Sleep Study LCD Is Another False Alarm

ATLANTA–While it confused some in the HME industry and rattled
others, a National Government Services’ LCD for sleep studies
issued last week was not the one that industry stakeholders are
awaiting, according to Kelly Riley, director of the National
Respiratory Network for Lubbock, Texas-based The MED Group.

“What everyone is seeing is the LCD for the testing
component,” Riley explained, adding that she had received
several inquiries from concerned providers and others.

She pointed out the NGS document is one of 10 that will be
popping up as each of the MACS overseeing testing issues its own
LCD. And while those LCDs do not govern HME procedures, Riley said,
“We have to pay a lot of attention to them.” For
example, she said, if a testing LCD stipulates that “only a
pulmonologist who works in a sleep lab can do a test, we’re going
to have issues.”

The NGS LCD did not contain anything of concern, according to
Riley. “To me, it was verbatim from the [national coverage
determination],” she said.

Riley noted that while all 10 of the testing LCDs could be
different, she expects the HME LCDs on sleep to be the same in all
four DME MAC regions.

Robert Hoover, Jr., MD, MPH, FACP, senior medical director for
Cigna Government Services DME MAC Jurisdiction C, said a revised
CPAP LCD would be released after receiving instructions from CMS
for implementation of the decision memo, which was issued on March
13.

“We will have 90 days to implement the NCD,” Hoover
said. “The LCD will be retroactive to dates of service on or
after March 13, 2008. The release of the policy is dependent upon
when CMS releases final instructions to the DME MAC
contractors.”

A similar incident shook providers in late February when a
Fiscal Intermediary policy update with no bearing for this industry
stated that in-home sleep studies were not covered. (See HomeCare Monday, March 3.)