SLEEP PROGRAM GUIDE
www.vgm.com/respiratory
TABLE OF CONTENTS > > > >
DECIDING IF A SLEEP PROGRAM IS RIGHT FOR YOUR BUSINESS............................... 3-5
GETTING STARTED.................................................................................................... 6-7
DEVELOPING YOUR PROGRAM............................................................................... 8-15
RESOURCE AND VENDOR CONTACTS.................................................................... 16-18
VGM Respiratory Sleep Program Guide | 2
DECIDING IF A SLEEP PROGRAM IS RIGHT FOR YOUR BUSINESS It is estimated that 22 million Americans suffer from sleep apnea, with 80% of the cases of moderate and severe obstructive sleep apnea (OSA) undiagnosed. And when you consider that sleep disorders such as OSA have been linked to increased rates of high blood pressure, heart disease, Type 2 diabetes, stroke, and depression, it means that millions of patients throughout the country are looking to home health care providers for the sleep therapy products and services they need. It’s a growing market, but is it a market that’s right for you?
CONSIDER YOUR PRODUCT MIX
Throughout this section, we’ll walk you through steps you can take to help decide if starting a sleep program is right for your business.
Even if you’re not currently providing some of the aforementioned items, maybe you’re being asked for them—or even sleep products— directly already.
LOOK AT THE MARKET It should be noted that getting into sleep therapy is about more than just providing equipment and supplies. It requires more than just setting up a CPAP and going about business as usual. To be successful, a sleep therapy program requires that your patients seek you out as a resource and a partner that can guide them in managing their disease state, which requires time and training. Sleep disorders are divided into several categories, including obstructive, central, and mixed. Understanding where your patients fit into these categories and finding the best techniques to help them manage their disease state uniquely positions you as a provider to be not only a resource for the patient, but for their physicians and your referral sources as well. Let’s look at how you can know for sure if a sleep program is right for you and your business.
Developing a sleep program may be worth looking into if you’re already providing items such as oxygen and nebulizers. Patients coming to you for these items are often looking for sleep therapy products. And if they already trust you for some of their home medical needs, they’ll likely come to you for these items as well. WHAT ARE YOU BEING ASKED FOR?
The easiest place to start is with the people you already work with. You’ve already developed a rapport with the patients you serve. Start documenting some of the items they ask about as you work with them. You could send a survey to them, but it may be as simple as noting what items they’re inquiring about when they come in or during a home visit.
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Payers may also be asking you about sleep equipment and supplies, but your referral sources especially provide another great opportunity for research. They’re already sending patients your way, so it’s worth contacting them to discuss what you can do to help provide the care their patients need. GETTING ADDITIONAL DATA After you’ve discussed potential offerings with your current referral sources, it’s worth reaching out to other sources. There are nearly 3,000 sleep labs in the United States. Look into what there is in your area and make a contact. Other individuals you’ll want to contact include neurologists and pulmonologists.
