Table of Contents
1. Introduction
2. Understanding Oxygen Services & Patient Eligibility
3. Oxygen Equipment Overview
4. Oxygen Prescription & Order Documentation
5. Medicare & Insurance Compliance
6. Portable Oxygen Concentrator (POC) Requirements
7. Hospital Discharge & Home Oxygen Qualification
8. Portability & Mobility Documentation
9. Oxygen Titration and Qualification Process
10. Exercise Testing & Oxygen Qualification
11. Pulsating Dose vs. Continuous Flow Oxygen
12. Pediatric Oxygen Considerations
13. Medicare Guidelines for Oxygen Coverage
14. Billing and Insurance Considerations
15. Appendix: Quick Reference Charts & Contact Information
16. Overview of Oxygen Therapy
17. Portable and Stationary Oxygen Equipment
18. Oxygen Concentrators and Conserving Devices
19. Equipment Setup, Usage, and Maintenance
20. Troubleshooting Common Issues
21. Medicare Qualifications for Oxygen Therapy
22. Oxygen Therapy for Sleep-Related Conditions
23. Billing and Equipment Limitations
24. Battery Information and Charging
25. Equipment Returns and Rentals
26. Patient Purchase Options
27. Frequently Asked Questions (FAQs)
1. Introduction
This training manual serves as a reference for A&R Medical Supply staff handling oxygen
orders, equipment setup, and Medicare compliance. It ensures that proper procedures are
followed, reducing errors and maintaining compliance with insurance requirements.2. Understanding Oxygen Services & Patient Eligibility
Before processing an oxygen order, confirm the following:
●
The patient is an active A&R Medical Supply customer.
●
Patients receiving oxygen services from another provider (e.g., Rotec) cannot be
serviced by A&R.
●
Medicaid plans do not cover Portable Oxygen Concentrators (POCs), requiring patients
to seek alternative options.
●
For transition patients (Presbyterian without secondary insurance):
○
All equipment from the previous provider must be picked up before A&R can
process an order.
3. Oxygen Equipment Overview
A&R Medical Supply provides two primary types of oxygen equipment:
Home Oxygen Equipment:
●
Requires a prescription indicating the need for continuous oxygen therapy.
●
Includes oxygen concentrators, stationary tanks, and home fill systems.
Portable Oxygen Equipment:
●
Suitable for patients with a documented need for mobility.
●
Includes portable tanks and POCs.
●
Patients must have a chronic lung or heart condition to qualify for a POC.
●
A credit card must be kept on file for POCs, even if the patient has dual insurance
coverage (e.g., Presbyterian & United Healthcare).
4. Oxygen Prescription & Order Documentation
To process an order, ensure the following requirements are met:
Doctor’s Prescription Must Include:
●
Printed and signed name with NPI number.●
Flow rate and delivery method (Nasal Cannula or Mask).
●
Duration of use (Lifetime, 3 months, etc.).
●
Oxygen saturation (O2 sat) results:
○
Outpatient: Within the last 30 days.
○
Hospital Discharge: Within 2 days before discharge.
○
If the test is older than 31 days, a new test is required.
●
Confirm the doctor is Medicare-certified via the PECOS system.
5. Medicare & Insurance Compliance
Basic Medicare Requirements:
1. Patient must have a diagnosis of a chronic lung or heart condition.
2. Prescription orders must be for at least three months.
3. Orders must specify:
○
Patient’s name.
○
Type of equipment ordered (e.g., Concentrator & Portable Tank, but not both a
Portable Tank and POC).
○
Flow rate (liters per minute).
○
Delivery method.
○
Duration of use.
4. Oxygen saturation (O2 sat) results must be recent:
○
Within 30 days for outpatient services.
○
Within 2 days before hospital discharge.
5. CGS (Medicare Database) Check:
○
Verify patient is NOT receiving oxygen services from another provider within the
last 36 months.
