[James T]

We have a gentleman who moved to our area and wants to get his CPAP supplies from us. Do we need to get ALL the docs that we would need if he was getting a CPAP? Or do we just need an order from his Doctor?

[DeeDee]

You should have a release of records form signed and obtain copies of the qualifying sleep study from either the physician or his previous supplier.

You are required to have proof in the even of an audit that the patient meets criteria for the equipment.

We require a copy of the sleep study before we will provide supplies for a new patient.

[JohnD]

Dee Dee - are you 100% certain about this? While supplies are a prescription item, why can you not dispense with a Dr.s script for the item(s)?
You may be thinking Medicare and in that case all the documentation might be required, but the majority of pap pts are private insurance and/or private payers. In that case it seems only a copy of script on file is required.
I'm learning here so please correct me if I'm wrong. Thanks John

[DeeDee]

Can I tell you right now that I am 100% - no.

However, when you dispense an item and bill an insurance company you are required to make sure that a patient qualifies for that item. The only way to know if a patient qualifies for a component or supply to be used with another item is to know that they qualify for the base.

Yes, it is a requirement for Medicare in the event of an audit. We are finding that more and more private insurance companies are following the same criteria. As in anything we do, I would prefer to know that I am more likely to keep my money in the event of an audit by having all necessary paperwork.

[mattmetz]

Here is my short answer:

What does his insurance require?

Rx is required to dispense as masks have become legend items. Then it is all related to insurance requirements. Medicare for sure requires that the Medicare patients sleep study meets all of TODAYS requirements no matter when it was done. Then keep in mind that some private insurers are following Medicare guidelines.

So bottom line is a good insurance verification and meeting that insurance companies guidelines for documentation.

Final thought: there is always non-assigned, collect cash, and bill for patient if Medicaid is not in the picture.

Good Luck

Matt Metzger, RRT

[jant]

Originally Posted by DeeDee

Can I tell you right now that I am 100% - no.

However, when you dispense an item and bill an insurance company you are required to make sure that a patient qualifies for that item. The only way to know if a patient qualifies for a component or supply to be used with another item is to know that they qualify for the base.

Yes, it is a requirement for Medicare in the event of an audit. We are finding that more and more private insurance companies are following the same criteria. As in anything we do, I would prefer to know that I am more likely to keep my money in the event of an audit by having all necessary paperwork.

Amen! I wish all providers would do this because we look bad with the Docs when we are the only ones asking for this level of needed info.