Section One: Deciding if a Sleep Program Is Right For Your Business
There are resources available to ease your way. VGM Market Data has the nation’s largest and most comprehensive claims database. This allows you to: •
Identify and rank high-value referral sources
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Find out who is referring patients to your competitors
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Target your team to make the biggest gains
VGM Market Data can tell you almost instantly whether developing a sleep program is right for you AND where you should focus your resources to be the most successful. CONSIDER PAYER REIMBURSEMENT You’ll also want to check the payer reimbursement rates that will be available should you decide that a sleep therapy program is right for you. Below, you can find the HCPCS codes (see example 1) to look for as you start your research. The easiest place to start is with the Centers for Medicare and Medicaid Services (CMS). CMS’ fee schedule is a matter of public record, so you can begin your research even if you don’t currently hold DME licensure. Commercial payers are also known to base their fee schedules on a percentage of CMS’ schedule. Commercial payers’ fee schedules are not public, however. When looking into fee schedules for commercial payers, start with the payers you already hold a current contract with. You probably already have the fee schedule outlined in your contract. Even if you don’t hold any contracts with current payers, that doesn’t mean you won’t be able to access them. It just requires a little more legwork. Contact the Payer Relations department for each commercial payer you’re interested in. Along with reimbursement rates, you’ll want to take note of any expectations payers—CMS, commercial, or otherwise—have outlined for providers who supply sleep therapy equipment to postacute patients. To make things a little easier yet, there’s HOMELINK. They contract with numerous insurance companies and other payer sources to provide in-network ancillary services. Reach out to HOMELINK to find out how to become a credentialed provider within their network. By joining the HOMELINK network, providers gain access to HOMELINK direct referrals. HOMELINK also affords the opportunity for providers to process out-of-network claims. DETERMINE COST OF GOODS AND CALCULATE YOUR MARGINS Finally, you’ll want to figure out your cost of goods (COG) and calculate your potential profit margins. COGs refers to the direct costs associated with the goods you sell, including the direct labor costs. It sounds more complicated than it is. VGM Respiratory can help guide you in your journey. In this case, simply contact your Philips Respironics, AG Industries, Circadiance, and/or Compass Health representative(s), and they can assist you with your COG. Remember, VGM Financial can assist with your financial needs. From there, calculate your profitability. VGM Respiratory has developed an easy to use Profitability Calculator that includes the cost of the materials used in creating the good along with the direct labor costs used to produce the good. Visit the VGM Respiratory Resources page for the Sleep Program here, download the Profitability Calculator, and follow the simple instructions to find your profitability. VGM Respiratory Sleep Program Guide | 4
E0601 E0470
E0471
E0561 E0562
CPAP/BiPAP Machine Insurance (HCPCS) Codes Continuous airway pressure (CPAP/APAP) device Respiratory assist device, bi-level pressure (BiPAP) capability, WITHOUT backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) Respiratory assist device, bi-level pressure (BiPAP) capability, WITH backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) Humidifier, non-heated, used with positive airway pressure (CPAP/BiPAP/APAP) device Humidifier, heated, used with positive airway pressure (CPAP/BiPAP/APAP) device DME MACs’ Determination of Reasonable and Necessary Replacement of CPAP Supplies
HCPCS Code A4604 A7027 A7028 A7029 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7046
Description CPAP Tubing with Heating Element Combination Oral/Nasal CPAP Mask Replacement Oral Cushion for Oral/Nasal Mask Replacement Nasal Pillows for Oral/Nasal Mask, One Pair Full Face Mask Full Face Mask Interface Cushion for Nasal Mask Interface Nasal Pillows Nasal Interface Headgear Chinstrap Tubing Disposable Filter Nondisposable Filter Humidifier Water Chamber
Frequency 1 per 3 months 1 per 3 months 2 per 1 month 2 per 1 month 1 per 3 months 1 per 1 month 2 per 1 month 2 per 1 month 1 per 3 months 1 per 6 months 1 per 6 months 1 per 3 months 2 per 1 month 1 per 6 months 1 per 6 months
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Source: DME MAC LCDs: CIGNA Government Services (L11518) dated Feb. 4, 2011; National Government Services (L27230) dated Oct. 1, 2011; National Heritage Insurance Company (L11504) dated Feb. 4, 2011; and Noridian Administrative Services (L171) dated Oct. 1, 2011.
WHEN IN DOUBT, CONTACT VGM RESPIRATORY As you’re looking at getting into sleep therapy, you’ll probably find yourself wondering how your staff is going to accommodate all the necessary aspects. Fortunately, there are a number of outsourcing solutions that can help you implement and grow your program in the most cost-effective way. We’ll cover some of our recommendations in the coming sections. If at any time you have questions or need assistance along the way to developing a Sleep Program, don’t hesitate to contact VGM Respiratory at respiratory@vgm.com.