6. Portable Oxygen Concentrator (POC) Requirements
To qualify for a POC, a patient must meet all of the following criteria:
●
Be an A&R Medical Supply customer.
●
Have a documented chronic lung or heart condition.
●
Require 3 liters per minute or less.
●
Be tested and titrated by a respiratory therapist.
●
Have a credit card on file for loss or damage coverage.7. Hospital Discharge & Home Oxygen Qualification
●
Patients must have two oxygen saturation tests within 2 days of discharge.
●
If discharge occurs more than 2 days after testing, a new test must be performed.
●
The oxygen prescription should align with the most recent O2 saturation results.
8. Portability & Mobility Documentation
Eligibility for Portable Oxygen:
✅ Doctor must document the patient’s mobility status.
✅ If the patient is bed-bound or house-bound, they do not qualify for portability.
✅ A concentrator may be provided, but not a portable unit.
9. Oxygen Titration and Qualification Process
●
Before prescribing a conserving device, a titration test is conducted to ensure
compatibility.
●
If patients qualify for portable oxygen pumps, retesting is not required.
●
Patients with conserving devices should have been titrated previously.
10. Exercise Testing & Oxygen Qualification
●
Patients qualify for oxygen therapy if their O2 saturation drops below 89% during
exercise.
Exercise Testing Steps:
1. Measure Room Air Saturation while sitting.
2. Conduct an Exercise Test (Walking or exertion).
3. Conduct a Recovery Test (Oxygen use, verifying improvement).11. Pulsating Dose vs. Continuous Flow Oxygen
Pulsating Dose Oxygen:
●
Oxygen is delivered only upon inhalation, making it more efficient and conserving
oxygen usage.
●
Suitable for patients who can tolerate intermittent flow.
Continuous Flow Oxygen:
●
Oxygen flows at a constant rate, regardless of inhalation.
●
Necessary for patients with more severe oxygen needs.
12. Pediatric Oxygen Considerations
●
Pediatric Regulators: Support fractional oxygen flow (¼, ½, ¾ liters).
●
Adult Regulators: Only support whole-number flow settings (1, 2, 3, etc.).
●
Flow Meters: Required for infants needing fractional flow rates.
●
Billing Considerations: Flow meters and cannulas are part of the oxygen package and
not separately billed.
13. Medicare Guidelines for Oxygen Coverage
●
Medicare covers oxygen therapy for 36 months (3 years).
●
After the 3-year rental period, equipment enters a maintenance phase for 2 additional
years without reimbursement.
●
After 5 years, a new rental cycle begins.
●
During maintenance periods, Medicare does not reimburse for new equipment.
Billing Notes:
●
If a patient is in the maintenance phase, new equipment should not be provided.
●
Patients who received a conserving device after 1 year receive Medicare compensation
for only 2 more years.
14. Billing and Insurance Considerations●
Portable Oxygen Code: EO-431.
●
Stationary Oxygen Code: EO-424.
●
Insurance Updates: Ensure accurate documentation when switching between portable
and stationary equipment.
●
Important: Do not remove a stationary code if only the portable unit is returned.
15. Appendix: Quick Reference Charts & Contact
Information
●
Oxygen Qualification Quick Chart.
●
Medicare Coverage Breakdown.
●
Key Contact Information.
16. Overview of Oxygen Therapy
Oxygen therapy is prescribed to patients with respiratory conditions that require supplemental
oxygen. It is used to manage conditions such as Chronic Obstructive Pulmonary Disease
(COPD), sleep apnea, and other chronic or acute respiratory issues.
Types of Oxygen Therapy:
●
Continuous Oxygen Therapy: Requires both portable and stationary systems.
●
Nocturnal Oxygen Therapy: Used only during sleep, typically with a stationary unit.
●
Portable Oxygen Therapy: Utilizes portable concentrators or tanks for mobile use.
17. Portable and Stationary Oxygen Equipment
Portable Oxygen Concentrators (POCs):
●
Designed for mobility, operating on battery or AC/DC power.
