Laws about Respiratory Therapists

Okay, I'm puzzling over this one... So much good info is shared here, I almost feel I don't need an RT. But I must admit, if I can find someone else to read my data and interpret it, I'd rather do that. I've got other fish to fry.

Do I have to find an RT who bills my insurance to do this? I realize there are many forum members here who volunteer to assist, but LEGALLY, am I supposed to find a CERTIFIED RT, and have them perform that service in a medical setting, and bill me and the insurance? I get the impression from my doc that that is the case.

She DID tell me that many RT's just have you mail the card, they do the reading, and mail it back to you. She said if I liked the RT at Swedish, that would probably be the best way to go there. Oh, I met an RT in Seattle that I liked, but I kinda hate driving the hour north. But I'll do it, if that's the only way.

So, I just wondered how it all works. If I met an RT here online, could that person perform the same mail-order service? And just help me via mail, email and phone? Is that legal? And how would the billing work? I realize I'll probably get the "out of network" song and dance by the insurance, but I think that would be okay. I don't think they'd DENY it.

Anyway, maybe I'm overthinking this? Having an OCD week, if you hadn't already figured that out.

Many thanks!!!!
Barbara

I would take a good multi-vitamin and go buy yourself something with the money you'll save.


My opinion:

No RT, Doctor or DME is going to know my condition better than I and KNOW what will make me feel better.

Very few of those professionals have OSA like you and I, very few have ever used the machine even a single night, much less a week or a month, very few have put on a mask and worn it more than a few minutes at a time. So how can they be in any better a position to tell you what will work better?

Is a RT more experienced at setting up your machine than you could get from here? Without causing a big argument, I doubt it.

The question I have is: Why do you even need a RT if you already know how to setup your machine? Ask an RT all they will do is reset it back to default parameters and hand it back to you set at 4-20cm tell you its an autopap, like we see them do time and time again.

Next, look at the Doctors, you are lucky if they spend 5-minutes with you tops, the rest of your alloted visit time is either filling out paperwork, writing a check and sitting in the waiting room for an hour reading outdated Yacht magazines. You think they are spending their time doing research on Xpap machines?



They don't spend any time to know how these machines operate with any kind of detail, why do you think they prescribe CPAP all the time? You don't need to know all that much, just set it at 10cm and give it to them, you'll wipe out more than 70% of all SDB seen. It is only through careful titration and use of a autopap are you able to improve on that by 20%. The only time they will learn anything new about these machines is maybe when it is part of some golf tournament put on by Respironics where they may be able to bend their ear on how they can make more money.

What are you expecting to get out of a RT? Advice?

You're obviously sleep-deprived and hallucinating.....

Please read your PMs, e-mails.....something.....

Yes, you're overthinking it.

Den

I am? Okay, I will admit I'm stressed out and OCD'ing to the max right now. Sorry and thank you for telling me!

I want someone else to evaluate my readouts. I'm completely discombobulated by all this talk and graphs ya'll bandy about.

So, for now, I think I'll take you lovely forum members up on your offers, and let you read my card and tell me what you think. I'll save "renting an RT" for future needs.

My humble thanks to both you Esteemed Gentlemen!
(flourishes her best 19thC curtsy and goes back to sewing said hoopskirt for tomorrow's BIG DAY)
B.

If you're talking about downloading the card and telling you what they think is shown in your data just to satisfy your curiosity, anyone can do that legally, I'd think. Whether they know what they're talking about when they "interpret" it for you is another matter.

I'd think most RT's, if they are familiar at all with downloading the Smart Card, are used to looking mainly at "compliance" -- how many hours a night you use the machine, and are you using it almost every night. They might glance at the 90th percentile AHI. And if it was an autopap trial to find a pressure, they'll note the 90th percentile pressure. Basic things that are found in the "Summary" report in Encore Pro. I'll bet they hardly give the average leak rate a glance.

I doubt if many RT's (unless they spend time on this message board) are familiar with looking at the "Daily Details" charts in Encore Pro. Understanding the Encore Pro detailed info isn't rocket science...the detailed data is just something they probably never bother to even glance at. But that's where the juicy details are that we want to see about our own treatment.

