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[News] OIG Urges CMS to Revise CPAP Replacement Schedules
#1
OIG Urges CMS to Revise CPAP Replacement Schedules

Following the results of a recent study, the Office of Inspector General (OIG) has urged the US Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) to review and revise the CPAP supply replacement schedule in a report published today.

The study, prompted by a 2012 finding that CMS beneficiaries may have received more CPAP supplies than medically necessary, was conducted to assess waste within health care services.

The OIG reviewed CPAP replacement supply schedules in effect as of January 1, 2012 from 50 fee-for-service State Medicaid programs and from four fee-for-service Federal Employees Health Benefits plans. They compared the replacement schedules for 15 types of CPAP supplies with Medicare’s schedules against recommended replacement schedules from five sleep disorder clinicians and four manufacturers.

The OIG concluded that 39% of frequencies were less than those under Medicare, 51% equaled those under Medicare, and 10% of frequencies exceeded those under Medicare.

Sleep medicine clinicians stress the importance of proper mask fit, but research suggests that once fit is established, necessary replacement of masks is less frequent than Medicare allows, according to the report. Also, manufacturers recommended specific replacement frequencies for only a few types of supplies on an as-needed basis and potentially less frequently than under Medicare’s replacement schedule.

CMS did not concur with the OIG’s suggestion to review CPAP supply replacement schedules and make efforts to revise the national and local coverage determination, stating that "failure to consider noncompliance or the potential impact of supplier fraud or abuse may bias the estimate of a clinically appropriate refill rate."


Fair use from:
http://www.sleepreviewmag.com/all-news/1...-schedules

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#2
What? Is it overspending or not? And what the heck did that last sentence mean?
PaulaO2
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#3
(07-04-2013, 07:41 PM)PaulaO2 Wrote: What? Is it overspending or not? And what the heck did that last sentence mean?

Maybe there's a US federal employee here who can translate. Smile
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#4
Having worked for Uncle Sam for more than 42 years I'd love to translate this. Basically CMS is contending that HHS-OIG did not take into consideration certain aspects of the process that CMS considers important. Or in other words, CMS is blowing smoke so that they do not have to comply with the OIG recommendations. (Having worked for 17 years as an auditor for USDA-OIG, I saw this type of response from audited offices a lot. Instead of taking corrective measures to fix the problem, the audited office is rebutting the findings based on the way the review was conducted).
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#5
The fitlife mask that I use may last forever. the new one works no better than the old one. Medicare will replace the mask every three months but the headgear only every six months. Because of high pressure and resultant very tight mask, headgear will not last six months without changing geometry as I continually tighten it.
Jim Quarles
hosehead
Illegitimus non Carborundum
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#6
The system (insurance and medicare) is broken and not responsive to individual needs and requirements. Do I need a new mask every 6 months or a hose every 3? NO. Do I need more than 2 disposable filters a month - YES (in fact I change the intake every week and use an inline outake every 2 - so that makes 6 filters a month, and they do not differentiate between the 2 types). Do I suspect that I need the foam intake filter changed more often than every 6 months (based on what I see on the disposables) - YES (and I do wash it every week). But, every locale and person is treated in the same way with the "standards" set by "somebody" who knows "best". I sometimes wonder if the costs of fraud prevention and standards setting exceeds what they save.
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