AHI transition is paper hassle

Saturday, May 31, 2003

INDIANAPOLIS, Ind. — The DMERCs are no longer accepting the Respiratory Disturbance Index (RDI) as a calculation for prescribing sleep therapy, according to a policy change now making the rounds in the DMERCs’ spring Supplier Bulletins.

Suppliers must now use the Apnea/Hypopnea Index(AHI) when filing claims for therapy. Although sleep labs record the AHI during sleep studies, they don’t always provide the index to suppliers as part of a new patient’s RDI.

The AHI refers to the average number of apneas and hypopneas per hour and must be based on a minimum of two hours of sleep on a positive pressure device.

Many sleep labs routinely provide the AHI when referring patients. For those that don’t, transitioning from the RDI has proved technically challenging, and time-consuming.

“It boils down to educating the sleep labs on the new DMERC requirements,” said John Goodman, president of Health Management Services in Houston. “They just have to give us the numbers we need in the first place.”

The policy change took many providers by surprise, including Renee McPhee, owner of Southern Medical in Atlanta. About 98% of Southern’s referrals come flagged with an RDI, not the AHI now required.

“We have 38 sleep labs in metro Atlanta,” said McPhee. “And some of the labs have wanted us to contact all the doctors associated with the labs. I’ve spent two weeks working on this, and I still have some coming in with the RDI.”

Although private payers are not subject to rules made by the DMERCS, they often follow suit as a matter of course. Sleep industry sources expect that the AHI will supplant the RDI everywhere.

“A lot of private payers have cut and pasted [the new policy] into their policy and procedure and reimbursement manuals already,” said Ron Richard, vice president of marketing at ResMed. HME