Section One: Deciding if a Sleep Program Is Right For Your Business
GETTING STARTED Let’s say you’ve read through Section One, done your homework, and determined that sleep therapy is right for your business. Before you begin developing your sleep program, there are still a few things you need to do to lay the groundwork. Follow the steps below to get started.
NOTIFY YOUR ACCREDITING BODY THAT YOU’RE TAKING REFERRALS
CONTACT CMS TO UPDATE YOUR CMS 855S FORM
HQAA
The first thing you need to do to get started is let CMS know that you’re entering the sleep therapy market. This simply requires you to update your CMS 855S form. (See example 2) •
Head to www.cms.gov/Medicare/CMSForms/CMS-Forms/Downloads/cms855s. pdf
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Go to Section 3: Products/Accreditation Information
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Find part D. Products and Services Furnished by This Supplier
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Check the box labeled Continuous Positive Airway Pressure (CPAP) Devices and/or Supplies
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Check the box labeled Respiratory Assist Devices
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Return the form to CMS
That’s it. Once CMS processes the update, they’ll know that you will be submitting CPAP devices and supplies for reimbursement.
Next, you’ll need to contact your accrediting body and inform them you’re taking referrals for sleep therapy. They’ll go over the next steps and any requirements there may be, such as policies, procedures, and other forms.
If you’re in the market for an accrediting body, VGM partners with the Healthcare Quality Association on Accreditation (HQAA). HQAA makes the accreditation process easy for HME providers. They even pair your organization with an accreditation coach to help you through the entire process. DEVELOP POLICIES AND PROCEDURES As part of your compliance initiatives, you’ll need to have your sleep therapy policies and procedures documented. You can find the information you need and even a policy template on our Sleep Product Class site. Here’s what you need: •
Get started by reviewing the CPAP Policy Requirements document available on the VGM Respiratory Sleep Product Class site. This document outlines all the requirements you’ll need to be aware of as you create your policies and procedures.
Example 2
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Use the PAP Policy Template from VGM Respiratory to create your own. Download the Word document from the VGM Respiratory Sleep Product Class site and update the text to fit your organization’s sleep program.
CONSIDER A PRE-SCREEN PROGRAM AND AUDIT PROTECTION Of course, no matter how well educated you are on compliance and reimbursement requirements, it never hurts to have a little help.
CREATE ANY NECESSARY FORMS
The van Halem Group
You’ll also need to ensure you have the necessary forms at your disposal. In most cases, this means familiarizing yourself and your staff with which forms are required. In others, you’ll want to create forms specific to your organization to help with documentation.
The van Halem Group offers both pre-screen programs to help you prevent overpayments leading to recoupments and audit protection to help you avoid an audit or navigate the process should you find yourself subject to an audit.
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You can find out what forms and documentation are required with the documentation checklists available on the Sleep Product Class site.
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Documentation Checklist – PAP Devices for OSA Treatment and Home-Based Sleep Study
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Documentation Checklist – Positive Airway Pressure: Home
One form you’ll want to create for your organization is the PAP Device Intake Form. Start with the sample version available on the VGM Respiratory Product Class site.
EDUCATE YOUR STAFF ON MEDICARE LCD AND COMPLIANCE REQUIREMENTS Local coverage determinations (LCDs) are decisions made by Medicare Administrative Contractors (MACs) on whether a service or item is reasonable and necessary. It’s important that you and your staff are knowledgeable on these LCDs, as well as other compliance requirements. However, you’ll also need to ensure you stay up to date on current and future changes to these requirements.
TEACH YOUR STAFF ON PRODUCT Perhaps this goes without saying, but you’ll want to make sure your staff understands the various products you’ll be providing to patients. The easiest way to do this is to contact your Philips Respironics, Circadiance, and/or Compass Health sales representative(s) about onsite training and other educational materials they may have available. VGM Education
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VGM Education also provides online education for every member of your team. They offer respiratory-related courses such as “Introduction to CPAP, AutoCPAP, and Bi-Level,” and “Mask Fitting 101.” They even offer courses focused on customer service and sales strategies. CONTACT VGM RESPIRATORY WITH QUESTIONS As always, if at any time you have questions or need assistance along the way to developing a Sleep Program, don’t hesitate to contact VGM Respiratory at respiratory@vgm.com.
