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      Home sleep tests: Medical directors await instruction

      WASHINGTON - It could be several months before the industry gets specifics on home sleep testing.

      On March 13, CMS issued a national coverage determination (NCD) supporting coverage for at-home sleep tests. Since then, providers have anxiously awaited details from the four DME Medicare Administrative

      Contractors (MACs) in the form of local coverage determinations (LCDs).

      "The medical directors are working on a revision of the CPAP LCD and policy article," said Dr. Robert Hoover, Jurisdiction C medical director, last week. "We will work collaboratively to ensure that the LCD and policy article is consistent across all four DME MAC jurisdictions."

      It may be a while, however, before providers see the fruits of their labor. CMS has yet to issue a change request to the MACs, and with national competitive bidding issues occupying much of the agency's attention, that won't happen any time soon, says Kelly Riley, director of The MED Group's National Respiratory Network.

      "We feel their plate is full," she said. "One of the medical directors told me it could be as late as October."

      Once CMS issues a change request, the medical directors have 90 days to finalize the policy.

      A couple of LCDs released in March and April caused confusion among providers. It is important to remember, Hoover said, that within each MAC, there are several Part B local carriers and Part A fiscal intermediaries who have jurisdiction over payment for the tests, both facility-based and portable. Any time there is a HCPCS code change, LCDs are updated and released, but they continue to reflect the old coverage guidelines for home sleep testing.

      "Part A and Part B contractors already have policies outlining the coverage and payment rules for these tests," said Hoover. "They will be responsible for revising their policies to comply with the requirements in the NCD related to home sleep tests."

      For providers wondering how to take advantage of at-home sleep testing, key questions remain: What is the reimbursement for the tests? Who can perform them? And what documentation is needed for continued treatment after a required 12-week trial period?

      "Everyone wants to make sure this is done well," said Riley. "The intent of the NCD was geared toward primary OSA patients, and I think our industry has a responsibility to implement the practice in the manner it was intended."

      Nevertheless, Riley expects things to heat up as physicians, sleep labs and industry associations lobby for the LCDs to include certain requirements.

      "CMS established the base rules," she said. "But you've got a set of players positioning themselves to fight anyone else being involved in testing."


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      CALENDAR

      February 2012
      AAHomecare's upcoming Washington Legislative Conference will include Council meetings, a half day program and a Thursday, Feb. 16 lobby day.

      ACHC will offer a workshop to help HME providers prepare for accreditation Feb. 21 in Georgetown, Ky.
      More information is available here.
      Register by Feb. 15.

      NRRTS to offer a webinar titled, "Pathophysiology: Cerebral Vascular Accident/Stroke (CVA) and Co-Morbidities," led by Barbara Crane, PhD, PT, ATP. 5-7 p.m. Pacific, Feb. 21.
      FMI click here.

      NRRTS to offer a webinar titled, "Dynamic Seating," led by Delia Freney, OTR/L, ATP. 5-7 p.m. Eastern, Feb. 23.
      FMI click here.


      March 2012
      Richmond, VA (Omni). More details to come. www.vadmec.org.

      NRRTS to offer a webinar titled, "Pathophysiology: Traumatic Brain Injuries (TBI) and Cerebral Palsy (CP)," led by Jill Sparacio, OTR/L, ATP. 5-7 p.m. Pacific, March 20.
      FMI click here.

      NRRTS to offer a webinar titled, "Power Assist Wheels: Clinical Indicators and Documentation for Funding," led by Theresa Berner, MOT, OTR/L, ATP. 5-7 p.m. Eastern, March 22.
      FMI click here.


      April 2012
      Medtrade Spring will be at the Sands Expo and Convention Center in Las Vegas.
      More information is available at http://www.medtrade.com/medtrade-spring/

      At the Hyatt Regency Hotel-Crystal City. More info to come. www.nrrts.org.

