CPAP policy revision takes industry by surprise

Sunday, March 31, 2002

WASHINGTON - More questions than answers are flying about in the wake of a new CPAP policy change announced by the DMERCs last month. While providers are generally happy about not having to obtain CMNs for CPAP starting April 1, they're scratching their heads over one part of the new policy change.

Here's the contentious issue, as published by the Region B DMERC: "Continued coverage of an E0601 [CPAP] device beyond the first three months of therapy requires that, no sooner than the 61st day after initiating therapy, the supplier ascertain from either the beneficiary or the treating physician that the beneficiary is continuing to use the CPAP device."

Providers say the 61-90 day window for checking patient compliance is an arbitrarily chosen time period, with no foundation in sound clinical practice. Indeed, they say, the more appropriate time to "ascertain" whether patients are "continuing to use" the CPAP is within the first few weeks.

And then there's the question of what "continuing to use" and "ascertain" means. "Is a phone call enough?" Asela Cuervo, v.p. of government relations at AAHomecare, asked rhetorically. "Do we need to write a letter? How do we document that we've done this?"

Not having appropriate guidance on the issue opens the door to problems down the road, said Bob Lauver, regional manager for the Lancaster, Penn.-based CPO2. "Obviously, this puts us in a very uncomfortable situation in a post-payment audit."

The new twist in local medical review policy caught providers off guard. They'd expected to see a revision to the policy as a consequence of the National Coverage Decision to allow the use of the apnea-hypopnea index for the diagnosis of OSA. But the CMN drop and compliance requirement came out of the blue.

That bothers Cuervo. The DMERCs "have added things [to the policy revision] that probably should have gone out for comment," she said. "This is a problem procedurally." HME