Dialing for data: Rules test providers

Saturday, February 28, 2009

YARMOUTH, Maine--New sleep policies that went into effect Nov. 1 have some providers questioning whether they want to provide CPAP for Medicare patients.

“We’re on the verge of dropping Medicare for CPAP because of all the requirements,” said Mike Kuller, president of Concord, Calif.-based Allstar Oxygen Services.

The new guidelines, issued in September, ramped up compliance requirements. For initial coverage of a CPAP, patients must have a face-to-face evaluation with a physician before the sleep test. Between 61 and 90 days, they must have a follow-up visit and meet certain criteria for continued coverage.

While most say the policy is good medicine, the burden of proof lies with CPAP providers if they want to get paid.

“We make numerous calls to patients to find out when their follow-up appointments are,” said Kuller. “We make numerous calls to doctors to try to get follow-up notes.”

CMS in December issued a FAQ sheet telling physicians that HMEs need documentation, but it has been of little help, said provider Glenn Steinke.

“None of them want to see that big letter that Medicare developed,” said Steinke, owner of Bishop, Calif.-based Airway Medical. “You give it to them and they say, ‘Just tell me the bottom line.’”

At least the sleep labs have been trying to help, said provider Eric Parkhill.

“They’re getting the face-to-face documentation and they will get the physician’s office notes from the patient’s visit,” said Parkhill, vice president of Atlanta-based Home Medical Professionals. “But inevitably, it doesn’t contain (everything). We hardly see an Epworth scale, and neck size is almost non-existent.”

The other challenge for providers: Patients don’t always understand they need to be compliant if they want Medicare to pay for their treatment after the first three months. Provider Todd Cressler has drafted a letter that he plans to send non-compliant patients at the 90-day mark.

“We will tell them they have one more month to get compliant,” said Cressler, president and CEO of Harrisburg, Pa.-based CressCare Medical. “We will be picking up some machines.”