Confusion surrounds sleep revision

Friday, October 31, 2008

One aspect of the newly revised local coverage determinations (LCDs) for sleep devices has industry stakeholders seeking clarification.

The original policy, issued in July, says compliance must be tracked using a downloadable device. The revised policy, issued Sept. 18, allows either “direct download from equipment or by visual inspection of adherence information.”

The problem, say industry stakeholders: Only machines with downloadable capability can provide the specific adherence information required-that is “use of PAP greater than or equal to four hours per night on 70% of nights during a consecutive 30-day period.”

“Yes, it’s acceptable for providers to phone in the compliance data (rather than download it),” said Kelly Riley, director of The MED Group’s National Respiratory Network. “But they haven’t changed the metric for compliance.”

A FAQ issued by the National Heritage Insurance Company, the Jurisdiction A DME MAC, also states that phone-in compliance satisfies the requirement.

“The potential exists for misunderstanding the types of devices that could be used to meet adherence documentation requirements,” said one industry stakeholder. “It’s one of those things where everybody and their brother has a definition of what phone-in means.”