Medicare meddles with sleep

Sunday, November 30, 2008

WASHINGTON--The public comment period on a proposed CMN for CPAP devices closed Oct. 27-to the surprise of many industry stakeholders who said they were unaware it even existed.

“I didn’t know we were expecting or even going back to CMNs,” said Clay Stribling, an attorney with Amarillo, Texas-based Brown & Fortunato. “It isn’t necessarily a bad or a good thing.”

In recent years, CMS has stepped back from requiring CMNs on many products. In 2006, it dropped them entirely for beds and support surfaces. With more stringent guidelines released this year for CPAP therapy, however, the proposed CMN may just be a more formal tool to aid providers, said Stribling.

“It can help remind the physician to consider the steps needed in order for the patient to be put on PAP therapy and continue beyond the initial period of usage,” he said.

Provider Gary Miller agreed CMNs can make life easier but he said this particular CMN-which asks for the date of a required follow-up visit with the physician and proof of compliance with therapy-will hold up his billing.

“It asks questions about (steps) that are going to happen in the future, yet need to be provided during the billing process,” said Miller, manager of Mt. Carmel Medical Equipment in Pittsburg, Kan.

Sleep alliances

The Medicare Physician Fee Schedule for 2009 made it clear that, when it comes to home sleep tests, HME providers cannot bill for CPAP if they have a relationship with the entity that performed the test.

In July, Medicare issued a proposal that stated it would not pay HME providers for a CPAP if they were affiliated directly or indirectly with the entity providing the sleep test, but the agency didn’t specify what it meant by affiliated. That raised concerns about possible repercussions for facility-based testing.

The new rule states: “No Medicare payment may be made to the supplier of a CPAP device if that supplier or its affiliate is directly or indirectly the provider of the sleep test used to diagnose the patient. This prohibition does not apply if the test is performed in an attended facility-based polysomnography.”

“They want to make sure they have made it crystal clear that HME suppliers should not be involved in the diagnostics of home sleep tests,” said Stribling. “If the patients are qualified using home sleep testing, then the DME should have no compensation from or ownership with that company.”