Moving the HME Industry Forward

Respiratory/Sleep

CMS Proposes Prior Authorization for CPAP

July 21, 2014

WASHINGTON, DC – On May 28, CMS published a proposed rule recommending a prior authorization (PA) process for certain DME. The rule identified a “master list” of DME items—including CPAP therapy and respiratory assist devices (RADs)—which could be subject to a proposed prior authorization process.

In a press release issued last week, the American Academy of Sleep Medicine (AASM) strongly disagreed with the proposal, saying threatened to cause significant delays in the delivery of critical therapy for Medicare patients with obstructive sleep apnea. Last week, the AASM submitted a comment letter discouraging CMS from implementing the proposed rule. AASM members were encouraged to submit their own comments via the Federal Register website.

Gary Sheehan, MBA (pictured above at Medtrade Spring 2014), does not have a problem with the concept of PA for CPAP, but the owner of Cape Medical Supply, Sandwich, Mass, with locations in Canton, Mass, and Kittery, Me, cautions that much depends on the execution of the program.

“We don’t look at PAs as a bad thing,” he says. “It provides certainty of payment. I think it would ultimately help us with this issue of post payment audits. It’s really a matter of how effective the process is put in place, how automated it is, and what they are going to be asking for. However, the devil is always in the details. We need to make sure that when they design that process that it is smooth, efficient, and doesn’t get in the way of providing care for patients.”

Another CPAP Acquisition for Verus Healthcare
NASHVILLE – Tennessee-based Verus Healthcare Inc recently completed its 85th acquisition of yet another CPAP business in the DME industry. Verus Healthcare now services more than 40,000 sleep apnea patients for their CPAP supply needs, and processes nearly 10,000 new orders per month.

“When we bought this platform two years ago, attrition among the patient base was very high,” said Richardson M. Roberts, CEO of Verus Healthcare. “We’ve grown the patient base seven-fold while decreasing our monthly attrition to approximately one percent per month which we believe is the best in the industry. It’s a testament to our high quality personnel, improved processes and automated systems.”

In addition, the company continues to invest in software development. “Once our system determines that we have the proper documentation, the patient’s order ships that day,” added Roberts. “Most of our DME competitors cannot match that. Our systems allow us to be patient-centric in everything we do. With our new web-based reordering capability, we are able to service the patient however they prefer, whether it be live calls or through the web. We continue to make improvements to our systems and believe they are the best in our industry.”

Sleep-Related Companies Scheduled to Exhibit at Medtrade
ATLANTA – Most estimates peg the number of undiagnosed sleep apnea patients at 80% nationwide. The figures add up to massive potential in the CPAP/oral appliance market. This year’s Medtrade, scheduled for Oct 20-23, 2014, at the Georgia World Congress Center in Atlanta, will feature several sleep-related exhibitors, including:

Battery Power Solutions – Booth #2245
Contour Products Inc – Booth #1025
Drive Medical – Booth #1617
Eastex Products Inc – Booth #2360
Fisher & Paykel Healthcare – Booth #1644
Glenn Medical Systems Inc – Booth #1029
Hudson Medical – Booth #1836
Inventory Solutions Inc – Booth #1237
Linak US Inc – Booth #1852
Nonin Medical Inc – Booth #1212
Philips Respironics Inc – Booth #1711
RemZzzs – Booth #1756
ResMed – Booth #1317
Roscoe Medical – Booth #1516
Sleep Nation Inc – Booth #2464
Transfer Master Products Inc – Booth #2252
U-Sleep – Booth #1330

• Providers who wish to register for Medtrade may do so by CLICKING HERE.    
• The full link for registration is http://registration.experientevent.com/showmth141/default.aspx?flowcode=att
• Pricing for events can be found at: https://www.medtrade.com/attendee/pricing.shtml

Exhibitors have already bought 95% of the floor space at the Georgia World Congress Center in anticipation of what could be the most important Medtrade in the event’s long history. For a complete list of exhibitors and/or additional information about the show, visit www.medtrade.com.