New Medicare CPAP requirement - how are you handling?
How are you handling the new requirement for Medicare CPAP/BIPAP business that says the physician interpreting the PSG must be credentialed? What process do you use to look these physicians up to see if they're credentialed, and do you turn away orders that come from non-credentialed physicians?
Here's the LCD Revision article from Region C (though it affects all regions)
January 28, 2010
Positive Airway Pressure (PAP) LCD Revision - January 2010
The PAP local coverage determination (LCD) has been revised, effective for dates of service on or after January 1, 2010. The revision addresses physician credentialing and the interpretation of facility-based polysomnograms (PSG). The current policy requirement is based on the date of service the PAP device is dispensed. The revised policy requirement is based on the date of service of the facility-based polysomnogram. The consequences of this change are illustrated in the scenarios below:
Polysomnogram date: November 15, 2009 by a non-credentialed physician PAP device initial DOS: January 15, 2010
Current Policy
Policy requires that for PAP devices with DOS on or after January 1, 2010, interpreting physician must meet credentialing requirements. PAP device would be denied since DOS for PAP claim after 1/1/2010.
Revised Policy
Policy requires that physicians interpreting facility-based PSGs performed on or after January 1, 2010 must be credentialed. PAP device allowed since date of test prior to effective date of 1/1/2010 for credentialing requirement.
Suppliers are encouraged to read the entire LCD and policy article for additional coverage, coding and documentation guidance.
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