CPAPBEST PRACTICES/WORST

PRACTICES

Explain Your CPAP Program….

• Intake Process….Who completes your intake?

• Customer Service Representatives• Respiratory Therapist• Sleep Tech• Billing Department• Any Staff Member That Is Available

How Quickly Do You Contact The Patient?• 24-48 Hours After Receiving The Order• 24 Hours After Verifying Coverage• Same Day For Orders Received Before 4:00 Pm.

Who Contacts The Patient To Schedule Set-up?• Respiratory Therapist• Customer Service Representatives• Sleep Tech

Explain Your CPAP Program….

• Documentation Required Before Setup….What Do You Require Before You Deliver The Equipment?

• All Qualifying Sleep Studies• Complete And Accurate Initial Face To Face Medical Records

– According To Medicare Guidelines• Appropriate Prescription• Berlin Questionnaire/Epworth Sleepiness Scale• Verify That Certified MD Interpreted The Study• Stringent Adherence To Medicare Guidelines• IVR – • Prior Authorization If Required By Payor • Sleep Studies and a Prescription – We pursue

other documentation afterwards

Explain Your CPAP Program….• Set up / Delivery

At Office Or Patient’s Home• Both• 90% In Patient Residence / 10% At Office

Who Schedules The Setups?• Respiratory Therapist• Customer Service

How Quickly Do You Attempt Delivery?• Based On Customer Preference• Based On Schedule Availability• Same Day Of Order• Within 48 Hours Of Receiving Order• Within 2- 3 Days Of Receiving Order• We Average 4 Days

Explain Your CPAP Program….• Follow up/Compliance

How Do You Follow Up After Delivery? Who?• RT That Delivers Equipment Maintains All Contact Until Patient Is Doing Well• Dedicated CPAP Compliance Coordinator • “The Employee That Makes Initial Contact With The Patients Should Maintain That

Contact”

Frequency….• 3 Calls In 30 Days• Day After Delivery And PRN• Within 7 Days Of The Setup• Day 3, Day 10, Day 35• Based On Need

How Are You Monitoring Compliance?• Smart Cards/ SD Cards• Phone Call To Patient And Asking Them to Retrieve Data From Machine• Wireless Modems• Wired Modems• RT Visit To Patient To Retrieve Data

Explain Your CPAP Program….• Patient Follow-Up Face To Face Visit

Do You Assist The Patient In Scheduling This Appointment?• YES!!!!!!!• Call Doctor At Time Of Set-Up To Schedule• Compliance Coordinator Notifies Doctor Once Patient Is Compliant So That A

Follow Up Appointment Can Be Scheduled.

How Do You Confirm That The Visit Occurred?• Compliance Coordinator Contacts Patient And/Or Doctor• Billing Dept. Contacts Patient And/Or Doctor

Explain Your CPAP Program….• Follow Up Visits With Patients

Do You Go To Patient’s Home/Office Or Require They Come To Your Office?• Both• Whatever The Patient Prefers• However Setup Was Handled• Depends on Payor Source

How Do You Get Compliance Information To Doctor?• Compliance Coordinator Sends As Soon As Available Via Email or Fax• Sent To Billing Department Then To Doctor• Sales Reps Deliver To Make It A Sales Call

How Do You Manage This Information?• Manufacturer Programs (Encore Anywhere, Res Scan, ResTraxx)• Billing Software

Explain Your CPAP Program….• Challenges / Obstacles

Initial Face To Face Visit• # 1 Problem• Often Incomplete And Must Request More Information• Rarely Sent With Order And Often Hard To Obtain• Solution….. Constant Re-education

Mask Issues / Mask Swaps?• Average At Least 2 Masks Per Patient Before Compliance• Average More Than 2 Per Patient Before Compliance• Solution….. Mask Replacement Programs, Continued RT Training, Limited Selection

Pressure Issues – CPAP To BiPAP Conversion?• Aggressive With Patients That Are Non-Compliant • Not A lot of Doctor Support• As Quickly As Pressure Becomes An Issue• Difficulty Getting Doctors To Document As Required• Solution…..Education Of Staff, Education of Doctors, Internal Protocol to Direct

Conversion, Strong Documentation

Explain Your CPAP Program….• Challenges / Obstacles

Use of Auto Devices……• Not An Issue• Often Ordered to “Desensitize Patients Prior To Sleep Studies”• No Payor Source• Will Not Dispense Without $$$$$ • This Is An Issue With Medicare Patients• Often Prescribed With Initial Order• Solution…..Use ABN If Delivering To Medicare Patients Prior To Qualifying Sleep

Studies, Do Not “Loan” Auto Devices,

Self-Pay / Indigent Patients• Require Payment Up-Front To Cover Costs Of Supplies• Not A Big Issue• Always Offer Used Equipment • I Am Not A Finance Company … No More Than 2 or 3 Payments

Do You Choose Certain Model CPAP Based On Payor Source?• YES!!!!!• NO… One Basic Model That All Patients Receive