technical resource guide for dme - virtuox
TRANSCRIPT
Technical Services Resource
Guide for DME/HME
Questions ?
Dial 877-337-7111
LCD: Centers for Medicare & Medicaid Services Page 5 of 16
http://www.cms.hhs.gov/mcd/viewlcd_pdf.asp?lcd_id=11446&lcd_version=53&contractor_id=140 3/15/2010
LCD Information
Beneficiaries may self-administer home based overnight oximetry tests under the direction of a Medi-
care enrolled Independent Diagnostic Testing Facility (IDTF). A DME supplier or another shipping en-
tity may deliver a pulse oximetry test unit and related technology, to a beneficiary’s home under the fol-
lowing circumstances:
1. The beneficiary’s treating physician has contacted the IDTF to order an overnight pulse oximetry
test before the test is performed.
2. The test is performed under the direction and/or instruction of a Medicare-approved IDTF. Because
it is the beneficiary who self-administers this test, the IDTF must provide clear written instructions
to the beneficiary on proper operation of the test equipment and must include access to the IDTF in
order to address other concerns that may arise. The DME supplier may not create this written in-
struction, provide verbal instructions, answer questions from the beneficiary, apply or demonstrate
the application of the testing equipment to the beneficiary, or otherwise participate in the conduct of
the test.
3. The test unit is sealed and tamper-proof such that test results cannot be accessed by anyone other
than the IDTF who is responsible for transmitting a test report to the treating physician. The DME
supplier may use related technology to download test results from the testing unit and transmit those
results to the IDTF. In no cases may the DME supplier access or manipulate the test results in any
form.
The IDTF must send the test results to the physician. The IDTF may send the test results to the supplier
if the supplier is currently providing or has an order to provide oxygen or other respiratory services to
the beneficiary or if the beneficiary has signed a release permitting the supplier to receive the report.
Oximetry test results obtained through a similar process while the beneficiary is awake, either at rest or
with exercise, may not be used for purposes of qualifying the beneficiary for home oxygen therapy.
Excerpt from the :
LCD for Oxygen and Oxygen Equipment (L11446) Top of page 5
Complete document available at link listed above.
System requirements
For FULL functionality VirtuOx requires Windows XP service pack 2
and a minimum of Intenet explorer 7.0, internet explorer which must be
set to not display pages saved in cache. The VirtuOx portal cannot be
used functionally with any other browser than Internet Explorer.
(Note that for initial installation the user MUST have an adminis-
trator logon otherwise you will need to contact your IT group or Help-
desk to gain access to one to install the device drivers and ActiveX con-
trol)
The Portal will work with some older systems however we cannot guar-
antee full functionality of features and can only offer limited computer
support.
Nonin/Respironics devices and OEM.
Windows XP, Windows Vista and Windows 7 all have known issues if
you are using a Non-Supported serial to USB adaptor. The only sup-
ported devices are the KeySpan USA-19US manufactured by TrippLite,
and the Model 1000USB Manufactured by Nonin.
V-Pod Devices:
Versions of windows older than XP sp2 may have limited function and
can be used short term, please contact VirtuOx Corporate Support for
Vpod Drivers used in Operating systems earlier than windows XP ser-
vice pack 2.
The VirtuOx Dashboard, How to read, how to use.
The Dashboard has 4 “Gadgets” sections Each will be covered by title.
Overnight Oximetry Order Statistics
This data will tell you at a glance:
Orders Pending- The total number of patients scheduled but not uploaded.
Orders Entered- the number of patients scheduled within the date range listed.
Orders Completed- the number of successfully uploaded tests within the date range.
Average days pending- calculated based on the average time per patient from the point scheduled to the day
uploaded. (Completed)
Sleep Study Candidates- the number of test results processed within the date range that that are recommended to
do a more in depth sleep study due to the information gathered by the Oximeter.
