Home Sleep Testing- Open and Directed Question Session. What clinical and business impact are you seeing?- Any trouble getting paid?, What about Private Insurance Reimbursement?, Pre-Auth’s? Patient selection, who is the right candidate?, Have you been successful getting the in-lab titration study post home study?, What if HST was done by an IDTF? What do you do about failed studies/What do you consider a failed study?: Examples: In regards to scoring a study with good flow and desats but inability to score effort because belt didn’t pick up well?, What if patient is symptomatic with a negative HST but tells you they were awake all night?

Home Sleep Testing

Dave Worley RPSGT, LRCP, LPN I have no conflicts of interest associated with this CEU. Not being sponsored by any manufacture of HST equipment.

Objectives Background of Home Sleep Testing. (5 min.) What does research say- IMPACT, CODING, REIMBURSEMENT, AND CLINICAL CONSIDERATIONS. (15 min.) Facilitated Discussion: WHAT DO YOU HAVE TO SAY. WHAT CAN WE LEARN FROM EACH OTHER. (30 min.)

History of Home Sleep Apnea Testing HST Devices have existed for over 20 years. CMS-(Centers for Medicare and Medicaid Services)- Previously rejected an NCD (National Coverage Determination) for HST a total of 5 times prior to 2005. American Academy of Otolaryngology-HNS-asked CMS to revisit the issue-at the time, the claim was there was an insufficient quantity of labs resulting in unacceptable delays in DX and TX.

History of Home Sleep Testing AASM guidelines published November 7, 2007.-Major Takeaway was: should be integrated into a comprehensive program of patient evaluation and treatment under the direction of a sleep specialist board certified in sleep medicine. March 2008- CMS (Centers for Medicare and Medicaid Services)-published a NCD (National Coverage Determination) to include the coverage for HST. – Opening the doors for Private payers to follow and set payment guidelines accordingly. Reference JCSM Journal of Clinical Sleep Medicine, Vol 3. November 7 2007-Clinical Guidelines for the Use of Unattended Portable Monitors in the Diagnosis of Obstructive Sleep Apnea in Adults.

2013 18,000 compared to 11,000 in 2012 Source: American Medical Association

Home Sleep Studies-Unattended Categorized as Type II, III, IV- LCD L33405 for Florida (medicare.fcso.com) Type II- “Unattended Sleep Study”-complete NPSG performed in the home, that is unattended. Very uncommon, requires sleep technician, not practical. Minimum of 7 channels, 1 of which is EEG. HCPCS # G0398- $206.65 TC $136.98 Mod 26 for Professional $69.67.-Source First Coast Service Options- CMS Medicare Admin. for FL, Part B-Oct 2016.

Types of Home Sleep Studies Type III-considered the most common of all HST’s. Does not record data to determine sleep stages. Minimum of 4 channels - respiratory effort/airflow, heart rate, O2 sat, snoring, body position. HCPCS# G0399 or CPT 95806-$155.27 TC $92.26 Mod 26 for Professional $63.09. -Source First Coast Service Options-CMS Medicare Admin. for FL, Part B-Oct 2016.

Types of Home Sleep Studies Type IV-very simplified version, measures O2 sat, thoracic/abdominal movement, and airflow. Minimum of 3 channels. HCPCS# G0400- $104.13 TC $47.57 Mod 26 for Professional $56.45. -Source First Coast Service Options-CMS Medicare Admin. for FL, Part B-Oct 2016.

Clinical Considerations (Patient) for Home Sleep Testing-CONS The Stanford University Sleep Research Center, established in 1970 by Dr. William C. Dement, has identified approximately 84 different Sleep Disorders. CONS- Ease of Use, Reliability, Diagnostic Accuracy, Comorbid Health Conditions, 84 Different Sleep Disorders.

Clinical Considerations (Patient) for Home Sleep Testing-PROS Convenience Comfort Cost

Clinical Considerations (Lab) for Home Sleep Testing Accreditation-AASM or ACHC (Accreditation Commission for Healthcare), Joint Commission. Physician Training/Certification The raw data from all sleep tests must be reviewed and the tests must be interpreted by either: 1. A Diplomate of the American Board of Sleep Medicine (ABSM) OR Board of Medical Specialties (ABMS) OR 2. A physician board certified in sleep medicine by a member board of the American Board of Medical Specialties (ABMS) OR 3. An osteopathic physician board certified in sleep medicine by a member board of the American Osteopathic Association (AOA) OR 4. An active physician staff member of an AASM accredited sleep center or sleep laboratory OR 5. An active physician staff member of a Joint Commission accredited sleep laboratory OR 6. An active physician staff member of a ACHC-accredited sleep laboratory OR 7. A Diplomate of the American Board of Family Medicine (ABFM) with Certificate of Added Qualifications (CAQ) in Sleep Medicine.

Clinical Considerations (Lab) for Home Sleep Testing Technologist/Technician Credentials/Training Sleep technicians or technologists attending PSG or sleep studies affiliated with HST must have appropriate personnel certification. Examples of certification in PSG and sleep technology for technologists are; 1. Registered Polysomnography Technologist (RPSGT) 2. Registered Electroencephalographic technologist (R. EEG T.) – Polysomnography 3. Certified Respiratory Therapist -Sleep Disorders Specialist (CRT-SDS) 4. Registered Respiratory Therapist Sleep Disorders Specialist (RRT-SDS) 5. American Board of Sleep Medicine Registered Sleep Technologist (RST)

Clinical Considerations-WHAT ABOUT IDTF’S, i.e. Physician Practice LCD for IDTF’s L33910- Requirements for non-physician personnel used by an IDTF must demonstrate the basic qualifications to perform the tests and have appropriate training and proficiency as evidenced by…..LICENSURE OR CERTIFICATION BY THE APPROPRIATE STATE HEALTH OR EDUCATION BOARD. IN THE ABSENCE OF A STATE LICENSING BOARD THE TECHNICIAN MUST BE CERTIFIED BY AN APPROPRIATE NATIONAL CREDENTIALING BODY. IT IS EXPECTED NON- PHYSICIAN PERSONNEL MUST MAINTAIN AN ACTIVE STATUS IN ORDER FOR THE DIAGNOSTIC TESTS TO BE COVERED. Source: medicace.fcso.com LCD L33910-This LCD has no Related National Coverage Documents.

Home Sleep Testing- Open and Directed Question Session. What clinical and business impact are you seeing?- Any trouble getting paid?, What about Private Insurance Reimbursement?, Pre-Auth’s? Patient selection, who is the right candidate? Have you been successful getting the in-lab titration study post home study?, What if HST was done by an IDTF? What do you do about failed studies/What do you consider a failed study?: Examples: In regards to scoring a study with good flow and desats but inability to score effort because belt didn’t pick up well?, What if patient is symptomatic with a negative HST but tells you they were awake all night?

Home Sleep Testing