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.)