Billing report shows increase in CPAP use

Wednesday, March 12, 2014

BALTIMORE – There may be more Medicare beneficiaries using CPAP devices than ever before, but that’s to be expected as awareness of obstructive sleep apnea—and its risks—grows, say providers.

“Every day, there’s a new co-morbidity associated with sleep apnea,” said Eric Parkill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. “Then, those specialists pick it up and it snowballs from there.”

In January, CMS released a comparative billing report for CPAP that tracks allowed charges for beneficiaries; number of accessories and devices and accessories per beneficiary; and use of more expensive devices and accessories. Providers who receive the reports can see how their billing stacks up locally and nationally.

Between July 2012 and June 2013, the number of beneficiaries receiving CPAP products increased 13% and allowed charges for CPAP increased 23%, according to the report.

“Why is that bad?” asks Lisa Feierstein, co-founder of Raleigh, N.C.-based Active Healthcare. “The industry has been touting for years the high rates of undiagnosed sleep apnea, so of course there’s going to be an increase.”

Although the reports are meant to serve as a learning tool for providers, it’s not clear that they do. Feierstein was startled to receive one for the first time this year.

“I have no idea why we got it,” she said. “We called a big executive meeting to discuss it.”

Providers who receive the report shouldn’t panic, says AAHomecare’s Kim Brummett.

“They have nothing to do with an audit bulls-eye on you,” said Brummett, senior director of regulatory affairs.