CMS reins in CPAP reviews

From: HME News

By Theresa Flaherty, Managing Editor

YARMOUTH, Maine – Providers should be able to catch their breaths now that CMS has told a recovery audit contractor (RAC) to ease up on semi-automated CPAP reviews.

“The audit hasn’t been rescinded, but it’s still a huge win,” said Andrea Stark, a reimbursement consultant with MiraVista in Columbia, S.C., and a member of the AAHomecare HME/RT Council, which worked with CMS on this issue. “They will not send out any new request letters, but providers must still respond to any letters they’ve already received.”

Connolly Healthcare, a Jurisdiction C RAC, has been asking providers for proof that patients had a qualified sleep study in cases where Medicare did not pay for the study. That’s basically any patient whose study was paid for by a private insurer or who paid out of pocket–not uncommon for a condition that is often diagnosed before patients reach Medicare age.

The reviews left providers scrambling to dig up sleep studies like never before.

“It was difficult, if not impossible, to even figure out when they occurred,” said Stacy Harms, manager of government affairs at AAHomecare. “A lot of them were more than seven years old and people were having a hard time to even get a copy of the study.”

Adding insult to injury: The high volume of letters that some providers have received–one reported receiving 1,900. (See related story:

CMS has instructed Connolly to give providers more time to produce the studies if they ask for it, says Stark. Also easing the burden: Providers can give a blanket response for each patient, she said.

“They don’t have to duplicate the sleep study for 13 different service dates,” said Stark. “I would recommend that they include a cover letter that states all the service dates.”

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