Home Sleep Test Order Statistics
This data will tell you at a glance:
Sleep Study Patients- those patients that have been sponsored by the DME for Sleep study with VirtuOx
HST Orders Completed- this is the number of studies completed within the date range.
HST CPAP Qualifiers- shows the number of patients recommended to CPAP therapy with the completed test
(within date range)
HST CPAP Delivered- The dme must enter the date that the patient was delivered CPAP (If Qualified) from the
Sleep Study Patients list.
HST O2 Qualifiers- the number of patients that have qualified for Oxygen via the Sleep Study.
HST O2 Delivered- shows the number of patients just recommended to Oxygen based on the Sleep Study.
Overnight Oximetry Completed Orders
Group 1 Qualifiers- the number of patients qualified for oxygen via any group 1 criteria via overnight Oximetry
(within date range)
Group 2 Qualifiers- the number of patients qualified for oxygen within the group 2 criteria via overnight Oxi-
metry (within date range)
Non Qualified- the number of patients not qualifying for oxygen based on either group 1 or group 2 criteria. (may
still recommend HST)
Borderline Qualifiers- the number of patients not qualifying by either criteria however close in range (Possible
recommend retesting Overnight Oximetry for longer test sample or better data)
O2 Delivered- these are patients the DME delivers oxygen to and notes on Oximetry test for patient. .
Pie Chart representation shows the data from Overnight Oximetry and compares group 1 to group 2 and Non
qualifiers by percentage
Yearly Order Trends Boxes (2 at bottom of Dashboard)
These display based on the year listed the number of Uploads made to the account within a given month for com-
parison to past data.
OXIMETRY CHECKLIST.
Patient Name: ________________________________________
Doctor Name: ________________________________________
Initials date time
1. Schedule test in VirtuOx ____ ____ _____ 2. Check diagnosis for validity ____ ____ _____ 3. Print and Fax RX to VirtuOx ____ ____ _____ 4. Print AOB for Patient ____ ____ _____ 5. Test and clear Oximeter ____ ____ _____ 6. Print instructions for patient ____ ____ _____ 7. Deliver Oximeter AND Docs ____ ____ _____ 8. Retrieve Docs and Oximeter ____ ____ _____ 9. Fax AOB to VirtuOx ____ ____ _____ 10. Upload results to website ____ ____ _____
11. Contact doctor regarding results and act!
Is this RX Valid for Oximetry?
A few things to keep in mind!
Before Faxing documentation the patient MUST be scheduled in Virtuox.
A valid RX Must have a few things to be considered valid.
1. The Doctors Name Printed Legibly.
2. The Patients Name Printed Legibly.
3. A Valid Diagnosis Code for Pulse Oximetry by IDTF (Please see Physicians
RX on website for complete Updated list.)
4. The Request for Overnight Oximetry OR one of the following Acceptable
variables of nomenclature.
Overnight Oximetry Overnight Pulse Oximetry Overnight Pulse Ox
O/N Pulse Ox Overnight SaO2 Test Overnight O2 Test
Overnight PO Overnight POX Nocturnal Oximetry
Nocturnal Pulse Oximetry Nocturnal Pulse Ox Nocturnal SaO2 Test
Nocturnal O2 Test Nocturnal PO Nocturnal POX
Sleeping Oximetry 24 hour O2 Test Overnight Noc Ox
Noc Ox Nocturnal O2 sat Sleeping o2 sat
Sleeping SaO2 Overnight O2 sat
Pulse Oximetry rest, exertion and Nocturnal
Overnight Oximetry on room air
Overnight oximetry on oxygen, cpap or Bipap
Pulse Oximetry rest, exertion and overnight
5. The Date the RX was Written
6. The Doctors Signature.
These 6 points on a single page constitute a valid RX.
REMEMBER!
ACCORDING TO GUIDELINES THIS DOCUMENT MUST BE FAXED TO
VIRTUOX BEFORE YOU SEND THE OXIMETER TO THE PATIENT!
Valid Vs Invalid Tests.
