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Requalifying Medicare patients

Discussion in 'Sleep Medicine' started by michaelrack, 11.23.12.

  1. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    For Medicare patients who fail the initial 3 month CPAP trial period, what type of requalifying study are you guys doing?

    My interpretation of the requirements is that the doc gets to choose which type of study is most appropriate (this can often be a retitration). On the other hand, some DME's want a psg or split-night.
  2. danielmd06

    danielmd06 Neurosomnologist

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    I've gotten away with both and if the DME has a particular request I simply follow through with that. I believe the strict interpretation is that a diagnostic PSG is required, though a retitration is often much more clinically useful to me.
  3. SmurfTurf

    SmurfTurf

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    Albeit i'm not a doctor, just a premed. However I am an RPSGT that works at a sleep lab and a DME company. From what I heard it used to be that it had to be another split or PSG to get them re-qualified, however a few months ago (sometime this summer) it changed so it can be any type of study. So you should be fine just doing a retitration instead. I just did a sleep study 2 week on a patient who needed re-qualified, and we just did a retitration and there were no problems with insurance.
  4. Faebinder

    Faebinder Slow Wave Smurf

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    It's a very stupid rule cause medicare and private insurances cost themselves more money with this requirement. We do a split night and that usually suffices.
  5. neurologist

    neurologist En garde Moderator

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    We do a split with a really low cutoff (ahi 5-10) to start cpap.
  6. michaelrack

    michaelrack All In at the wrong time SDN Advisor

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    that's what I usually do, also. I do plan on looking into what SmurfTurf mentions.
  7. danielmd06

    danielmd06 Neurosomnologist

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    This sounds like a great idea.
  8. danielmd06

    danielmd06 Neurosomnologist

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    It looks like for Medicare, the type of PSG does not matter.

    For other particular insurance entities, a diagnostic test is most often what is required, but a split night would be accpeted also.

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