HME Industry Asks CMS to Revise ABN Policy for CPAP

October 14, 2011

Current Medicare Coverage and Reimbursement policy for home care companies providing CPAP devices to beneficiaries requires attestation that the patient continues to be in compliance with physician orders and the use of their CPAP devices.

Patient compliance in using CPAP devices has always been problematic. Recognizing that patients often will not follow the prescribed CPAP therapy, (thus ending Medicare coverage), CMS permits home care providers on day 60 of CPAP coverage to give patients a advance beneficiary notice (ABN) form. The ABN in essence states the patient has agreed that if Medicare coverage of an item is ended (in this case due to non compliance) that the patient will pay the home care provider for the cost of renting the item in question.

The Home Care Industry, led by AAHomecare, recently submitted a request to CMS to “reconsider the timeframe in which a durable medical equipment (DME) provider may give an advance beneficiary notice (ABN) to a Medicare beneficiary who initiates therapy with a continuous positive airway pressure (CPAP) device.”

 The letter requests that CMS revise the policy to permit the home care companies to present the ABN to the patient at the start of CPAP therapy after “carefully assess(ing) the beneficiary’s propensity to comply or not comply with medical instructions.”

As this is a recent request on the part of the Industry, any response from CMS has not been made public.