Wednesday, December 05, 2007

Sleep Lab Busted by Medicare

Sleep Review magazine reports that HMS Diagnostics Inc was recently busted by CMS (Medicare) for having uncertified technicians run sleep studies on Medicare patients:
Sleep Lab Medicare Claims Under Investigation
According to the release, the US Attorney's Office seems to be suggesting that any CPT 98510 or CPT 98511 study not actually performed by a credentialed technician cannot be billed. The fact that the credentialed technician is on site and supervising apparently is not a factor, HMS Diagnostics stated in the release.
Rest of quote from Sleep Review article deleted, due to their request
“If what CMS is saying is true, then the amount of money that would be owed to Medicare by the industry is phenomenal,” says Goodman. “The liability potential on an industry such as ours with Medicare could be a very big number.”
This is a disturbing development. The requirement for tech certification is virtually unknown in the sleep community. On the AASM message boards, we were recently discussing a new CMS regulation that All studies are to be done by a certified polysomnographer by January 1, 2008 in Arkansas, Louisiana, Eastern Missouri, New Mexico, and Oklahoma and by October 1, 2008 in Rhode Island; and the consensus was that uncertified technicians were ok for the time being in most other states. Most sleep labs have a combination of certified and uncertified techs, and I agree with the article that if CMS is going to enforce this newly discovered regulation, the amount of money owed would be phenomenal.


Michael Rack, MD said...

I don't think there is a standard definition of "certified". My guess is that it probably includes both RPSGT and RRT.

Michael Rack, MD said...

According to a post on the AASM discussion form, if there is no state certification/licensure for techs, then any national certification would be acceptable, including RPSGT, RRT, or RN.

Michael Rack, MD said...

My understanding is that sleep studies on Medicare patients must be performed by a "cerified" tech- it's not enought to have a certified tech in the control room, the certified tech must be the one actually performing the psg.
To answer your question, Barthlen, you are taking a risk if you run studies on Medicare patients depsite not having a "certified" tech.

Todd said...

I am a sleep specialist in Houston not affiliated with the lab in question. However, I am VERY concerned about the implications of this case for one reason I live in one of the affected States and secondly, it entails a codicil that is essentially unkown to the sleep community. I did some digging and the only paragraph that is applicable is the following:
CMS document 410.33 (2)(c) states "Nonphysician personnel. Any non-physician personnell used by the IDTF to perform tests must demonstrate the basic qualifications to perform the tests in question and have training and proficiency as ev idenced by licensure or certificvation by the appropiate Styate health or education department. In the absence of a State licensding board, the technician must be certified by an appropiate national credentialing body. The IDTF must maintain documentation available for review that these requirements are met."
Thus, we in Texas can be subjected to high penalities and paybacks that could put many of us out of business. WHERE IS OUR NATIONAL SOCIETY when we really need them???

stephen_98 said...

Hi Michael,

Do you know if this reg applies to a sleep lab that is part of a physicain's practice. Or, does it only apply to an IDTF?


Michael Rack, MD said...

I don't know if applies to non-IDTF's. I'll try to find out on the AASM forum and report back here.

info said...

MR wrote:
"...sleep studies on Medicare patients must be performed by a "cerified" [SIC] tech- it's not enought to have a certified tech in the control room, the certified tech must be the one actually performing the psg."

This is interesting, WHAT is the "performance of PSG?" The act of touching the patient, or the recording correctly in the control room?
I think this just shows, once again, CMS naive understanding of the whole process of PSG.

If someone arranged a patient's arm under an x-ray device, without taking the X-ray have they performed an X-Ray? If a team of technicians, one in the room adjusting the location of the arm under the device, and one pushing the button to take the X-Ray, is any one of them performing the X-Ray. Is any one component more appropriate for licensure? If licensure is truly for patient protection (physical I assume) then the one in phyisical proximity to the patient should be the one licensed. But, if the data gets "viewed" remotely for appropriateness and only needed interventions are requested of the proximate tech for intervention, then is the remote viewer actually performing PSG?
And should the "performance" of PSG include the review and compilation of data from the recording.

Dr. Chris said...

Has anyone received any info on this ruling yet? Does it only effect IDTF's or physician owned labs as well?

Sleepy Steve said...

It is certainly ironic that Medicare would require all IDTF sleep studies be performed by a certified polysomnographer, while they have approved home testing which requires NO attendance.

Dr. Chris said...

I would have to agree with that as well Steve.

richard said...

if the techs have to have 18 months of training how will a lab ever become fully functionable unless there is a grace period.

RPSGT1518 said...

Does Certified mean Registered? Medicare just approved in home studies and now they want only "certified" techs performing tests. Good Grief! We are an accredited faciltiy and per the AASM guidelines we really are only required to have one registered technician on staff.
Medicare is so uninformed about what goes on in a sleep center. Maybe they should take a field trip and see. REmeber when they had 4 or 5 versions of how to qualify for a split night. This is just bad news for all of us.

Somnochick said...

I am the Director of an IDFT close to Houston and have worked hand in hand with a Sleep Specialist in Waco whose standards surpass any set by Medicare so it is not strange to me that an RPSGT or RRT should be providing care to patients. I guess what it all boils down to is listed in #12 of the IDTF standards. It says a credentialed technologist has to perform the study not just be there, not supervise, not just score it, but perform the actual study. We all know how important quality care is and the Gold Standards we all should apply. Being clear that RPSGTs or RRTs are required to perform Medicare/Medicaid/Tricare studies just spreads the approximate 11,000 RPSGTs that much thinner. I hope to see the eligible people take their boards as soon as they can! I know how hard it is to come by Registered Techs in my area; I am the only one here.

Jm said...

Does anyone know if a RPSGT is required to score a sleep study? Also is computerized scoring accepted by AASM and Medicare?

Jm said...

Does anyone know if AASM or medicare requires sleep studies be scored by a RPSGT or is computerized scoring acceptable?

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