●
Typically use pulse dose technology to conserve oxygen.
●
Equipped with carrying bags allowing proper airflow.
Stationary Oxygen Concentrators:
●
Provide continuous oxygen at home.
●
Require access to a power source.●
Have higher oxygen output than portable systems.
Conserving Devices:
●
Extend oxygen supply by releasing oxygen only during inhalation.
18. Oxygen Concentrators and Conserving Devices
Portable Concentrators:
●
Require a warm-up period and may be loud initially.
●
Display screens show: flow settings, battery life, and operational status.
●
Will alarm if no breath is detected.
Conserving Devices:
●
Reduce oxygen waste by delivering oxygen only when inhaling.
●
Improve tank longevity for portable use.
19. Equipment Setup, Usage, and Maintenance
Setup Guidelines:
1. Secure tubing connection to the unit.
2. Turn on the device and adjust settings per prescription.
3. Ensure patient is receiving oxygen by checking the indicator.
Usage Best Practices:
●
Keep air vents unobstructed.
●
Ensure external filters are cleaned regularly.
●
Replace foam filters every three months or as recommended.
Maintenance Recommendations:
●
Patients should bring in units periodically for servicing.
●
Equipment must be checked for proper functioning.20. Troubleshooting Common Issues
Device Alarms:
●
No Breath Detected Alarm: Ensure the nasal cannula is properly connected.
●
Overheating Warning: Check for blocked air vents and remove obstructions.
●
Low Battery Alert: Charge the battery or connect to AC/DC power.
●
Blocked Airflow Alert: Inspect for tubing kinks or clogged filters.
21. Medicare Qualifications for Oxygen Therapy
Non-Chronic Conditions (e.g., Bronchiolitis):
●
Requires an oxygen saturation (O2 stats) of 88% or lower.
●
Order must include a diagnosis and cannot exceed three months.
●
If oxygen is needed beyond three months, PCP reevaluation is required.
Chronic Conditions (e.g., COPD, ALS, Cystic Fibrosis):
●
Eligible for long-term oxygen therapy.
●
Covered under durable medical equipment (DME) guidelines.
22. Oxygen Therapy for Sleep-Related Conditions
Obstructive Sleep Apnea (OSA) & Nocturnal Oxygen:
●
Requires a sleep study or overnight oximetry while using a PAP device.
●
The order must state “Nocturnal Oxygen” and include flow rate details.
COPD Patients & Nocturnal Oxygen:
●
Overnight oximetry is required for qualification.
●
A full sleep study is not necessary.
23. Billing and Equipment Limitations
●
Medicare covers specific oxygen-related equipment under strict guidelines.●
Non-billable supplies (e.g., extra tubing, cannulas) are limited.
●
Equipment billing depends on prescribed therapy (24/7 vs. nocturnal use).
●
Staff can reference CGS.org for up-to-date Medicare policies.
24. Battery Information and Charging
Battery Life:
●
Battery duration varies by usage and charging habits.
●
A fully depleted battery takes approximately six hours to recharge.
Charging Best Practices:
1. Charge immediately upon returning home.
2. Avoid full battery depletion before recharging.
3. Use only approved chargers (AC for wall outlets, DC for cars).
Backup Power Options:
●
Additional batteries available for purchase.
●
Standalone chargers allow for separate battery charging.
●
Larger concentrators require direct AC power.
25. Equipment Returns and Rentals
Returning Equipment:
●
Patients returning rentals must include all components:
○
Main unit, battery, AC and DC chargers.
○
Equipment must retain A&R Medical Supply stickers.
Insurance Rental Guidelines:
●
Medicare follows a five-year rental cycle.
●
Insurance does not cover outright equipment purchases.
26. Patient Purchase Options●
Patients may purchase units outright with a prescription.
●
Warranty Coverage:
○
Equipment: 5 years
○
Batteries: 1 year
○
Internal filtration system: 1 year
●
Used equipment does not carry warranties.
