Changing DME Companies for CPAP Supplies
Simply provide the new DME company with a current prescription for CPAP therapy and your patient's insurance information, then coordinate the transfer of care to ensure continuity of adherence monitoring. 1
Administrative Steps for the Provider
Essential Documentation to Provide
Send a current CPAP prescription to the new DME company that includes the prescribed pressure settings, mask type, and any accessories (heated humidifier, chinstrap, etc.). 1
Include the patient's diagnosis with documentation of obstructive sleep apnea severity (AHI from diagnostic study) to support medical necessity. 1
Provide insurance authorization information if the patient requires prior authorization or if you need to complete any insurer-specific forms for DME coverage. 2
Coordination of Adherence Monitoring
Ensure the new DME company has capability to monitor CPAP adherence data remotely, as sleep providers are encouraged to assist their affiliated DME companies to monitor and improve PAP adherence. 1
Establish a system for receiving download data from the new DME company, as coordinated PAP download data with follow-up visits is sufficient to meet standards for PAP troubleshooting and adherence. 1
Document therapeutic adherence responsibility remains with you as the prescribing provider, regardless of which DME company supplies the equipment. 1
Critical Considerations for Continuity of Care
Medicare/CMS Compliance Requirements
Be aware that CMS requires specific adherence thresholds (≥4 hours/night for ≥70% of nights during a consecutive 30-day period within the first 90 days) for continued coverage, though this threshold lacks strong evidence for optimal outcomes. 1, 2
Ensure face-to-face evaluation documentation is completed within the required timeframe if the patient is within the initial 90-day coverage period, as CMS mandates this for reimbursement continuation. 2
Recognize that switching DME companies mid-coverage period may complicate adherence documentation if the previous company's data is not transferred, potentially jeopardizing Medicare coverage. 2
Equipment Compatibility and Settings Transfer
Verify the new DME company can provide the same CPAP device manufacturer if possible, as different manufacturers use different algorithms for apnea/hypopnea detection and leak measurement, which can affect therapy efficacy. 1
If changing device manufacturers is unavoidable, be aware that a patient's therapy may fail despite identical pressure settings due to different proprietary algorithms, and close monitoring is essential. 3
Ensure exact pressure settings, mask type, and comfort features (ramp, expiratory pressure relief) are communicated to prevent disruption in therapy that could affect adherence. 1, 4
Common Pitfalls to Avoid
Do not assume the patient can simply switch without provider involvement – a valid prescription and coordination are required for the new DME company to dispense supplies. 1
Do not lose access to adherence data during the transition – establish the monitoring connection with the new DME company before the patient stops using the old company's services. 1
Do not overlook that patients experiencing side effects use CPAP significantly less – use this transition as an opportunity to reassess mask fit, humidification, and pressure settings to optimize adherence. 5
Avoid assuming all CPAP devices are equivalent – newer devices with "upgraded" algorithms may actually worsen therapy despite manufacturer claims, requiring verification of efficacy after any device change. 3