VGM’s reimbursement experts hold regular webinars and present at state and local meetings all across the country to educate providers. For a good place to start, visit www.vgm.com/ reimbursement. Section Two: Getting Started
DEVELOPING YOUR PROGRAM Throughout the previous two sections, you’ve analyzed if sleep therapy is right for your business and established the foundations for your program to get started. In this section, we’ll outline the various aspects of a well-developed sleep program and recommend solutions for your organization. Let’s get started. MANAGE YOUR RISK WITH PROPER INSURANCE COVERAGE Medicare requires that providers carry comprehensive liability insurance. However, you shouldn’t stop there. For starters, your general liability explicitly excludes everything a respiratory therapist does. Because of this, you’ll want to ensure you’re covered with a professional liability policy—both an individual policy for the RT and a company policy that covers all. It may sound foreboding, but don’t let this scare you away from getting into sleep therapy. VGM Insurance We partner with VGM Insurance to help providers get the coverage they need. No one understands HME and respiratory risks like VGM Insurance, and they underwrite and service all of their policies in-house. They can also provide the necessary surety bonds if you’re billing CMS.
Parachute Health Parachute Health brings companies into the digital age with its comprehensive e-prescribing platform for ordering. It simplifies the order intake process, improves patient care, reduces costs, and improves your bottom line (helps you get paid faster) by changing the way you do business. Parachute dramatically reduces order errors, insurance claim denials, and time spent processing orders by providing an all-digital solution that seamlessly integrates with current IT systems such as Brightree, Epic EHR, and many more. DMEscripts LLC DMEscripts LLC is an independent e-prescribe company dedicated to improving the patient, prescriber, and provider experience by eliminating inefficiencies and reducing paperwork. DMEscripts aims to drastically improve the current order-to-delivery process by empowering and accelerating the widespread adoption of an electronic ordering application for DME. DMEscripts utilizes proprietary e-prescribe software to operate an open network for any DME supplier to join at no cost to prescribers or patients.
It’s never too early to reach out. Contact VGM Insurance to learn more and get a competitive quote today. ORDER PROCESS Increasingly, prescriptions are moving to digital. That’s why it’s important to consider a preprescription platform to help manage how you receive prescriptions from the physician.
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INTAKE AND BILLING
INVENTORY MANAGEMENT
When it comes to intake and billing, you’ll undoubtedly need to consider adding staff. For example, as part of your sleep therapy program, you can expect to need one worker for every 16 intakes—at a salary range of $34,000-69,000. VGM Respiratory has two partners to help you stave off the costs associated with hiring additional personnel.
Since you’re entering a new market, you’ll have extra inventory to manage. VGM Respiratory partners with Brightree, which offers a robust cloud-based solution.
Darby Darby purpose builds software specifically for “fax wranglers.” Their AI-powered fax automation technology supercharges intake and qualification teams, allowing them to say goodbye to manual, error-prone, and timeconsuming processes without requiring a new workflow. Darby’s Smart Intake automates PDF document processing, allowing intake teams to process referrals and other files faster and with fewer errors. The result: No more bottlenecks via intelligent document review, expedited insurance compliance checks, and automated outreach to providers to collect missing information – all supporting a superior employee and patient experience. Rndsoft Rndsoft is the leading staffing solution company for DME/HME providers and other medical offices. Along with saving more than 50% on employee cost, RND addresses the staffing needs, training, attrition, absenteeism, and seasonal business fluctuations. Benefits: •
RND has appropriate control measures to protect PHI
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Has international best practices to mitigate security threats
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Has established a formal information risk management process
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100% legal compliance: both national and international
Brightree From purchasing and warehousing to shipping, tracking, and billing, Brightree’s inventory management and delivery software integrates e-purchasing and fulfillment solutions so you can tackle your inventory and delivery challenges. FULFILLMENT OF ORDERS AND SHIPPING You don’t necessarily have to make room for your added inventory or add logistics processes to your staff’s workload. VGM Fulfillment VGM Fulfillment processes and ships medical supplies so you don’t have to. By outsourcing with VGM Fulfillment, you can reduce the inventory and overhead costs of running your own operation, continue to negotiate best pricing directly from the manufacturer, get custom reporting and analytics, and most importantly…focus on helping your customers. And there are additional opportunities to include extra information with your shipments—flyers, newsletters, coupons, postcards, and more.
