CPAP equipment providers must follow compliance rules

Durable medical equipment providers must follow certain compliance rules for providing continuous positive airway pressure devices to our members.

These rules specify that:

• Downloads and documentation are required for all CPAP set-ups, regardless of previous usage.
• The BCBSM member compliance form is required for all CPAP set-ups. You must have this form in each patient’s record for audit review.
• You must collect compliance downloads for days 31 through 90 of a trial period to qualify for continued rental. The member’s chart must show 70 percent compliance in using the CPAP device.
• Each new trial period, as outlined in the Continuing Coverage Guidelines, must be started with a physician order.

If any of this documentation is missing from your file during an audit, the entire rental and subsequent supplies can be denied for a lack of documentation or medical necessity.