"please keep me updated about oximeters "
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New RERA Ruling by "Medicare" Effective 01 Apr 2010
Clarifications regarding calculation of AHI and RDI are also spelled out in the policy. Among other clarifications, the policy states that the respiratory effort related arousals (RERAs) can’t be used in the calculation of AHI or RDI.
http://http://www.sleepreviewmag.com/sleep_report/2010-03-31_01.asp
DME MACs Revise PAP LCDs
Views: 630
Replies to This Discussion
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Permalink Reply by RockRpsgt on
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RERAs have never been calculated in AHI. They have manipulated the true function of RDI so bad that it is not funny. If we can't calculate RERAs into the formula then RDI no longer exist. this tells me that Medicare no longer gives UARS any credit.
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Permalink Reply by Judy on
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Hey, they are probably sweating blood at the cost of all these new people going on the "rolls" and the rising awareness of OSA and don't want to make it "too easy" to get an OSA Dx and get started on xPAP. Remember, these are the policy makers, not the "treating" physicians.
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I found out that RERAs have never been acknowledged by medicare. So the only thing that this changes for us is the way we document Bpap. All they did was reword the existing rule.
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Permalink Reply by Renee on
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Hey Rock ~
I think it's great how you checked this out and clarified it.
Considering ALL the changes that will surely be coming along - it'll be important to keep up with them - and it was good of Judy to note, early on, the change in Medicare language so it could be investigated. This is just our 1st signal of how the wording in the various bills, legislations and bureau / department regulations will be incredibly and diabolically perplexing for quite some time to come.
Thanks Rock for sorting this particular one out.
Best,
Renee
Rock Hinkle said:I found out that RERAs have never been acknowledged by medicare. So the only thing that this changes for us is the way we document Bpap. All they did was reword the existing rule.
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I don't know how much sorting I did Renee. The more I read on the medicare rules the more confusing it gets. They have completely changed the use of RDI to fit their own parameters. RDI= Respiratory Disturbance index. It is the average number of apneas, hypopneas, and RERAs per hour. RDI is now only supposed to be used in conjunction with the home testing unit. It is a calculation of breathing events from lights out to lights on. With no seperation between sleep and wake. that means that insignificant wake events are being calcualted in the use of home studies. This raises the chances of a false positve for SBDs. As I have said many times in previous post your AHI/RDI will be higher if calculated with a home study.
When I had the home study done it showed that my AHI was around 10. I have had 3 PSGs since. All results put my AHI under 5 with one having 0 events. I have lost some weight, but it still makes me wonder.
In some parts of the country Medicare will reimburse for RERAs. They will pay for a titration that has been based on an RDI calculation. They will not pay for the CPAP unit if the calculations included RERAS. Figure that one out.
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Hey Rock ~
It seems a shame to me how much the leeway / latitude is built into home testing results - sure seems a basis for an "iffy" dx. AND, I really do wonder WHY they would want RDI to be used only in conjunction with home testing. It would seem so much more valid in lab testing when one is being scored during ACTUAL awake and sleep time.
Now, about: "In some parts of the country Medicare will reimburse for RERAs. They will pay for a titration that has been based on an RDI calculation. They will not pay for the CPAP unit if the calculations included RERAS. Figure that one out." WOOWWWWW - Absolutely Crazy ! ! !
That was in interesting puzzle to noodle over . . .
Best,
Renee
Rock Hinkle said:I don't know how much sorting I did Renee. The more I read on the medicare rules the more confusing it gets. They have completely changed the use of RDI to fit their own parameters. RDI= Respiratory Disturbance index. It is the average number of apneas, hypopneas, and RERAs per hour. RDI is now only supposed to be used in conjunction with the home testing unit. It is a calculation of breathing events from lights out to lights on. With no seperation between sleep and wake. that means that insignificant wake events are being calcualted in the use of home studies. This raises the chances of a false positve for SBDs. As I have said many times in previous post your AHI/RDI will be higher if calculated with a home study.
In some parts of the country Medicare will reimburse for RERAs. They will pay for a titration that has been based on an RDI calculation. They will not pay for the CPAP unit if the calculations included RERAS. Figure that one out.
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I do not want to take away from the home study unit. It is a valued tool in my arsenal to combat bad sleep. I just believe that the parameters, along with the units themselves, are underdeveloped at this point. As a pre-screening tool there is no equal. If the results showed that a pt had an RDI of say 35 I would not question anything. An RDI of 10 or less I would question everytime.
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Permalink Reply by D. W. Conn on
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It was not that long ago that Hypopnea couldn't be used in calculations. In the next 2 to 4 years we are going to see big changes in what medicare will and will not allow. Hang on its going to get bumpy.
Rock Hinkle said:RERAs have never been calculated in AHI. They have manipulated the true function of RDI so bad that it is not funny. If we can't calculate RERAs into the formula then RDI no longer exist. this tells me that Medicare no longer gives UARS any credit.
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Not that I am an Einstein or anything, but I figured it out. Medicare uses RDI in conjunction with homestudies. If a person proves positive for apnea during one of these studies there numbers would have to be based on RDI. Therefore medicare would approve the need for a titration study. They will not cover a diagnosis based on RDI calculated via a PSG titration. The final calculation for CPAP reimbursement must be done using the AHI formula. Voila!
As long as the insurance companies are able to dictate diagnosis and treatment no reform will fix the system.
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Hey Rock ~ Well said - all the way around !
Rock Hinkle said:Not that I am an Einstein or anything, but I figured it out. Medicare uses RDI in conjunction with homestudies. If a person proves positive for apnea during one of these studies there numbers would have to be based on RDI. Therefore medicare would approve the need for a titration study. They will not cover a diagnosis based on RDI calculated via a PSG titration. The final calculation for CPAP reimbursement must be done using the AHI formula. Voila!
As long as the insurance companies are able to dictate diagnosis and treatment no reform will fix the system.
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