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WORKFLOW There’s no denying that regulatory and billing requirements have become more complicated, which slows down the process, can lead to errors, and wastes time pushing papers around. Through our partnerships, VGM Respiratory has recommendations for helping you streamline your workflow.
Section Three: Developing Your Program
REMOTE SETUP AND COMPLIANCE Once a patient develops a sleep disorder, they will always have a sleep disorder. That’s why patient compliance is so important in managing their disease state and why payers increasingly look to providers to encourage outcomes. Consider technology solutions designed to promote patient compliance such as Encore Healthcare, rtNOW, and VGM Sleep Services Program. Encore Healthcare We Manage Patient Outcomes (not just equipment) TeleRespiratory is the delivery of respiratory therapy using telecommunications technologies without a respiratory therapist physically present at the point of care. Our Respiratory Navigators create an exceptional experience that helps patients manage their respiratory care, from the comfort of their own home. Pap 360° Remote PAP setup & compliance management Short on RT staffing? Have a PAP setup wait list? Our respiratory therapist-led TeleRespiratory Services team engages with your PAP patients for you. You can reduce patients’ wait time and convert your setup backlog into recognized revenue more quickly!
rtNow rtNOW is a pioneering telerespiratory care staffing company that allows HME companies to scale fearlessly. rtNOW provides fully statelicensed and highly experienced telerespiratory therapists to perform remote PAP setups (including mask fit), remote PAP adherence, remote ventilator follow-ups, general troubleshooting, and more. VGM Sleep Services Program Sleep Services is a CPAP set up and compliance program that aims to create relationships with patients for ongoing care and success. This program helps our members with staffing, revenue, and patient compliance. By using Sleep Services as their outsourced clinical service, the member/provider can be more efficient and reduce costs as opposed to hiring additional clinicians. Sleep Services provides more efficiency and higher compliance rates.
855-543-5015 | https://www.encorehc.com/ telerespiratory
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SleepGlad
Rectangle Health
SleepGlad offers a completely secure 3D PAP/ NIV mask fitting platform built on artificial intelligence. The innovative, patented program is completely and securely cloud-based with no need to purchase any hardware or download an app, even for your patients. The right mask fit can be achieved easily and remotely by the patient or in a clinical atmosphere in just seconds.
No matter how many locations you have, Rectangle Health can help streamline your payment and premium processing. Their software is designed specifically for the healthcare market, so they understand the unique needs of your business and your patients.
Multiple manufacturers participate, which ensures the ultimate mask selection for the patient, and connectivity between you and your referral source generates more referrals for you while ensuring compliance for all. With its machine learning, SleepGlad maximizes compliance and outcomes by determining the best fit for sleep apnea or non-invasive ventilation patients from the very start of setup and facilitating this connection. With the use of business intelligence, optimize established patients onto ideal newer products, view powerful predictive analysis including inventory management tools, and monitor datadriven results even with patient follow-ups. 866-SLP-GLAD | hello@sleepglad.com VGM Fulfillment CPAP Resupply and Machine Setup Solutions In today’s environment, offering your CPAP patients the option of contactless home delivery is crucial. That’s why VGM Fulfillment has created our new VGM Fulfillment CPAP Resupply and Machine Setup Solutions. Our solution accommodates orders requesting just a machine or a machine set to prescribed specifications.
