SleepPartners News
Listening to the Government
By David S. Szabo, Edwards Angell Palmer & Dodge LLP
On June 21, 2011, the Office of the Inspector General of the U.S. Department of Health and Human Services (the “OIG”) issued Advisory Opinion No. 11-08. The Opinion reviewed existing and proposed contracts between a sleep lab and a CPAP supplier, and concluded that both the existing arrangement and the proposed arrangement could potentially generate prohibited remuneration under the anti-kickback statute and that the OIG could potentially impose sanctions on the parties. This unfavorable ruling demonstrates the high level of concern that the OIG has about financial dealings between Sleep Labs and DME suppliers. Click here to read the full article.
Listening to the Government
By David S. Szabo, Edwards Angell Palmer & Dodge LLP
Are you compliant with Medicare regulations? A look inside the OIG’s upcoming review on Sleep Care. To read the complete article written by David S. Szabo, click here.
Sleep HealthCenters Partners with Roadside Medical
Sleep HealthCenters has entered into an agreement with Roadside Medical Clinic + Lab to provide sleep medicine services as part of Roadside Medical's industry-leading Driver Wellness programs. Several SleepPartners members are subcontracting to provide services to Roadside Medical patients in geographic areas not presently served by Sleep HealthCenters.
Designed to enhance roadway safety by improving the health of commercial drivers, Roadside Medical Clinic + Lab provides cost-effective and professional medical services including DOT compliant physicals, drug testing, Driver Wellness Programs, and now sleep services in the most convenient locations for professional drivers-both on the highway and in company terminals. Sleep HealthCenters will support Roadside's sleep wellness program by providing education, professional diagnosis and treatment support, all incorporated into Roadside's overall Driver Wellness program.
To view the full press release click here.
Decrease in Physician Visits
According to a recent analysis of physician services by Deutsche Bank Securities, total patient visits to physician offices were down in July and August (7.3% and 1.3% respectively) from a year earlier, creating the fifth consecutive month to post negative growth in physician visits. Overall, primary care visits were down by 5.7% for the month of July 2010, but showing a modest increase in August up 2.4%. "From a regional perspective, the East region looked particularly weak in August 2010 (-9.8%), while the West region was the weakest region in July 2010 (-8.8%)." According to Deutsche Bank, physician office visits tend to be an important leading indicator for elective outpatient surgery volumes, such that ambulatory surgical centers may be impacted as well with not only soft demand but over-capacity to create a "very difficult fundamental environment" over the near-term. We believe sleep medicine services are also often seen as elective and may be similarly impacted.
To read the full report from Deutsche Bank, click here.
Healthcare Reform Law Contains New Referral and Encounters Requirements For Durable Medical Equipment Suppliers.
By David S. Szabo, Edwards Angell Palmer & Dodge LLP
The new federal health reform law contains important changes for sleep labs that provide CPAP to their patients. The law, officially known as the Patient Protection and Affordable Care Act of 2010, added new referral requirements for DME suppliers and new compliance mandates for all providers participating in Medicare and Medicaid. This article will describe just a few of the many new requirements and challenges created by the Act.
Physicians who order DME for Medicare patients must be enrolled with Medicare.
Physicians who order durable medical equipment or home health services for Medicare beneficiaries must be enrolled with the Medicare program. Further, the Secretary of Health and Human Services is authorized to extend this recruitment to other items or services under Medicare, including Part D covered drugs. Physicians who are not enrolled in the Medicare program cannot order durable medical equipment for Medicare beneficiaries. This requirement will become effective July 1, 2010.
While apparently a simple requirement, this new rule is likely to force equipment suppliers to verify the Medicare enrollment of physicians who order services, which could become a significant administrative burden. Failure to observe their requirement could lead to coverage denials, false claims liability, or other sanctions.
Enhanced Documentation of Referrals for DME and Encounter Requirements
Physicians, suppliers and providers now are required to maintain documentation relating to written orders or requests for payment for durable medical equipment. Significantly, the Act also empowers the Secretary to expand this requirement to other kinds of services covered by Medicare. The Secretary is also empowered to revoke the Medicare enrollment of suppliers and physicians who do not provide access to such documentation on request. The Act further expands the Office of the Inspector General’s permissive exclusion authority to exclude entities that fail to provide information relating to the “ordering, referring for furnishing, or certifying the need for” items or services covered by the Medicare and Medicaid programs. This requirement applies to orders, certifications, and referrals made on or after January 1, 2010.
Congress appears to be concerned that medical equipment orders are not being properly documented and that some portion of the durable medical equipment currently being paid for by Medicare might not be medically necessary.
The Act now requires a face-to-face encounter between a patient and a physician, physician assistant, nurse practitioner, or clinical nurse specialist before an order is made for durable medical equipment. This section also permits encounters made through telehealth technology. The Act’s requirements apply to both Medicare and Medicaid. Significantly, the Act allows the Secretary to expand the scope of this face-to-face encounter requirement to other items and services covered by Medicare, based upon a finding that such a requirement could reduce the risk of waste, fraud, and abuse. These requirements also have an effective date of January 1, 2010.
As equipment suppliers generally do not maintain the documentation proving whether and when a face-to-face encounter occurred, this requirement will place more stress on the relationship between equipment suppliers and referring physicians.
Health care reform will give many more Americans access to health insurance. At the same time, it will impose new compliance and documentation burdens on health care providers. Sleep labs and CPAP suppliers will have to be vigilant about documenting medical necessity in order to avoid costly compliance problems with the Medicare program.
Starting a Sleep Center
By Lawrence J. Epstein, MD and Paul S. Valentine
Published in Chest 2010;137;1217-1224. <<read article
Sleep Apnea and Trucking Conference 2010 by Kirsty J. Kerin, PhD
The inaugural Sleep Apnea & Trucking Conference was held in Baltimore MD on May 11-12th 2010. The event was organized by the American Sleep Apnea Association and co-sponsored by the Federal Motor Carrier Safety Administration and the American Trucking Association. SHC’s Regional Medical Director in Arizona, Dr. Rochelle Goldberg, was the chair person for the event and SHC’s Chief Medical Officer, Dr. Lawrence Epstein, presented “Sleep Apnea 101” to experts from the trucking, regulatory, medical, liability insurance, and legal fields.
The FMCSA reiterated that there is currently no date scheduled for the much anticipated change in Department of Transportation sleep apnea guidelines, regulations, and FAQs, although the administration is working diligently on the issue. Martin R. Walker, PhD, Chief of the Research Division from FMCSA, and Karl Sieber, from NIOSH, presented the data from which any new regulations would be based, as well as detailed areas of research still needed. Clarification of the current role that the Interstate Medical Examiner should be taking in assessing patients for sleep apnea was provided by Natalie Hartenbaum, MD, MPH, President of OccuMedix.
Five different sleep apnea management programs were presented by various vendors. Each group had a different focus, from a 100% PSG-based-program to a 100% LCT-based-program (Limited Channel Testing). Don Osterberg, senior vice president of safety for Schneider National presented methods by which trucking companies could implement a sleep apnea management program and save medical costs and reduce accidents.
The conference provided clarification on the status of the regulatory environment in which sleep apnea is managed, and several cost-effective high quality technologies and programs that trucking companies could utilize to treat their drivers. For more information visit www.satc2010.org.
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