Prepayment review focuses on CPAP

Thursday, May 22, 2014

INDIANAPOLIS – National Government Services, the Jurisdiction B DME MAC, plans to target CPAP devices for a widespread prepayment medical review, it announced in a message yesterday. Providers randomly selected for review will receive an additional development request asking for a detailed written order for the CPAP device and any accessory billed on the same claim; medical records documenting a face-to-face clinical evaluation prior to the sleep test detailing symptoms of sleep disorder, their duration, cardiopulmonary and upper airway exam, neck circumference and BMI; a Medicare-covered sleep test; and documentation that the patient or caregiver was instructed on proper use and care of equipment. If the claim is for the fourth or subsequent rental month, providers will be asked to submit documentation of a re-evaluation by the treating physician and documentation verifying the patient used the device four or more hours on 70% of the nights during a period of 30 consecutive days. Refill requests are to include documentation of contact with the patient within a week of dispensing a supply of new accessories, according to the statement.