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Offers HIPAA compliant card-on-file capabilities
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Increasing options for patient payment plans and decreases accounts receivable
Brightree Brightrees’ web-based platform is another great option that lets providers significantly decrease workflow processing time. The main goal is to make work better, faster, and more rewarding. If you’re not already using Brightree, you can even request a hands-on demo at their website. SCHEDULING Be sure you have a process in place that helps streamline the scheduling of setups and service with your patients. Many of the solutions discussed in the Workflow and Patient Satisfaction and Engagement portions of this section offer ways to help you automate communications with the patient—including text alerts, emails, and live phone calls. Ask your rep about the scheduling solutions available for your particular platform.
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Call us at 877-648-7959 or email us at fulfillmentinfo@vgm.com to see how VGM Fulfillment CPAP Resupply and Machine Setup Solutions can benefit your business
Section Three: Developing Your Program
EQUIPMENT SETUP AND EDUCATION
COMPLETION OF PAPERWORK TO BILLING
Whether you’re looking to do home setups on an individual basis or scheduling groups to go over the setup process, there are resources available to help you educate your patients. It’s also worth exploring telehealth solutions to help service more remote patients and reduce the amount of time your staff spends out of the office on setups.
Completion of paperwork can be done either on paper or digitally. And, we’ve discussed previously how complicated gathering the necessary elements to properly and compliantly complete paperwork can be. Our billing and reimbursement experts have a number of resources available to help you in the process. You can find what you need in the Billing/Tips section of the Sleep Product Class site, including:
React Health React Health is a manufacturer and distributor of medical devices for the diagnosis and treatment of sleep disordered breathing and chronic respiratory conditions. Their Luna line of CPAP, Auto-CPAP, and Bi-Level devices offer all of the features that matter to your patients and your business. Luna devices offer multiple options to connect to iCodeConnect, their cloud-based compliance software. They offer a full line of CPAP mask interfaces which offer the patient comfort and ease of use, with a less than one percent refit rate. PATIENT SATISFACTION AND ENGAGEMENT One of the best ways to display our value in the respiratory market is to show the positive impact providers have on patient outcomes. And one of the best ways to do this is by engaging with your patients to ensure they’re happy with their care. pulseM The pulseM platform allows businesses to manage their online reputation by engaging with patients via SMS and email to communicate pre-appointment reminders and post-appointment feedback. 90% of texts are read in the first three minutes. This level of communication allows home owners and caretakers to feel safe and secure by knowing who will be showing up to their door, as well as gives you the opportunity to capture valuable feedback that can enable growth and continued training for employees.
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Links to PAP LCD (local coverage determination)
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National coverage determination for CPAP for OSA
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Refill requirements for items provided on a recurring basis
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And more
RESUPPLY PROGRAM A major portion of your work as a sleep therapy provider will be ensuring your patients are resupplied on time, which also has a profound impact on patient outcomes. You can find a CPAP Resupply Schedule on the Product Class site. But, resupply also means communicating with your patients when they’re due for replacement supplies. Brightree Resupply Brightree Resupply is patient management software built on artificial intelligence that automates the outdated manual processing that slows down patient management. The AI suite allows you to focus on your patients rather than paperwork. The goal is to help patients enjoy happier lives while you enjoy healthier profits. •
More than 50% of orders go through without using any manpower
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Orders generated, fulfilled, and sent within hours, not days
Orders don’t ship until all appropriate documents are present, meaning an order is ready to bill as soon as it ships.
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S3 Resupply
Strategic Imaging
S3 Resupply provides a unique outreach method that centers around live management. Their platform has proven outcomes with companies experiencing significant growth annually with their replacement PAP supply program. S3 offers integrated software solutions with management reporting to help you see inside your organization. S3 Resupply can also dramatically increase your long-term patient retention.
