Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) supplies had an improper payment rate of 56 percent and a projected improper payment amount of approximately $356 million during the 2012 report period, according to the Medicare Fee-for-Service (FFS) 2012 Improper Payments Report. Most of the improper payments were due to insufficient documentation to support the medical necessity of the devices. The improper payment rate was calculated by the Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program.
The report also acknowledged that it is often difficult to obtain proper documentation for durable medical equipment claims because the supplier must obtain detailed documentation from the medical professional who ordered the item. The report asserted that involvement of multiple parties contributes to missing or incomplete documentation and delays in the receipt of documentation. This fragmented system exists because the current federal Stark Law prohibits sleep medicine physicians from providing therapeutic DME to Medicare patients for the treatment of obstructive sleep apnea, forcing patients to interact with an outside DME company.
The AASM continues to advocate for a Stark Law exception that will bring continuity of care to Medicare by allowing board certified sleep medicine physicians to provide PAP therapy for Medicare patients with OSA. AASM members can support this effort by making a donation to the AASM’s bi-partisan Political Action Committee (PAC).