27. Frequently Asked Questions (FAQs)
1. Can a patient charge the unit while using it?
○
Yes, but charging takes longer when in use.
2. Do larger units have backup batteries?
○
No, they require direct AC power.
3. What happens if rental equipment is returned incomplete?
○
Missing components must be replaced before returning to inventory.
A&R Medical Supply Oxygen Concentrator
Training Manual
Introduction
Welcome to A&R Medical Supply’s Oxygen Concentrator Training Manual. This guide provides detailed instructions on the operation, troubleshooting, and proper handling of oxygen concentrators to ensure seamless service and minimize unnecessary service calls.
Understanding Oxygen Concentrators
Oxygen concentrators are essential medical devices that deliver concentrated oxygen to
patients. Proper handling and maintenance are crucial to avoid malfunctions and alarms. This
manual will help staff, including drivers and customer service representatives (CSRs), identify
and troubleshoot common issues.
1. Identifying and Handling Filters
Key Points:
●
Different concentrators require specific filters. Two filters may look similar but are
designed for different models.
●
Incorrect filter installation can cause the machine to malfunction.
Illustration: (Image of two similar-looking filters with labels identifying which concentrator each
belongs to.)
Troubleshooting Tip: If a high-flow machine is alarming, check if the correct filter is installed.
2. Common Alarm Causes & Troubleshooting
A. Insufficient Airflow Due to Filter Issues
●
Some concentrators have seals that must be removed before use.
●
Failure to remove the seal can restrict airflow and trigger alarms.B. Cold Environments & Alarms
●
Concentrators should always be stored in warm areas.
●
Cold environments can cause new or used machines to alarm upon startup.
Illustration: (Image of a concentrator in a cold vs. warm environment.)
Best Practice: Advise patients to keep their machines in a room-temperature environment.
3. Proper Machine Placement & Power Supply
A. Outlet & Power Considerations
●
Do not plug concentrators into power strips, especially in mobile homes.
●
Mobile home wiring may not support high-powered devices and can cause frequent
alarms.
B. Avoiding Shared Outlets
●
Do not plug CPAP machines and oxygen concentrators into the same outlet.
●
Ensure each device has a dedicated power source to prevent power fluctuations.
Illustration: (Diagram showing incorrect vs. correct power setups.)
4. Humidifier Bottle Setup & Misuse Prevention
A. Common User Errors
●
Patients may not fully close the humidifier bottle, causing alarms.
●
Kinked tubing can restrict airflow and cause a loss of oxygen delivery.
B. Prescription Requirements for Humidifiers
●
Patients must have a doctor’s prescription to receive a humidifier.
●
High-flow machines (10 liters) require green-labeled humidifiers, while 5-liter
concentrators use black or brown humidifiers.
Illustration: (Image of different humidifier bottle types with labels.)
Best Practice: Verify prescriptions before dispensing humidifiers.5. Effective Communication & Documentation
A. CSR Responsibilities
●
When receiving a service call, identify the type of concentrator before dispatching a
driver.
●
Ask the patient for the concentrator brand, model, and filter type.
B. Driver Responsibilities
●
Drivers should confirm machine specifications before taking a replacement unit.
●
Follow standard procedures when troubleshooting over the phone.
C. Maintaining Accurate Patient Records
●
CSRs must create and update templates in the system (e.g., Brightree) to keep track of
patient setups.
●
A 48-hour follow-up call should be made to ensure proper machine function.
Illustration: (Screenshot example of a well-maintained patient record.)
Best Practice: Keep clear documentation to streamline service and prevent repeat issues.
6. Customer Education on Machine Usage
A. Instructing Patients on Proper Use
●
Always inform patients that their concentrators must stay in a warm area.
●
Emphasize the importance of proper humidifier attachment and tubing placement.
B. What to Do if a Machine Alarms
●
Instruct patients to check filters, tubing, and power sources before calling for service.
