AAHomecare, AASM meet on CPAP documentation issues

CHICAGO - There's definite room for improvement when it comes to communication between physicians and providers, stakeholders say.

In February, AAHomecare met with the American Academy of Sleep Medicine (AASM) to discuss ways in which the two groups could work together to ensure Medicare documentation requirements for sleep therapy are understood and are being met.

“We believe, based on the current system where we rely heavily on the doctor's ability to document medical necessity, we need to have a multi-pronged approach to educating providers and physicians on proper documentation rules,” said Walt Gorski, vice president of government affairs for AAHomecare.

More than half of all CPAP claims submitted by providers are consistently denied—most recently National Government Services reported a 68% denial rate in Jurisdiction B.

For its part, the AASM said it hadn't been aware that a documentation problem existed, says Executive Director Jerry Barrett.

“It's the first time I have ever met with reps of the DME industry and it probably should have happened a long time ago,” he said. “We are sympathetic and want to be helpful.”

However, Barrett says, the larger problem lies not with sleep specialists but with primary care doctors.

“I would say sleep physicians are very well aware of what they need to send to the DME,” he said.

During the meeting, the AASM expressed concerns that prescriptions are not always filled according to the physician's specifications.

“We get a lot of complaints that, 'We prescribed X and they ended up with Y,'” said Barrett. “There's a concern in the physician community that that has an impact on compliance rates.”

That should be a consultative process between physician and supplier, says Gorski.

“What works in a sleep lab for a sleep study may not be the mask that is most appropriate for the beneficiary to have for his or her life,” he said.