This content has been reviewed for accuracy by  Ryan Bullock, Chief Strategy Officer

Centers for Medicare & Medicaid Services (CMS) made significant changes to the ordering process for positive airway pressure (PAP) and respiratory assist device (RAD) supplies. These changes, outlined in a Dear Physician Letter from the Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Directors, aim to simplify the Standard Written Order (SWO) for supplies. This landmark change underscores the dedication CMS has towards reducing administrative barriers that prevent access to care. 

The update encourages physicians to use general descriptions like “CPAP Mask” or “Mask – Fit to Comfort” to accommodate mask variations without requiring a new SWO for each change. This flexibility not only reduces administrative burdens by ordering providers and DME suppliers but also ensures patients receive the most suitable masks and supplies without delays.

Flexibility for Physicians:

• Physicians are now freed from the previous obligation to specify the mask type (e.g., full-face mask, nasal mask, nasal cushions, etc.) when prescribing items such as PAP devices and their associated components. This change allows physicians to issue a more general prescription, reducing the need for extensive communication with DME suppliers as patients explore different mask options.

Impact on Patient Adherence:

• Aligning the SWO with more generic terms fosters a patient-centric approach, guaranteeing convenient access to the most suitable mask without delays caused by providers seeking updated documentation.

Addressing Supplier Concerns:

• The SWO requires all items that will be billed must be separately listed on the prescription. It states, “For supplies – In addition to the description of the base item, the DMEPOS order/prescription may include all concurrently ordered supplies that are separately billed (list each separately)” Both the mask and the interface must be listed separately. However, the interface can/should be listed as “Mask Interface” instead of “Mask Cushions.” Mask interface allows suppliers to bill either pillow or cushion whereas “Mask Cushions” limits suppliers to providing cushions only.

These updates from CMS represent a significant step forward in streamlining the ordering process for PAP and RAD supplies. Aeroflow Health remains committed to championing the broader adoption of these updated policies across more health plans. These changes, aimed at reducing administrative burdens and promoting patient adherence, align with the goals and objectives shared by our health plan partners.We are excited to see the positive impact these updates will have on patient care and look forward to continuing to work together to improve health outcomes for all.