●
Ensure patients understand the proper use of their humidifier bottles and oxygen
delivery systems.
Illustration: (Step-by-step flowchart for troubleshooting an alarming concentrator.)7. Oxygen Tubing and Flow Rates
Understanding Oxygen Tubing
●
There are two types of oxygen tubing provided:
○
High-flow tubing (darker in color) is used for higher oxygen flow rates.
○
Standard tubing is designed for 5-liter per minute (LPM) flow rates.
●
If a machine alarms at 20% functionality, check for kinked tubing as this is the most
common cause.
●
Patients should always be provided with extra tubing to prevent disruptions in oxygen
delivery.
Handling Alarms on EverFlo Units
●
EverFlo concentrators tend to alarm when set to 0.5 LPM for pediatric patients.
●
To avoid alarms, use a pediatric flow meter, which allows precise adjustments down to:
○
0.5 LPM
○
0.25 LPM
○
0.125 LPM
●
Set the flow meter at 2 LPM and adjust accordingly.
●
Always check for availability of pediatric flow meters.
Setting Up Oxygen Flow for a Pediatric Patient
1. At the patient’s home, use a 4-foot oxygen tubing:
○
Connect tubing from the concentrator to the pediatric flow meter.
○
Adjust the flow to the prescribed amount (0.5 LPM, 0.25 LPM, etc.).
○
Ensure the output flows properly to the child.
2. Only specific concentrators will not alarm at 0.5 LPM—verify the equipment.
8. Patient Setup Protocol
Introducing Yourself to the Patient
1. Identify yourself and the company:
○
Example: “Hello, I’m [Your Name] from A&R Medical. I’m here to set you up with
oxygen.
”
2. Confirm the prescribed oxygen flow rate:
○
Example: “Do you know your prescribed liter per minute (LPM)?”
○
Drivers should have this information on their delivery sheet.
3. Verify usage instructions:
○
“You will be using 2 LPM at night only / 24 hours a day, as prescribed.
”Common Patient Questions and Answers
●
Can I plug the concentrator into an extension cord?
○
No. It must be plugged directly into a wall outlet to avoid overheating and
potential hazards.
●
Can I use my CPAP with the concentrator?
○
Patients should consult their respiratory therapist (RT) for proper CPAP oxygen
integration.
●
Can I smoke while using oxygen?
○
Absolutely not. Smoking can contaminate the unit and cause fires. The machine
absorbs smoke, affecting future users.
●
Can I keep my concentrator in a closet?
○
No. The machine requires adequate airflow to function properly. It should be at
least 6 inches away from the wall.
Machine Maintenance Responsibilities
●
Routine Checks:
○
After setup, a Customer Service Representative (CSR) will contact the patient
within 48 hours.
○
A technician will schedule a concentrator check, which includes:
■ Filter replacement
■ Oxygen purity testing
■ General maintenance
●
Patient’s Responsibility:
○
If oxygen is no longer needed, they must contact A&R Medical for pickup.
○
Regular concentrator maintenance checks are required per prescription.
9. Cleaning and Storage Guidelines
Proper Care for Oxygen Concentrators
●
Filters must be cleaned weekly.
●
Patients can only clean the external cabin filter by rinsing it with water and allowing it
to dry completely before reinstalling.
●
Patients should request an extra filter for swapping out during cleaning.Common Issues and Troubleshooting
Issue Possible
Cause
Solution
Machine alarms Kinked tubing Check and straighten tubing
Machine overheats Blocked vents Ensure a 6-inch clearance from walls and objects
Low oxygen output Dirty filter Clean filter weekly, request a replacement if
needed
Unusual Findings During Maintenance Checks
●
Always inspect the unit for contaminants (e.g., dust, smoke, roaches, or rodents).
●
If a machine has been exposed to excessive smoking, it must not be reassigned to a
new patient.