Strategic Imaging is dedicated to relevant marketing through personalized direct mail. Let Strategic Imaging help you get a better response rate with their top-quality variable data and variable image printing. They combine years of printing expertise and state-of-the-art digital imaging with data management and programming specialists for target marketing and direct mail campaigns.
VGM members also receive a 5% discount on subscription fees.
VGM Off the Shelf
MARKETING AND SALES EFFORTS In addition to contacting your current referral sources, you’re going to want to get the word out that you’re providing sleep therapy. VGM Respiratory has several partners that can help in this area. VGM Forbin VGM Forbin specializes in building HIPAAcompliant websites and developing online marketing strategies that include social media, search engine optimization, and reputation management. From mobile responsive and results-focused online marketing services to online portals that help you operate your business more efficiently, VGM Forbin creates solutions to meet your specific needs.
VGM Off the Shelf (OTS) offers effective, costconscious standard and customizable marketing options to help you build your brand fast. Guides, handbooks, fliers, and inserts are all available through VGM OTS. VGM Market Data By providing VGM members exclusive access to the largest and most comprehensive DME, O&P, PT, and Infusion claims database in the country, VGM Market Data can help you put your money in the right place. VGM Market Data can help you identify your main competitor’s top 20 referral sources. Or, it can help you find your top 50 referral sources by volume who send you less than 50% of their patients. These are just a few examples of the valuable data they can provide. Target smarter with VGM Market Data.
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Section Three: Developing Your Program
INCREMENTAL PRODUCTS
Portable Outlet
If your patients aren’t buying these products from you, they are likely purchasing online or from a big box store. In addition to PAP equipment and supplies, patients will be looking for other products to help keep their equipment clean and increase their comfort. Not only are some of these products great opportunities for you to increase cash sales, they can actually encourage patient compliance.
Portable Outlet is the only CPAP battery that can power any brand and model without any additional adapters or accessories. Their 110 volt input port is as simple as plugging your CPAP into the bedroom wall. There is also no need to carry multiple battery models to power specific CPAP brands. At 155 watts, it’s the longest lasting, most versatile CPAP battery. It can even power a TV, laptop, or CPAP while powering a phone or tablet.
VGM Retail has provided an example of how offering cash pay products to go along with a CPAP device could impact your bottom line. Here are a few of our partners that offer some highlyrequested products: Contour Products Contour Products brings a complete range of products specifically designed to provide therapeutic support, encourage proper posture, and offer your patients the ultimate comfort. Their products are specifically designed to:
REMOTE PATIENT MONITORING Verustat Verustat offers a remote patient monitoring platform that is a pathway to better health for providers’ patients. Verustat manages patient’s physiological data at home, which offers patients accurate care and adds profit to the provider’s bottom line, without unnecessary extra work for their staff.
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Make CPAP easier
5-YEAR REPLACEMENT PROGRAM
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Improve seating comfort and support
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Enhance rest and sleep with elevated wedges
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Promote a good night’s sleep with therapeutic head, neck, and leg pillow
CMS sets the replacement schedule for PAP devices based on the 5-year reasonable useful lifetime (RUL). This is important to understand when it comes to replacing a patient’s device. There’s too much in the policy to cover in a short section, but here are some highlights: PAP Devices Replaced After 5 Years According to the LCD, if a PAP device is replaced following the 5-year RUL, there must be a face-to-face (F2F) evaluation by their treating practitioner that documents that the beneficiary continues to use and benefit from the PAP device. There is no requirement for a new sleep test or trial period. If the 5-year RUL is reached, the following apply: •
New F2F evaluation stating the patient benefits from PAP device and continues to use it
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New detailed written order. This needs to be within six months and prior to delivery
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No new sleep study and no new trial period
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Need to have provider documentation as to why it needs replaced, such as patient requested, patient wants a newer version, or device is broken beyond repair
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Need a narrative on the claim in the NTE section—RUL E0601 original date of service
PAP Devices Replaced During 5-year RUL PAP devices may be replaced during the 5-year RUL due to: •
Loss
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Theft
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Damaged beyond repair due to a specific incident
MedEquip Service Solutions, A Trace Medical Company Our company values honesty and integrity and is dedicated to helping our customers with all of their medical equipment service needs. We offer a unique set of quality and comprehensive services with an industry leading turnaround time and industry leading pricing. Furthermore, we have a trusted relationship with each of our customers creating a mutual trust their equipment repair needs will be met at all times. You can trust Trace to support your company when you need us! Trace Medical is excited to offer factoryauthorized repair services. You can count on Trace Medical for:
There are no requirements for a new clinical evaluation, sleep test, or trial period.