To be considered a valid test in VirtuOx Standard it must meet the fol-
lowing requirements and statements:
1. Reports must be a minimum of 30 minutes in length.
2. Reports must have an artifact time less than half or the total test
length.
3. If the artifact length subtracted from the total test length brings the
test duration below 30 minutes, this will also be considered an
invalid test.
4. No sessions may overlap in time. This is caused by equipment
malfunction or misuse by the patient. These tests cannot be
validated. It is the responsibility of the DME to identify this
situation and retest the patient.
5. No multiple sessions outside the date range the test was conducted
may be attached to the patient. It is the DME responsibility to
delete any questionable reports before setting the test conditions.
6. The test end time must be within 25 hours of start time or the test
will be considered invalid.
The VirtuOx system automatically rejects any test result that has previ-
ously been uploaded to your account. This protects you by not allowing
a patient to be medically diagnosed by data derived from another pa-
tient.
WHAT IF:
The Wrong Doctor is Showing on a report.
• First step is to notify the incorrect Doctor that he will be receiving a fax in error.
• Second step is to fill out the Report Change Request form.
• Re-verify that the RX is valid and signed by the Doctor.
• Verify that the AOB is valid and signed and dated by the Patient.
• Fax ALL THREE documents to the Fax Number at the bottom of the Report
Change Request Form.
• Once the form has been received and all documentation has been verified the
report will be edited to reflect the information listed on the RX. Not what is
written by the DME.
• The correct doctor will receive an direct fax and the DME will be able to view the corrected
report in their Archived results area once the correction has been validated.
(Please note that if for some reason our verification team finds the test is not billable at
this point the correction will NOT be made until the DME submits proper documentation as
instructed by our corrections team)
What IF: I Uploaded the wrong Oximeter to my patient.
(Please note that for reasons beyond our control VirtuOx cannot for any reason correct
Core Patient information on any test result.)
The following steps must be followed to recover from this error.
A= the patient uploaded to by mistake
B= the Patient whose data is actually on the Oximeter
1. Immediately notify the doctor listed on Patient A’s report (Incorrect Patient /
Incorrect Doctor) and let Him/Her know that the proper documents will
arrive soon.
2. Reschedule patient A so that once his/her Oximeter data is available there will
be a place to upload it to.
3. Verify that all documentation is re-faxed for the patient A to assure that the new
upload will be viewable.
4. Clear and Delete all data from the Oximeter. Patient B will need to be retested
to acquire valid data to upload. VirtuOx cannot accept uploads of Identical
Data more than once as a safeguard to misdiagnosis.
5. Deliver either the same Oximeter OR a new Oximeter to patient B.
6. Proceed as normally, these steps now have everything set to operate normally,
Patient A’s test must be performed within a 30 day period starting the day of
the mistake to avoid double billing.
WHAT IF: The wrong time and date show on my report
Before starting this process please read the following notice outlining what we can time/
date correct and what we cannot. The DME has the ability to delete any session at the
time they set the test conditions, at this stage the DME verifies that ALL sessions belong to
the patient.
1. VirtuOx cannot validate a result showing ANY overlapping sessions by date due to the
fact that there is no way to verify what session happened when. It is the DMEs respon-
sibility to verify that the device was sent out cleared and with the time and date set
properly and has sufficient battery life to conduct test.
2. Reports showing more than 3 dates cannot be validated and will likely contain data
from another patient.
If any of the above is the case and you have gone beyond the upload
stage that sets the test conditions, please re-schedule and retest the
patient.
1. Be certain that the patient has signed and dated the AOB. Any time
and date corrections will be made based on the information from this
document.
2. Verify that the RX is valid for the billing purpose. (Please see posted
list)
3. Fax the Report Edit Request form along with BOTH valid documents
to the fax number on the Request form (Faxing to any other number
can result in up to a 4 day delay in processing the request)
(Please note that all conditions and documentation must be valid for billing
purposes or your correction will NOT be made until the documentation
issues have been corrected)
WHAT IF:
The wrong test condition shows on my report
1. Please contact the Doctor the report is being faxed to and notify
him/her of the error and assure them that a corrected version will be
faxed in a short time.
