Coding decision redirects RemZzzs

Tuesday, November 12, 2013

JACKSON, Mich. – RemZzzs may not have given up on restoring Medicare coverage for its CPAP mask liners, but the company, in at least one way, has moved on.

Rewind to March 2013. That’s when a Medicare contractor notified RemZzzs that, in consultation with the four medical directors, it had re-assigned the liners to a non-covered code (A9270). The reason: The contractor stated the liners were a comfort product and “duplicative of what is already provided on the mask.” It also stated they lacked peer review.

Bob Rutan, CEO of RemZzzs, has been fighting the decision to no longer cover the liners under A7031 and A7032, but so far to no avail.

“We’ve spent $10,000 trying to find a way out of this,” he said. “More than 2,000 customers have written to us and asked us why Medicare is doing this. We sent a five-pound box of testimonials and other documentation to the contractor. It just doesn’t seem fair.”

It seems even less fair because other comfort products by other manufacturers are still covered under the two codes, Rutan points out.

RemZzzs has taken a 40% hit in sales due to the contractor’s decision, Rutan says.

“It puts us back to where we were three years ago when we didn’t have the codes to begin with,” he said.

Fast forward to October. After hearing horror stories while on his “Dreams With Hope” tour to raise awareness of sleep therapy, Rutan started to promote the liners to the respiratory departments of hospitals. Mask use in hospitals can often mean a lot of wrenching down on a patient’s face to prevent leaks, which can often mean, at best, rashes and, at worst, a hole in a nose, he says.

“In one hospital, when they come in with the liners, the patients chant, ‘RemZzzs, RemZzzs,’” he said. “That’s how well they work. We’re pretty encouraged we can be a big voice in the hospital market, and it’s bigger than the sleep market.”

Still, Rutan hates knowing there are people out there who want and need his product to comply with their sleep therapy at home, and who just can’t get it.

“If one good thing happened from the code being gone, it’s that it moved us into another area,” he said. “But I’m still upset, because they’re suffering without it.”

Attempts to reach the medical directors for this story were unsuccessful.