If it's going to cost you anything out of pocket to get an "interpretation", I'd say stick to the help you can get from the message board. Download the card yourself and ask questions, or take advantage of the generosity of anyone who will download it for you for free. If someone, whether it be doctor, RT, or another cpap user, offers an opinion about what your data might be indicating, you've gotta decide for yourself if their opinion is right, wrong, partly right, partly wrong, off the wall, or what.

I cannot imagine that it would be illegal in any way to have anyone you choose download your card and tell you what they think. It's going to be just an opinion, whether it's from a doctor, an RT, or someone on the message board. Any of them might be right; might be wrong.

But, what the hey... the more info, the better. So let the RT of your choice do it there. Get his/her interp. Then post a couple of your daily details graphs here on the board and ask for opinions. You'll get plenty of those.

Important: No matter who you have do the download for you (DME/RT there, or message board person here) be sure to ask them if they have set the Encore Pro on their own computer to NOT erase the data from the card after the download. Tell them you want your card back with all the data still intact after the download. They have to have changed Encore Pro's default setting in their own computer before doing the download, or the data's gonna be wiped from the card.

It suits me fine to have the data erased after each download with my card, since I don't ever have to answer to anyone or "prove" compliance, and each download I do is stored in my computer.

But you might want to have a second or third person do a download for you after you have your fling with the RT , so you want the data to remain on the card. Or 4th or 5th person... hey, is OCD contagious?

Right now I am doing the Encore Pro tutorials, Lots of good info there. Tomorrow I plat to try getting EP and EA working together. then I will definitely know more than my RT.

Very good post, RG! Thank you!!! I think a few opinions are definitely worthwhile. I will most likely have to have help figuring out how to get the data onto my computer - when I get to that point, I'll holler for help. I think there's a forum member here in town who has set it up, and if I'm remembering correctly, she offered to help me. You know how all these balls spin in my brain sometimes - Random Access Memory.

I'm glad I asked all this. I need to save this thread to re-read when I have my little panic attacks in the middle of the shower about weird things. Along with all the other "panic attack" threads I've saved.

Must go sew. No more cpap. Friday is for sewing. Wed and Thur were for CPAP.

LOL,
B.

Tutorials? Where? OP, are you holding out on us?
B.

rested gal wrote: after you have your fling with the RT

(in my best Austin Powers voice)

Yeahhhh baby!!!


RT's need love too.....


But anyway,
No we don't charge insurances or things like that. Most of us work under the umbrella of a DME and they do the billing, but, things like read your card, interpretation, etc. aren't chargeable expenditures. It's included with being a customer (at least it is at my DME)

There's nothing illegal about anyone doing the downloading and I would venture to guess, the interpretation either. SOME people might feel like only a physician should intrepret test results but I digress. Most of the ones that I've worked with (docs).....I'VE been the one explaining the results to them and pretty much telling them what I need an order for.

Babette wrote:Tutorials? Where? OP, are you holding out on us?
B.

They are on the Encore 1.8 program.

BrianRT, that's what my doc told me. She'd like me to use an RT to download and interpret the data, then send her a report and she'll write the scrip changes from there. She's just the "Director" signing off on the reports. I get that. Works like that in my professional life. My coordinators do the work, I get the paperwork together, and pass it to my Director for his sig, and then the work gets done.

It's a system. Once I know how to work the system, I'm pretty compliant. If I think the system's broke, I can also figure out how to fix it or work around it.

But if no one TELLS ME THE SYSTEM PROCEDURES, then I'm pretty frustrated. I think I'm getting into the groove now.

So, I actually NEED an RT when I'm ready to make a change, so that person can send a report to the Doc. I don't need to spend alot of time with that person, though, and the doc doesn't care who I use. So, I think I'll do some interviewing around with the info I have and see what I can figure out.

Many thanks!!!
Barbara

Your lucky if you have an RT that can or will read & opinionate on the data...

My story is I took the card into my ?? DME and was informed the could not read the card but would send it out to the MAIN office to SEE if anybody their could read it? { I had already copied the data off & into my computer!}
Told them I would try my Dr. and ever the sleep study people??
NOT nether of them could read the card --- The DME sent it off and the report bac was "You are complaint ........... nothing else........ and the card was erased!!!
GUSS who had some new four letter words!!!
BERT

I didn't know you could charge for reading a card and interpreting data. I've been doing it for free for years!

Brian, you're DME is cheating themselves of some income!!!! I've read here in the forum of at least one DME supplier that charges $35 to download a data card and give the printout to the patient. And read of another DME supplier that charges $50 to download and printout the data card data.

