TBO PAP Resupply
What does PAP stand for in sleep therapy?
Positive Airway Pressure
What does BiPAP stand for?
Bilevel Positive Airway Pressure
Wrong size or style of mask
Work closely with your doctor and PAP supplier to make sure you have a PAP mask that suits your needs and fits you.
Everyone has different needs and face shapes. A mask that works for someone else, may not work for you.
Written Order for PAP Supplies must have these information:
1. Patient Name
2. DOB
3. Physician Name, Signature, Date & NPI
4. Diagnosis (DX)
5. LON
6. Dated within 12 months of order date
7. Accessory items/supplies needed
A patient calls asking for the status of their order. What should you do first?
Verify the patient’s account information before discussing details.
Why are PAP resupplies important for patients?
Proper maintenance, ensuring patient's comfortability, proper fit and maximum effectiveness.
Which condition may commonly require BiPAP therapy instead of CPAP?
Obstructive Sleep Apnea with difficulty tolerating CPAP or CPAP is ineffective.
Unintentionally removing the PAP device
during the night
Resolution:
• If you move a lot in your sleep, you may find that a full-face mask will stay on your face better.
• You may be pulling off the mask because your
nose is congested. If so, ensuring a good mask fit
and adding a PAP heated humidifier may help.
• A chinstrap may also help keep the device on
your face.
• If this becomes a consistent problem, consider
setting an alarm for some time in the night to
check whether it is still on
F2F/Chart Notes for PAP Supplies must have these information:
1. It must mention sleep-related issue/s
2. It must be dated within the last year from your order date.
3. It must be signed.
A patient is frustrated because their delivery is delayed. What is the BEST way for you to respond?
Show empathy, apologize for the inconvenience, and review the order status.
What is the Replacement Schedule of Full-Face Mask & Face Mask Cushion? (MEDICARE)
A7030 1 per 3 months - Full Face Mask
A7031 1 per 1 month - Face Mask Cushion
What IPAP and EPAP stands for?
IPAP stands for Inspiratory Positive Airway Pressure
EPAP stands for Expiratory Positive Airway Pressure
Difficulty tolerating
forced air
Resolution:
• You may be able to overcome this by using a
“ramp” feature on the machine. This feature
allows you to start with low air pressure
followed by an automatic gradual increase in
the pressure to your prescribed setting.
• If this doesn’t help, contact your physician to
discuss changing to a different type of device
that automatically adjusts the pressure while
you’re sleeping.
Written Order criteria for BiPAP:
1. Patient Name
2. DOB
3. Physician Name, Signature & NPI
4. Description of Item and Accessory/Supplies needed
5. LON
6. Date must be on or after the F2F date.
A patient states they did not receive the PAP supplies marked as delivered. What should you do?
Review tracking information and coordinate with the shipping department or courier.
What HCPCS code is used for disposable PAP filters that are typically replaced 2 per month? (MEDICARE)
A7038 - Disposable Filter - 2 per 1 month
What setting in a BiPAP machine helps keep the airway open during exhalation?
EPAP (Expiratory Positive Airway Pressure) helps:
Trouble falling asleep
Resolution:
• Wearing the mask alone for some
time during the day may help you
get accustomed to how it feels.
• Use the “ramp” feature to
gradually increase air pressure over
time.
• Practice good general sleep habits:
exercise regularly, avoid caffeine
and alcohol before bedtime, take a
warm bath before bedtime, and
avoid going to bed until you’re
tired
Sleep Study Criteria for BiPAP:
1. The sleep study should be signed.
2. The doctor’s credentials must be indicated & the physician should be certified in Sleep Medicine.
3. AHI or RDI is greater than or equal to 15 events per hour, with a minimum of 30 events.
4. AHI or RDI is greater than or equal to 5 and less than or equal to 14 events per hour, with a minimum of 10 events, AND the patient has a documented secondary diagnosis noted in the chart.
5. CPAP does not help the patient during the titration sleep study, and the clinician documents that CPAP failed to relieve the patient’s issues, the patient may receive a BiPAP.
The statement indicating CPAP failure must be documented in the sleep study records. Documentation in face-to-face notes alone is not sufficient.
A patient requests to speak with a supervisor because they are unhappy with the insurance coverage explanation. What should you do FIRST?
Remain calm, acknowledge the concern, and attempt to review the account before escalating.
A patient received the following PAP supplies 2 months ago:
The patient is requesting all items again today. Based on standard PAP resupply guidelines, which items may be eligible for replacement at this time? (MEDICARE)
A7031 only
Replacement Schedule:
A7031 - 1 per 1 month - Face Mask Cushion
How do you resolve an issue of Leaky mask/Irritation or Pressure Sores?
Leaky mask - No mask will seal 100% of the time. Try adjusting pads and straps to get a better fit.
Irritation - If experiencing minor skin irritations or small cuts, cover it with zinc oxide, a band-aid, or skin tape after you loosen your mask.
Pressure Sores - Contact your doctor if you develop skin deterioration or sores.
Addition Information: You may need to ask your supplier to help you find a different size mask particularly if your weight has changed markedly.
Annoyed by noise
Resolution:
• Most new models of PAP devices are
almost silent. But if you find a device’s
noise is bothersome, check to make
sure, the device’s air filter is clean and
unblocked.
• If the device is working correctly and
the noise still bothers you, try wearing
earplugs or using a white-noise sound
machine to mask the noise.
Medicare Coverage Criteria for CPAP & BiPAP.
An E0601 device is covered for the treatment of obstructive sleep apnea (OSA) if criteria A – C are met:
A patient is upset because their BiPAP order cannot be processed due to missing documentation from the physician’s office. The patient says they urgently need the equipment today. How would you handle this?
Explain the missing requirements clearly, contact the physician’s office for follow-up, and provide realistic expectations to the patient.