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Compliance Program for those being treated with CPAP Therapy

After the process of talking to a doctor, having a sleep study and being issued a CPAP machine, there is one more important step involved in the successful treatment of sleep apnea.  Depending on a patient’s insurance coverage, it is necessary to prove compliance concerning the usage of the CPAP machine. The insurance company won’t pay for a piece of equipment that isn’t being used.

CPAP Titration

Part of this process is called titration.  CPAP titration calibrates the machines to the optimal pressure setting. It requires to spend another night in the sleep lab with your CPAP machine to be observed. Other patients will take home an “auto-titrating” CPAP machine that will be used over several nights to find the best pressure for the patient and later be issued a “permanent” machine.  Either way, the right pressure is found.  Your insurance coverage might require a specific type of titration study.

CPAP Tracking

What the insurance companies want to see is that the patient is dedicated to his or her treatment for sleep apnea.  Medicare, for example, wants to see 30 days of usage of 4 hours or more for 70% of the time.  This equates to about 5 days a week for 4 hours or more.  They can see this one of two ways.

compliance testing

The above graph is a representation of compliant and non-compliant sleep patterns.

When the machine is issued to the patient by a clinician, the nurse will include either a modem or a smartcard with the machine.  The machine will internally record the patient’s usage, and if using a modem, the modem will call into the medical equipment company on a daily basis to inform them on the patient’s performance through their compliance software.  This information is forwarded not only to the insurance company but to the patient’s doctor and the patient his or herself.

If a smartcard is used, the usage is recorded by the machine and then later downloaded onto the smartcard, which is mailed to the medical equipment company.  There it is uploaded to the company’s chosen compliance software and a report is created and distributed to the patient, the doctor and the insurance company.  Over time, the patient becomes compliant, and as well, becomes accustomed to using the CPAP machine, which is reported to be difficult at times.  The process takes time but has proven to benefit patients and insurance companies both.

Compliance Tracking with Aeroflow

Aeroflow Healthcare provides patients with all of the tools they need to comply with insurance and Medicare regulations. Our compliance representative will review your data and submit it to your insurance plan for you. Our staff will work closely with you to help you meet these requirements. Aeroflow Healthcare will provide patients with CPAP machines with the necessary compliance tracking software.

 

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