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One-year warranty on all our repairs, covering both parts and labor
VGM Fulfillment CPAP Resupply and Machine Setup Solutions
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Factory-certified repair for Philips Respironics, ResMed, BREAS, Invacare, and Drive Medical.
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Industry-leading turnaround time on basic preventative maintenance
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Lowest pricing for preventative maintenance and repairs
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Repairs on insect and smoke ingress machines
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Free standard ground return shipping for all units sent in for service
In today’s environment, offering your CPAP patients the option of contactless home delivery is crucial. That’s why VGM Fulfillment has created our new VGM Fulfillment CPAP Resupply and Machine Setup Solutions. Our solution accommodates orders requesting just a machine or a machine set to prescribed specifications. Call us at 877-648-7959 or email us at fulfillmentinfo@vgm.com to see how VGM Fulfillment CPAP Resupply and Machine Setup Solutions can benefit your business.
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STILL HAVE QUESTIONS? CONTACT VGM RESPIRATORY This Sleep Program Guide is just the beginning. We regularly update the Sleep Product Class site with resources and solutions to help you develop and grow your own sleep program. But if you can’t find what you’re looking for or you have any questions at all, we’re here to help.
Section Three: Developing Your Program
RESOURCE AND VENDOR CONTACTS
888-598-7797 brightree.com
925-321-3828 info@fphcare.com www.fphcare.com
800-482-1993 vgmhomelink.com sales@contourhealth.com contourproducts.com
866-909-4722 info.hqaa.org
508-944-5728 emily.addy@getdarby.com www.getdarby.com
949-633-1262 trish.dillon@dmescripts.com dmescripts.com
sales@parachutehealth.com parachutehealth.com
855-543-5015 www.encorehc.com respironics.com
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RESOURCE AND VENDOR CONTACTS
orders@portableoutlet.com portableoutlet.com
855-866-3253 sales@pulsem.me pulsem.me
833-786-6948 rtnow.net
888-510-1438 support@papresupply.com s3sleepcoach.com
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863-226-6285 www.reacthealth.com
888-852-6055 info@rectanglehealth.com www.rectanglehealth.com
866-757-4523 hello@sleepglad.com www.sleepglad.com
strategic-imaging.com
404-343-1815 844-RND-SOFT csr@rndsoftech.net www.rndsoftech.net
info@vanhalemgroup.com vanhalemgroup.com
Section Four: Resource and Vendor Contacts
RESOURCE AND VENDOR CONTACTS
800-362-3363 vgminsurance.com
888-427-8500 information@verustat.com www.verustat.com
866-227-8171 vgmeducation@vgm.com shop.vgmu.com/respiratory
844-236-4022 vgmmarketdata.com
888-875-7707 vgm.com/services/ots/ forbin.com
VGM Fulfillment CPAP Resupply and Machine Setup Solutions 877-648-7959 fulfillmentinfo@vgm.com
VGM Respiratory Sleep Program Guide | 18
vgm.com/sleep
SLEEP PROGRAM GUIDE www.vgm.com/respiratory