Some of these DME suppliers are real money-grubbers. Actually, I can see where they pay their RT's $xx per hour, and there is some time spent on the 'puter to download and there is the toner and wear and tear on the printer as well as the paper the data is printed on .... but $35-$50???

Now, IF the RT spends some time w/the patient going over the printout w/them and explains the data, maybe makes some suggestions .... that becomes a whole new ballgame again and the $35 doesn't look quite so bad. ASSUMING the RT even understands the printout him or her self!!

Either my CPAP DME supplier's RT is dumb as a rock or she's darn good at playing dumb. It might be interesting to know which. She's got the initials after her name to look impressive: CRTT, RRT, Respiratory Care Supervisor, BLS Instructor. Maybe she's just a good "fabricator" 'cause she doesn't WANT to answer my questions??

KansasRT wrote:I didn't know you could charge for reading a card and interpreting data. I've been doing it for free for years!

KansasRT,

If you weren't such a sweet person, I wouldn't be doing this.....
But......
You just need to come to CPAPTALK.COM to find the right resources.
(I can't believe I have to teach these folks how to charges us more)

Den

Insert the hypertext transfer protocol slash/slash/ colon: in front of the following: reimbursement.respironics.com/downloads/Encore_Pro_Software_062106.pdf?file=1025847_EncoreProSmartCardSlpLink_HelpfulHints.pdf

The following is from a couple of years ago, but the original document is still out on the Respironics site.


