Re-supply clarification to come, says Dr. Hoover

Friday, August 3, 2012

YARMOUTH, Maine – CPAP providers who want more guidance on the new re-supply rule will get it—eventually.

The four CMS medical directors are working on a FAQ, according to Dr. Robert Hoover, medical director at Cigna Government Services, the Jurisdiction C DME MAC.

"I think the volume of questions has gotten to the point where it would be useful to do an article or FAQ," he said. "As far as a date, we have some other things on our plate first."

CMS in June published a notice that states that for items that need periodic replacement, like CPAP supplies, providers must determine whether the items are non-functioning before they replace them.

With the rule already in effect, but without much guidance, providers are doing their best to comply, they say.

"We're waiting for clarification on what the definition of failure is," said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. "We are asking patients probing questions and documenting very thoroughly that each specific item that's being shipped to the patient is discussed and noted in the record."

It's fairly easy to establish, through questioning, whether patients are experiencing certain problems, such as cracked tubing, but communicating with patients about whether, say, the mask frame doesn't work, is more difficult, say providers.

"One of the challenges is getting them to understand what is and isn't the frame," said Scott Lloyd, president of Extrakare in Norcross, Ga. "We think we'll end up selling less whole masks and more pieces, which means they'll have to un-assemble and reassemble the masks."

Another complication: Some patients are confused by the questions, say providers.

"We really have to drill down—'Are you experiencing leaks?'" said Chris Rice, CEO of Diamond Respiratory Care in Riverside, Calif. "Some of them, we just can't provide to them."

For patients used to getting their supplies regularly—Medicare's local coverage determination for PAP allows supplies like tubing, cushions and filters to be replaced every three months—the new rule feels like an obstacle.

"We've had some patients very frustrated with the process," said Lloyd. "It's slowed things down considerably. But it's not the end of the world."