2. Fill out a Report Edit Request form noting the Incorrect entry and the
Correct Entry in the proper places
3. Verify that the AOB and RX are both Valid AND complete.
4. Fax all three documents to the fax number on the Report Edit Request
Form. (Faxes to other numbers may not reach the corrections team within
the 24 hour limit)
5. Once our Document validation team has approved the documentation
the report will be edited and a new copy faxed to the Physician of
Record. The VirtuOx Database and archives will reflect the correction and
it will be available to print once the correction is Validated.
(Please note that all documentation must be valid for billing or your
correction will NOT be made until the documentation issues have been
corrected)
WHAT IF:
I uploaded to Standard but test belonged in Office.
Virtuox cannot in this case guarantee a reversal of billing or a free test. It is
the DME/HME responsibility to monitor the uploads made and therefore it is
the DME/HME that is responsible for any situations that arise.
Beyond 24 hours the billing has already been generated and may be beyond possibility to
reverse
The first thing to do is to Notify [email protected] with the Patients name and information.
Without this we will NOT be able to stop the billing cycle.
From that point follow the next steps in order to proceed.
1. Schedule the test in Office and do the upload normally
2. Notify the doctor of the mistake and make sure he ignores the test he will be faxed ,
the Office side of VirtuOx reads differently than the Standard side.
Let the Patient know that they may be receiving a bill and NOT to ignore it, they must contact
YOU so you may get back to VirtuOx to rectify and confirm the billing had been cancelled and
that no further processing will occur.
This situation requires notes in the patient file outlining the situation because it may require fu-
ture follow-up. Make certain to keep track of anyone you spoke to in VirtuOx billing and print
out any email instructions given and note the action on your part.
Patient Retest Checklist for DME use.
If there is less than 30 minutes of data on a test, No data on a test, or the data on the oximeter is a Duplicate of
information already Uploaded to another patient the system should return the Patients name to your “Upload
Results” queue. If this is the case Please skip to step “5”
In the case that the Doctor or DME wishes to conduct a Retest the following rules
and procedures must be followed OR the DME/Doctor should EXPECT delays in
obtaining their results. Not following this procedure will create confusion causing
delays.
1. Please Notify VirtuOx via Email of the Pending Retest by Emailing Tech-
[email protected] with: The Reading ID of the test. and the reason for
Retesting.
2. Notify Doctor (if necessary) to disregard the results he will be receiving due
to a whatever reason they are bad, (Short, to much artifact, etc.)
3. Reschedule the patient using the “Schedule Test” selection in VirtuOx. The
system will prompt you to select either a “New” or a “Re-Test” once all of
the demographics are entered.
4. Proceed to retest and upload new result for patient.
BE CERTAIN THAT ALL DOCUMENTATION IS VALID AND ACCEPTED
BY OUR VALIDATION TEAM BEFORE RESCHEDULING A TEST.
Who Do I need to talk to? We would LOVE to speak to you. We understand that you
need the answers to your questions in the fastest way possi-
ble. If the answers to your questions are not contained in
this guide Please contact us using the following methods for
fastest service keep in mind that we are just a few qualified
individuals servicing many of you, allow us to assist as
many as possible by using the methods below for contact.
Upload issues:
877-337-7111 Opt 1
Home Sleep Testing Issues:
RX / AOB issues:
Orders or Device sales:
Uploading Vpod Devices PAGE 1.
First step is to confirm that the Individual has already installed both the CP210X and ActiveX drivers and knows
their com port If not please see section regarding DRIVER INSTALLATION and return to this reference when
completed.
