CQW Panacea-re-brand-rev3


For the Week of October 20, 2014


Our sleep lab has been receiving rejects for not having proper documentation for claims for PAP devices. What is the appropriate documentation?


The Centers for Medicare & Medicaid Services (CMS) offers an informational brochure entitled "Continuous and Bi-Level Positive Airway Pressure (CPAP/BPAP) Devices: Complying with Documentation and Coverage Requirements." In that publication, CMS lists the following as ways to prevent errors.

  • Request the treating physician's initial face-to-face evaluation performed before the sleep study. This evaluation assesses the patient for OSA and is one of four criteria that may qualify the patient for PAP therapy.
  • Retain a copy of the Medicare-covered sleep study as soon as the order is received. The sleep study must meet certain conditions for coverage and is one of four criteria that may qualify the patient for PAP therapy.
  • Review the treating order to ensure that all equipment and supplies dispensed are itemized on the order. Ensure that there has been a face-to-face encounter during the 6 months prior to the written order.
  • Remind the patient that a re-evaluation is required for continuing PAP coverage beyond the initial 3 months. This re-evaluation must document that the patient is benefiting from, and adhering to, the PAP therapy as ordered (that is, continued need and continued use). This requirement may be facilitated by the use of compliance cards/memory cards in the PAP device.

This publication is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/PAP_DocCvg_Factsheet_ICN905064.pdf.



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