OCST- Slep Lab vs Physicians Office

Topics related to in home sleep testing (portable monitoring)

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OCST- Slep Lab vs Physicians Office

Postby Krob » Wed Jun 12, 2013 5:28 pm

We have referring sleep physicians who would like to perform OCST from their office rather than send pt to the lab for OCST equipment, set up and education. They feel it is "more convenient" for the patient
We are accredited.
We have a meeting set up to discuss this....My question is.....Does anyone have information that will help us to reinforce the benefits of pt coming to the sleep lab for this? either insurance, AASM, or other reasoning, anything that will help us support/validate the use of the lab vs physicians office.
Thanks in advance for your help
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info

Postby polysomprincess » Wed Jun 12, 2013 5:47 pm

this info is texas medicare/caid guidelines...maybe it will help trigger something for you...


Home Sleep Testing (HST), Portable Monitoring (PM) or Out of the Facility (OOF) Testing

When the diagnostic evaluation of sleep disorders requires overnight examination of the sleeping patient by means of polysomnography to assess severity, effect on sleep architecture and continuity, and the effects on gas exchange, cardiac function, etc. the polysomnography is used in conjunction with the patient's history, other laboratory tests and observations, and the physician's knowledge of sleep disorders to reach a diagnosis and to recommend appropriate treatment and follow-up.

A Final Decision Memo (FDM) was issued by CMS on March 13, 2009 concerning Home Sleep Testing (HST) acceptance for coverage to determining need for CPAP.

Several issues were unanswered by this FDM. This LCD shall attempt to clarify under what circumstances this type of testing (i.e., Portable Monitoring, Out of Facility testing, and Home Sleep Testing) will be considered reasonable and necessary and therefore payable. The accuracy of diagnostic sleep studies depends on the knowledge, skill, and experience of the technologist and interpreter and does not matter if Type I, II, III, or IV or where the test is performed. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit. (See "Documentation Requirements" section of this policy for certification/ accreditation requirements.) Because patients referred for sleep studies must be evaluated thoroughly, the participation of a physician in the program is required. After evaluation, diagnosis, and the development of a treatment plan, patients are usually returned to their referring physicians, some patients will elect at least some treatment and follow-up with the sleep disorders program staff, particularly for prescription refills, the follow-up of nasal CPAP, etc. It is expected that ongoing education of the patient is an integral part of the treatment.

Space, equipment, and staffing must be consistent with the requirements noted in the Documentation Requirements Section below.

•All studies and application of HST/PM/OOF testing devices must have face to face education and application performed by an acceptable technician before the study is performed as noted in the Documentation Requirement sections.
•All sleep studies (in facility or out of facility) are to be supervised and with an over read by the providers meeting the accreditation requirements list below in the Documentation Requirements Section to be considered reasonable and necessary and thereby payable.
All facility based (non-hospital affiliated) ordered sleep studies (in facility or OOF) shall be performed under the direction of a Center/Laboratory that meets the following criteria:



1.Each center/laboratory must have as medical director a physician with a license valid in the state of the center;
2.Technicians must work under the direction and control of a licensed physician, even though this test may be covered in the absence of direct supervision. This information should be documented and available upon request;
3.Each center/laboratory, non-hospital based, must be accredited by and comply with the standards set in the Documentation Requirements below to be considered reasonable and necessary and thereby payable. (AASM, The Joint Commission, ACHC).
Each center/laboratory in a freestanding center that is a direct extension of a physician's office associated with physician must have on staff (1) a physician/PhD psychologist who has the credentials listed in the Documentation Requirement Section or (2) special training in sleep medicine with the specialty designation of either pulmonary medicine, neurology, psychiatry, or otolaryngology so credentialed as noted in the Documentation Requirements Section below to be considered reasonable and necessary and thereby payable.



Hospital based sleep, as well as non hospital based sleep clinics shall be credentialed with the qualification listed in the Documentation Requirements below and shall meet the following criteria for HST/ PM/ or OOF testing:

•Physicians shall document the face to face clinical evaluation in a detailed narrative note in their charts, done prior to the testing being done.
•The notes must clearly indicate the patient has a high likelihood of having moderate to severe sleep apnea
•This increased likelihood is evidenced by symptoms and physical examination documented in the note
•That no comorbidities exist that are contraindications to HST/PM/OOF testing.
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Postby need2zz » Wed Jun 12, 2013 7:17 pm

Encourage them to do them themselves and charge the technical component $119. Your lab will interpret and collect professional fee $68. They must own or lease equipment. They now have an incentive to HST everyone who snores. Have them send all positive HSTs to your lab for titrations. You will end up with more business in the end. Works even better if you sell DME.
The 2013 Sleep Lab.
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Postby somnonaut » Wed Jun 12, 2013 7:28 pm

Well Poly, right here they wrong:
"The accuracy of diagnostic sleep studies depends on the knowledge, skill, and experience of the technologist and interpreter and does not matter if Type I, II, III, or IV or where the test is performed."

Type I tests (gold standard polysomnography) are for all types of sleep disorders, where type III and IV are ONLY for OSA testing. So, off the bat they have no clue what they are talking about. As usual.
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Home Sleep Testing (HST)

Postby Krob » Thu Jun 13, 2013 1:48 pm

Thanks-
We are looking for leverage to keep the HST at our lab.
This practice is part of our facility. If they are doing their own OCST how will this effect our accredidation?
Besides HPHC dose anyone know of any other insurance companies regulating that HST be done by an accredited OCST facility?
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Postby polysomprincess » Thu Jun 13, 2013 6:14 pm

Trust me Claude when i went thru the entire 23 pages I found lots of interesting errors....

would love to know who drafted that crap....
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Re: Home Sleep Testing (HST)

Postby Vix » Thu Jun 13, 2013 6:46 pm

Krob wrote:Thanks-
We are looking for leverage to keep the HST at our lab.
This practice is part of our facility. If they are doing their own OCST how will this effect our accredidation?
Besides HPHC dose anyone know of any other insurance companies regulating that HST be done by an accredited OCST facility?


If they are just referring MDs, as you said in your original post, then this would not affect your accreditation.

If they are MDs that are included as sleep center staff on your accreditation application, then you could lose your overall center accreditation status if you do not get your sleep center accredited as an OCST provider.
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Postby somnonaut » Thu Jun 13, 2013 7:10 pm

Or use an accredited OCST provider.
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Postby #42dreamweaver » Fri Jun 14, 2013 5:36 am

if a reffering physician can make $100 to do an HST vs sending them to the hospital for nothing, they're going to take the $100 any day. well, probably 90% of them.
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Postby PREDatude » Fri Jul 12, 2013 10:26 am

So...must the staff member that provides pt education/instruction on applying the HST equipment be an RPSGT? Or can any staff (nurse, MA) do it?

Is there a link to these 28 pages? :)
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