VPOD W HD
Make sure that the Device is Plugged in and turned on The VPOD W HD will show a Probe Off message if this is
the case. Be certain that the Upload cable turns to the RIGHT of the device and falls toward the Buttons on the
VPOD W See Illustration. (Probe Off does not show in Picture)
Once this is confirmed, Navigate to VirtuOx and select “Upload Results”
• From “Upload Results” you will need to select the patient that the Individual had scheduled earlier by double
clicking the notepad and pencil next to the name.
• Select the Device being uploaded, in this case the VPOD Wrist HD and click the next button
• At this point you will need to accept the terms and conditions by placing a check mark and your Initials in the
proper locations and again clicking on the Next button.
• On many computers the default com port that will show is 1 or 2, at this point the individual will need to select
the com port showing the Silicon Labs CP210X in their Device manager (See Finding Com Ports if Nec)
• Re confirm that the device shows Probe off on the screen and click on the Connect button. If actually
connected the computer will show a percentage and the Oximeter will show Numbers rapidly rising on the
screen.
• Once the Oximeter reaches 100% and transfers to the server If everything on the oximeter is a good date
(within 30 days) and not a duplicate of data already uploaded to your account the page will automatically
forward itself to step 4. If the website gives you a message that says the time and date may have been set
incorrectly, please pay EXTREMELY close attention to the dates and times on the reports generated. In
certain cases the results may be deemed invalid and it is the DMEs responsibility to know how to proceed.
If there are any questions please see the reference on Valid Versus Invalid Tests.
• Once you have verified the test results and selected the proper test condition for each session click on the next
button to advance to step 5 and generate the report.
• You should see your reports listed at the bottom of the page in sets of three, If you do not see them please take
note of any message in that general area that will let you know what the issue may be and give
instructions on how to move forward. This Information will be LOST if you navigate away from this
page.
Uploading Vpod Devices PAGE 2.
Vpod Handheld HD V1 and V2
Advise individual to make sure that the Device is plugged into the computer but left off, Be certain that the ONLY
cable being plugged into the Vpod Handheld series has Grey, blue or light purple color. ALL OTHER CABLES
WILL DAMAGE THE OXIMETER IN SOME WAY. (See Pictures below)
A. from “Upload Results” you will need to select the patient that the Individual had scheduled earlier by
double clicking the notepad and pencil next to the name.
B. select the Device being uploaded, in this case the VPOD Handheld and click the next button.
C. at this point you will need to accept the terms and conditions by placing a check mark and your Initials in
the proper locations and again clicking on the Next button.
D. On many computers the default com port that will show is 1 or 2, at this point the individual will need to
select the com port showing the Silicon Labs CP210X in their Device manager (See Finding
Com Ports if Nec)
E. At this point press the power button and wait for the device to show probe off and click on the Connect
button. If actually connected the computer will show a percentage and the Oximeter will show
Numbers rapidly rising on the screen.
F. Once the Oximeter reaches 100% and transfers to the server If everything on the oximeter is a good date
(within 30 days) and not a duplicate of data already uploaded to your account the page will
automatically forward itself to step 4. If the website gives you a message that says the time and
date may have been set incorrectly, please pay EXTREMELY close attention to the dates and
times on the reports generated. In certain cases the results may be deemed invalid and it is the
DMEs responsibility to know how to proceed. If there are any questions please see the reference
on Valid Versus Invalid Tests.
G. Once you have verified the test results and selected the proper test condition for each session click on the
next button to advance to step 5 and generate the report.
H. You should see your reports listed at the bottom of the page in sets of three, If you do not see them please
take note of any message in that general area that will let you know what the issue may be and
give instructions on how to move forward. This information will be LOST if you navigate away
from this page.
Error messages on my Oximeter Dialogue
Listings here are for all known error messages on all supported Oximeters and in
some cases come from the manufacturers Guides.
VPOD W HD Error codes and Explanations.
E13- The current the device is receiving is less than 1.1 volts
Solution: REPLACE THE BATTERY
E1- Is a malfunction of the SPO2 Data and is Often a sign of a Bad Probe.