Reimbursement Services
HELPFUL HINTS FOR FILING
Encore® Pro SmartCard®
Overview
The following provides an overview of coding, coverage and payment for services associated with the download and interpretation of the Encore Pro SmartCard when performed in a physician’s office. Coding information and national average Medicare fee schedule amounts are listed on the back. The fee schedules do not take into consideration geographic practice cost indices.
Although accurate coding is essential to ensure prompt claims processing and reimbursement, inclusion of a specific code and fee schedule amount does not guarantee payment. It is critical to be aware of each payer’s coverage guidelines. For information regarding specific reimbursement guidelines, including coding, coverage and payment, please consult your local payer, the Federal Register or the Physicians’ Current Procedural Terminology (CPT)1. The Respironics Reimbursement Support Line can also further address your complex reimbursement issues.
When selecting a CPT code, health care providers should choose the one that most accurately identifies the procedure or service performed. In addition to diagnostic or therapeutic procedures, the physician may also report other medically necessary procedures that are performed. All procedures and services should be accurately documented in the patient’s medical record.
General Coding Guidelines
There are several factors to consider when selecting a CPT code to report the download and interpretation of data from the Encore Pro SmartCard. The first factor is whether the physician has face-to-face contact with the patient during the office visit that involves the download and interpretation of data. Providers should also consider the payer that is being billed. Payers may
have additional guidelines or specific coding recommendations for these types of services. Providers should contact the payer directly to confirm the most appropriate coding for these services.
Physician has direct (face-to-face) patient contact
If the physician has direct (face-to-face) contact with the patient, several coding options exist for the download and interpretation of data from the Encore Pro SmartCard.
• If the visit is in conjunction with a follow-up office visit for management of a patient’s PAP therapy, it may be appropriate to report the following code:
94660 Continuous positive airway pressure ventilation (CPAP), initiation and management
• Another option for reporting follow-up visits for management of PAP therapy is with the appropriate Evaluation and Management (E/M) CPT code. These codes vary according to the patient status (new or established), and the complexity of the presenting problem as documented in the patient record. When selecting an E/M code, there are several components
that physicians and their billing staff should consider and document:
Sample E/M codes used to report physician office or outpatient services for established patients include:
99212 Evaluation and management, established patient, presenting problems are self-limited or minor
99213 Evaluation and management, established patient, presenting problems are of low to moderate severity
99214 Evaluation and management, established patient, presenting problems are of moderate to high severity
Providers may not bill an E/M code in addition to CPT code 94660 for the same patient service. An E/M code may be reported in addition to CPT code 94660 only if there is a “significant, separately identifiable service” above and beyond management of the PAP therapy.
-over-
1 Current Procedural Terminology (CPT), Fourth Edition, 2003. American Medical Association, 2002. All rights reserved.
• Patient history
• Type of examination
• Level of medical decision-making
• Counseling provided
• Coordination of care
• Nature of presenting problem
• Time spent in direct contact with
the patient or family
• Additionally, there are several CPT codes that may be used by providers to report special services, such as the download and interpretation of Encore Pro SmartCard data. For example:
99090 Analysis of clinical data stored in computers (e.g., ECGs, blood pressure, hematologic data)
99091 Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time Code 99090 may be used to report the interpretation of Encore Pro SmartCard data, and 99091 may be appropriate to report both the download and the interpretation of the data. Providers should not report both of these codes for one service encounter.
Physician does not have direct (face-to-face) patient contact
In the absence of a face-to-face encounter between the physician and the patient, coding options for reporting the download and interpretation of Encore Pro SmartCard data will vary.
• One option is to report the download and interpretation with a miscellaneous CPT code, such as:
99499 Unlisted evaluation and management service
The American Medical Association (AMA)2 has confirmed that this CPT code may be used by providers to report interpretation of Encore Pro SmartCard data in the absence of an actual patient office visit/encounter. As this is a miscellaneous code, providers should attach supporting documentation to the claim, such as an explanation of services provided and the medical necessity for those services. The payment level for this code will be determined on a case-by-case basis upon individual payer review.
• Another option is to report the download and interpretation of Encore Pro SmartCard data with 99090 or 99091. Again, code 99090 would be used to report the interpretation of the data, and 99091 may be appropriate to report both the download and the interpretation of the data. Providers should not report both of these codes for one service.
Coverage and Payment Guidelines
Medicare
Under Medicare, codes 99090 and 99091 have a “bundled” status. This means Medicare payment for these codes is bundled into reimbursement for other basic services rendered. Even though these codes are not separately reimbursable under Medicare, providers may report these codes when appropriate to represent the additional time and resources spent providing these services.
E/M codes and CPT code 94660 are eligible for Medicare coverage and payment. If an E/M code is billed in conjunction with CPT code 94660, payment will be bundled, unless a “significant and separately identifiable service” is provided. Payment is based on the Medicare Physician Fee Schedule. The following table indicates some sample coding options and corresponding national average
Medicare fee schedule amounts:
2004 National CPT Code Description Average Medicare Code Fee Schedule Amount*
94660 CPAP initiation and management $54.51
99212 Evaluation and management, established patient, presenting problems are self-limited or minor $37.71
99213 Evaluation and management, established patient, presenting problems are of low to moderate severity $52.65
99214 Evaluation and management, established patient, presenting problems are of moderate to high severity $82.14
99090 Analysis of clinical data stored in computers (e.g., ECGs, blood pressure, hematologic data) Bundled
99091 Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the Bundled physician or other qualified health care professional, requiring a minimum of 30 minutes of time
99499 Unlisted evaluation and management service Manually priced
2 Based on guidance provided by AMA’s CPT Information Services representatives.
* 69 Fed. Reg. 1083–1267 (2004) (to be codified at 42 CFR ◊ 405 and 414)
Private Payers and Medicaid
Private payers and Medicaid programs reimburse providers for professional services in a variety of ways, including fee schedules and a percentage of the usual and customary charges. CPT-4 codes 99090 and 99091 may be considered bundled by some private payer plans, while other plans may provide separate reimbursement. The provider should contact the specific plan to determine actual payment rates.
Note: Inclusion or exclusion of a code for a specific product or supply does not imply any health insurance coverage or reimbursement policy.
All referenced information and codes were taken from HCPCS. Please refer to DMEPOS Supplier Manual for complete explanations.
FOR MORE INFORMATION FROM RESPIRONICS CONCERNING
Reimbursement Contact Website/Phone
Information & Fee Schedules Respironics Website http://www.respironics.com
Educational Materials & Questions Customer Service 1-800-345-6443; listen to the instructions
(coding, coverage & payment) and follow prompts to select the Insurance Reimbursement Information option
Government Relations Consulting Services 1-724-387-4475
1020314 SB 3/24/04
PEOPLE.PRODUCTS.PROGRAMS.
Encore, SmartCard and Respironics are registered trademarks and
PEOPLE.PRODUCTS.PROGRAMS. is a service mark of Respironics, Inc. and its affiliates.
© 2004 Respironics, Inc. and its affiliates. All rights reserved. SM