm so that they operate correctly and efficiently.

If you are using a portable oxygen concentrator for travel, you would not want to leave the equipment in a cold vehicle overnight as this can affect performance of the batteries in particular. Oxygen cylinders should also not be stored outside during extreme cold as seals can be affected by the low temperatures. Concentrators should also be allowed to warm up before use to ensure optimal operating conditions for use.

For more information on troubleshooting oxygen related equipment please see the below information. After all, it's not just cold weather that can lead to problems with equipment operation.


Concentrator does not turn on.
  1. Make sure unit is plugged in.
  2. Check outlet for power with a working light. If the outlet does not have power, switch plug to new outlet.
  3. If outlet has power and unit is plugged in but still does not turn on switch oxygen tubing to back-up tanks and call NRS.
Concentrator turns on but oxygen does not flow.
  1. Check oxygen flow meter on the front of the unit. Be sure flow rate is set.
  2. Check humidity bottle for bubbling. If humidity bottle is not bubbling, disconnect humidity bottle and reconnect.
  3. Place cannula tips in a glass of water and check for bubbles. If water does not bubble, check tubing for kinks or disconnect.
  4. Replace Oxygen Tubing.
  5. Switch oxygen tubing to back-up tanks and call NRS if oxygen still does not flow.
Concentrator alarms low oxygen.
  1. Make sure nothing is within 12 inches of the concentrator.
  2. Remove and clean filter (do not put a wet filter back on the concentrator).
  3. Re-start concentrator.
  4. If concentrator alarm continues, call NRS.

Liquid Oxygen

Liquid oxygen system does not provide oxygen.
  1. Check for tubing disconnect or kinks.
  2. Disconnect humidify bottle or oxygen adapter and reconnect.
  3. Check for bubbling in humidity bottle.
  4. If the humidifier bottle is not bubbling unscrew cup and reconnect.
  5. If humidity bottle is bubbling and oxygen still does not flow, place cannula in a cup of water and check for bubbles.
  6. Check liquid oxygen content level.
  7. If empty or oxygen still does not flow, switch to back-up oxygen tanks and call NRS.
Liquid portable oxygen and stationary system are frozen together.
  1. Do not force apart.
  2. Wait 10-30 minutes and then separate the two pieces.
  3. If units still do not separate, call NRS.

Oxygen Cylinders

Oxygen leaking from cylinder regulator.
  1. Close oxygen cylinder valve.
  2. Remove oxygen regulator and make sure yoke seal (washer) is on the regulator.
  3. Align regulator pins on oxygen cylinder and tighten “T-handle”.
  4. Turn cylinder valve on with wrench.
  5. If problem persist call NRS.
Oxygen does not flow from oxygen cylinder.
  1. Turn valve “on” by turn valve counterclockwise.
  2. Check gauge for oxygen content. If empty replace cylinder.
  3. Check oxygen-tubing connections for disconnect or kinks. Un-kink and reconnect any tubing issues.
  4. Place oxygen tubing in a glass of water to see if oxygen is flowing. The water will bubble if oxygen is flowing.
  5. Call NRS if problem continues

Please do not hesitate to call NRS @ 800-232-0706 if you are having troubles with your equipment.

Wednesday, November 2, 2011

Your Oxygen Prescription

Oxygen is a drug. It must be prescribed for you by your physician. Just as you are unique, so is your disease that requires oxygen, and so is your oxygen prescription. Your doctor has, after having examined you and ordered specific tests, determined:
• How much oxygen you need to use, and
• When you need to use your oxygen.
Your doctor has given us your oxygen prescription and we have supplied you with the appropriate equipment and supplies. It is very important that you follow your doctor’s orders by always using the prescribed flow at the prescribed times. Your medical technician can answer any questions you might have regarding your oxygen and its use.
If you feel you need a change in either, how much oxygen you are using, or when you are to use it, please see your doctor. He or She can determine if a change in your prescription is necessary. If we receive a new oxygen order for you from your doctor, we will re-evaluate your equipment needs and supplies to assure that they are appropriate for your new prescription.

Contact NRS with any questions, we're here to help!  1-800-232-0706