Solution: Switch Probe with a known working one and see if the Error code
follows the Probe or follows the Device. If the error follows the Probe, the
probe will need to be replaced. If the error stays with the device please sub-
mit the device for RMA.
E2- Failure to store data.
Solution: this device will need to be Cleared via the VirtuOx website, to
format the Memory which has for some reason corrupted. If the error per-
sists (VERY RARE) the unit will need to be submitted for RMA
Prob Off- This is not an error,
this merely says that the device is on and no sensor is plugged in, if
there is a sensor plugged in and the wire to the finger probe turns to the
right please submit for RMA.
SEN OFF- this is not an error.
This means that the patient needs to place the probe on their finger in the
proper manner.
Vpod HandHeld HD Error Codes and Explanations
E1- Firmware and or Programming memory damaged or courrupt. (Rare)
Solution: Clear the device via the VirtuOx website if possible, If error per-
sists Please submit for RMA
E2- Data Memory damaged and or corrupt.
Solution: Clear the device via the VirtuOx website if possible, if error per-
sists please submit for RMA
E7, E3, E4 or E5.- Probe Damaged.
Solution: Please test with alternate probe to assure that there is not an addi-
tional issue. Please replace Finger Probe.
E6- crystal Oscillator damaged (Rare)
Solution: Please submit the device for RMA.
E9- Real Time Clock damaged.
Solution: Please submit the device for RMA.
E10- Eeprom Damaged
Solution: Please submit the device for RMA.
Prob Off- This is not an error,
this merely says that the device is on and no sensor is plugged in, if
there is a sensor plugged in and this still shows please submit for RMA.
SEN OFF- this is not an error.
This means that the patient needs to place the probe on their finger in the
proper manner.
Finding Com Ports:
For Win 2000, XP, and Vista. (Please contact VirtuOx Tier 3 for WIN 7)
To find out which com port you need to use you need to know 2 things for certain. The type of device
you are using AND the type of connection you are using.
For 9pin (rs232, serial) devices:
check to confirm that the cable connects DIRECTLY to the PC without using any Adaptive devices or
cables.
the exceptions to this rule will ONLY be for the Keyspan USA-19HS (see Adaptive
Devices Dialogue) and the VPOD Handheld cable which is a direct interface not an
actual rs232 adaptor cable (9 pin end will be Grey, Blue or Purple), and the Model
1000USB By Nonin (Will say “Nonin” on front)
Many computers having direct 9pin ports on the back of the computer have more than one, they should
be labeled please note which one the upload cable is connected to
(1 or 2) as this will be the com port used for upload. In the case that the Serial port is on an add on card
please see notes regarding that situation below.
For Vpod Devices, add on serial cards and all Adaptive Devices:
Access the “Start” Button at the bottom left hand corner of the screen and select “Settings” or “Control
Panel”, We are looking for the Control panel to proceed.
Once the control panel window is opened you need to look for an entry called “System”
(You may need to look at the left hand side of the window and select “Change to Classic View” to see
this list properly)
Once you locate the “System” Icon click on it and another small window will open. Please select the
“Hardware” tab from the selection presented.
From the “Hardware” tab, select the button labeled “Device Manager” this will open yet another listing.
Once the Device Manager is opened, look about 2 thirds of the page down to locate the entry labeled
“Ports (Com & LPT)” click on the plus sign next to the entry.
This will display all “Connected” devices (or Hardware Ports in the case of standard RS232). From this
point we are looking for the following supported entries.
1. Silicon Labs Cp210X USB to UART Bridge (Com “X”) for VPOD
2. Keyspan USB Serial Port (Com “X”) for Nonin/Resp
3. USB Serial Port (Com “X”) for Nonin/Resp
4. An IDE serial port adaptor in the case of a hardware upgrade to RS232.
In Each case a device must be hooked to the unit to see the Com port and Driver. Please take note of the
Com Port for your device(s) this will be a permanent com port for upload to THIS computer.