      NRRTS to offer a webinar titled, "Pathophysiology: Multiple Sclerosis (MS) and Amyotrophic Lateral Sclerosis (ALS)," led by Mary Shea, MA, OTR/L, ATP. 5-7 p.m. Pacific, April 17.
      FMI click here.

      NRRTS to offer a webinar titled, "Home Accessibility: From the Front Door to the Upstairs Bath," led by Cynthia Petito, OTR/L, ATP, CAPS. 5-7 p.m. Eastern, April 19.
      FMI click here.


      May 2012
      NRRTS to offer a webinar titled, "Pathophysiology: Duchene’s Muscular Dystrophy and Spinal Muscular Atrophy (SMA)," led by Michelle L. Lange, OTR, ABDA, ATP/SMS. 5-7 p.m. Pacific, May 22.
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      NRRTS to offer a webinar titled, "Positioning vs. Restraint: Appropriate Use and Justification of Secondary Seating Components," led by Michelle L. Lange, OTR, ABDA, ATP/SMS. 5-7 p.m. Eastern, May 24.
      FMI click here.


      June 2012
      NRRTS to offer a webinar titled, "Power Wheelchairs: Using IR Transmission to Control Devices in the Environment," led by Jill Kolczynski, ATP. 5-7 p.m. Eastern, June 21.
      FMI click here.


      July 2012
      NRRTS to offer a webinar titled, "Power Seating Functions: Clinical Indicators for Each," led by Stephanie Tanguay, OTR. 5-7 p.m. Pacific, July 17.
      FMI click here.

      NRRTS to offer a webinar titled, "Access to fun! Recreation for all," led by Mary Carol Peterson, OTR. 5-7 p.m. Eastern, July 19.
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      August 2012
      NRRTS to offer a webinar titled, "Medical Interventions and Their Relationship to Assistive Technology Intervention: Tone Management, Surgeries and Orthotics," led by Pamela Wilson, MD. 5-7 p.m. Pacific, Aug. 21.
      FMI click here.

      NRRTS to offer a webinar titled, "Seating Considerations for Clients with High Tone," led by Sharon Pratt, PT. 5-7 p.m. Eastern, Aug. 23.
      FMI click here.


      September 2012
      NRRTS to offer a webinar titled, "Power Wheelchairs: Using the Access Method to Control the Computer Mouse," led by Mike Babinec, B.A., B.S., OTR/L, ABDA, ATP. 5-7 p.m. Pacific, Sept. 18.
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      NRRTS to offer a webinar titled, "Advocacy for All! Consumer Driven Change," led by Ann Eubank, OTR, ATP. 5-7 p.m. Eastern, Sept. 20.
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      October 2012
      NRRTS to offer a webinar titled, "Getting it right the first time: Measurements," led by Robert Lindholm, ATP. 5-7 p.m. Pacific, Oct. 23.
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      NRRTS to offer a webinar titled, "Pathophysiology: Osteogenesis Imperfecta (OI) and Arthrogryposis," led by Michelle L. Lange, OTR, ABDA, ATP/SMS. 5-7 p.m. Eastern, Oct. 25.
      FMI click here.


      November 2012
      NRRTS to offer a webinar titled, "Wheelchairs and Transport," led by Mary Ellen Buning, PhD, OTR/L, ATP. 5-7 p.m. Pacific, Nov. 13.
      FMI click here.

      NRRTS to offer a webinar titled, "Funding: What’s New in the World of Reimbursement?" led by Liz Cole, PT. 5-7 p.m. Eastern, Nov. 15.
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      December 2012
      NRRTS to offer a webinar titled, "Positioning: Clinical Considerations of Molded Seating," led by Jill Sparacio, OTR/L, ATP. 5-7 p.m. Eastern, Dec. 18.
      FMI click here.

      NRRTS to offer a webinar titled, "Assisted Ambulation: Gait Trainers, Walkers, Crutches and Canes - Clinical Indicators," led by TD Schenck, ATP. 5-7 p.m. Pacific, Dec. 20.
      FMI click here.

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