CPAP BEST 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? 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 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