Illustrations & Visual Guides:
(Illustrations should be included showing:)
1. Correct and incorrect tubing setups.
2. Proper flow meter adjustments for pediatric use.
3. Correct placement of a concentrator in a room with necessary airflow.
4. How to clean and replace filters.
This manual serves as a comprehensive guide for A&R Medical Supply staff to ensure the
proper setup, maintenance, and patient education regarding oxygen concentrators.
10. Oxygen Tubing and Concentrator Best PracticesOxygen Tubing Overview
●
There are two types of oxygen tubing:
○
High-flow tubing (darker in color)
○
Standard 5-liter tubing
●
Approximately 20% of machine alarms occur due to kinked tubing.
●
Patients should always be provided with extra oxygen tubing to prevent interruptions in
therapy.
Common Oxygen Tubing Issues & Solutions
Issue Possible Cause Solution
Machine alarm sounds Kinked or old tubing Replace tubing
EverFlo concentrator alarm at 0.5L
for pediatric use
Normal function for EverFlo
units
Use a pediatric flow
meterinstead
Patient reports weak oxygen flow Possible kinked tubing or
obstructed flow
Inspect and replace
tubing as needed
11. Pediatric Oxygen Setup
●
For pediatric patients requiring less than 1 liter per minute, a pediatric flow meter
must be used.
●
Setup instructions:
1. Attach a 4-foot tubing from the concentrator to the pediatric flow meter.
2. Adjust flow meter to 2 liters per minute.
3. Connect another tubing section from the flow meter to the patient.
4. Set the flow rate based on prescription (e.g., 0.5L, 0.25L, etc.).
Important Notes on Pediatric Oxygen Use
●
EverFlo concentrators alarm at 0.5L – this is a known issue.
●
Pediatric flow meters allow for precise adjustments below 1L.
●
Some newer machines may not require peak flow meters but should be tested.12. Patient Setup & Safety Guidelines
Step-by-Step Setup for New Patients
1. Introduction & Verification
○
Introduce yourself as an A&R Medical representative.
○
Confirm the patient’s prescribed liter per minute (LPM) flow.
2. Equipment Installation
○
Set up the cannula and connect to the oxygen source.
○
Verify oxygen flow and ensure the patient understands how to adjust settings.
3. Answer Common Questions
○
Can I use an extension cord? No. Plug the concentrator directly into a wall
outlet.
○
Can I use my CPAP with oxygen? Consult the RT (Respiratory Therapist).
○
Can I smoke while using oxygen? Absolutely not. Smoking contaminates the
unit and poses a fire hazard.
○
Can I store the concentrator in a closet? No. The concentrator requires proper
ventilation.
○
How do I clean my filter? Rinse the cabin filter weekly with water and
air-dry before reinstalling.
Safety Guidelines
●
Ventilation: Keep at least 6 inches of space around the concentrator.
●
Obstruction Check: Ensure no objects, clothes, or covers block the concentrator vents.
●
Contaminants: Smoking (including cigarettes, vapes, and marijuana) can damage the
unit and cause odor contamination.
●
Fire Hazards: Patients should never smoke near oxygen equipment. Strictly enforce
safety policies.
13. Routine Maintenance & Troubleshooting
Maintenance Responsibilities
●
Drivers:
○
Perform scheduled concentrator checks every few months.
○
Replace filters and conduct purity tests.
●
Patients:
○
Clean the cabin filter weekly.○
Report any alarms, low flow, or unusual machine behavior.
Common Issues & Fixes
Problem Cause Solution
Machine overheating Poor ventilation Move the concentrator to an open
area
Alarm at low flow rates EverFlo units at 0.5L Use a pediatric flow meter
Odor from the machine Smoke contamination Replace unit if necessary
Weak oxygen flow Clogged filter or tubing Clean filter and check tubing
Final Notes
●
Any concerns with equipment performance should be reported immediately.
●
A&R Medical’s technicians conduct inspections regularly to ensure proper function.
●
Proper documentation of patient smoking habits is crucial for equipment management.
