Nevada Accreditation

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Nevada Accreditation

Postby LadyHypnos » Tue Apr 05, 2016 3:43 am

Hi everyone, I'm sure this has been asked before but does anyone have information about running medicare patients in Nevada? As far as do we need to be accredited to run medicare patients and are only registered techs allowed to run them? I thought both were true but I'm having trouble locating any info on this. Any info is greatly appreciated!!!
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Re: Nevada Accreditation

Postby MrBig » Wed Apr 06, 2016 6:43 am

Things one should learn before they start a lab......
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Re: Nevada Accreditation

Postby LadyHypnos » Wed Apr 06, 2016 4:52 pm

Thank you for your informative answer Mr.Big. You would think the lab I've been hired at would know for sure but now I've been given the task to track down any current rules to place in our P&P for new techs. Figured this forum of fellow sleep techs would have some literature and would be a good place to reach out. Instead of a snarky answer maybe try to point me in the right direction, it's a lot more helpful.
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Re: Nevada Accreditation

Postby Water Boy » Wed Apr 06, 2016 9:27 pm

Lady Hypnos,
You will want to look up your Local Coverage Determination (LCD) to get that information. There are also nat'l coverage determinations (NCD) that govern sleep services and DMEs reimbursement (NCDs override LCDs if they conflict). Medicare is governed by CMS, which breaks up the US into regions and assigns regional contractors to administer Medicare reimbursement and enforce the LCDs. I believe (but not sure) Nevada is in region E and your contractor (Noridian) is here: https://med.noridianmedicare.com/web/je ... lcd/active
That is your starting point, search through the website for LCDs that govern sleep studies and CPAP/BiPAP reimbursement. Much of the LCD language in our state (Florida) is written around reimbursement for PAP, so you want to become familiar with those LCDs also because if you do not follow them your patient may not be able to get reimbursed for PAP, even if the sleep study was covered.
Another warning about Medicare, they contract for RAC audits sometimes years after the service was provided and if they find you did not follow the all of the NCD/LCDs, they will demand their money back. The contractors that perform the RAC audits are paid by commission on how much $ they recover from providers, they are aggressive, and if you have broken a lot of LCD rules over a long period, you may have to pay a LOT of money back. Some sleep programs in our region have been financially devastated by RAC audits to the point of closing their doors. And if CMS should determine that you willfully and purposely violated the LCD/NCDs you can go to jail for a while. That also has happened a few times here in Florida (the sunny place for shady people), and a few sleep techs have become wealthy turning in their employers via federal whistle blower lawsuits (you get a percentage of the $ they recover from the provider!).

Our regional CMS contractor offers a weekly newsletter and webinars to help you stay up on the latest changes to LCDs and NCDs, I highly recommend you take advantage of that and make yourself an LCD expert. The DMEs will usually assist you also, because they depend on sleep labs complying with the LCDs so they can get paid for PAP provision.

Good luck!
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