Proposed change could add teeth to CPAP policy

BALTIMORE  Medicare won't pay for CPAP therapy after the first 90 days if patients are noncompliant, but usually it's providers who are left holding the bag.

"If I give you a CPAP bill after the third month and then you choose to not answer your door when I knock, not return letters that I mail, and not answer the phone when I call, you have effectively stolen that device from me and I can't bill for it," said Scott Lloyd, president of Extrakare in Norcross, Ga., and a member of AAHomecare's CPAP task force.

So the association in June asked CMS to allow providers to use an advance beneficiary notice (ABN) on the first day of CPAP set-up if they think there's a high likelihood of noncompliance.

Letting beneficiaries know they have a financial stake in their therapy gives providers a leg to stand on, they say.

"What we'd like to be able to do is continue to communicate clearly what (the beneficiary's) responsibilities are," said Lloyd. "Then, if they fail in those, we have the ability to send them an invoice."

Medicare allows providers to give patients an ABN on day 60 in they're noncompliant. But by then, it's often too late, say providers.

"Most people don't want to sign something like that," said Debra Drillen, owner of Sleep Well in Parsonsfield, Maine. "It almost makes them a joke."

Using ABNs could also help providers increase patient compliance, they say.

"I think it's a motivator for some patients," said Eric Parkhill, vice president of Home Medical Professionals in Atlanta. "A lot of people think the equipment is free and its not, and it's a good thing to let them know that upfront."

This is not the first time ABNs for CPAPs have come up. In 2009, CMS ruled that requiring all new patients to sign an ABN would be considered a blanket ABN. Stakeholders understand CMS's concerns, but say that they would use the ABNs on a case-by-case basis.

"We've outlined several instances where a provider could deduce an individual patient's propensity to be noncompliant," said Andrea Stark, a reimbursement consultant with MiraVista, who worked with the task force. "Then, based on a series of questions, they could determine whether an ABN would be warranted."

Such questions could include whether the patient has ever been described a course of antibiotics and not finished it, or whether they have failed to follow post-discharge instructions after a hospital stay.