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Compliance Program for CPAP Therapy

compliance testing

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

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.   If a patient is not using the machine, then he or she is not treating his or her sleep apnea, and having the machine is doing no good.  An insurance company knows this and does not want to pay for a machine that is not being used.  Therefore, insurance companies have come up with rules patients can follow to become compliant and ultimately have their insurance contribute to the payment for the machine, if not cover it completely.

Part of this process is called titration.  Sometimes a patient is “titrated” on their CPAP machine in a lab at a hospital.  This means they spend the night in a sleep lab while using a CPAP machine that will adjust pressure over the night to find the optimum pressure for the patient.  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.  How the titration is done depends on the patient’s insurance coverage as well.

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.

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.

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