Based on numerous questions about how suppliers should verify the credentials of the physician interpreting sleep tests when requested during the course of a contractor’s claim review, the Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs) released the following clarification.
As noted in the local coverage determination (LCD) for Positive Airway Pressures (PAP) Devices:
For PAP devices with initial dates of service on or after November 1, 2008, all HSTs (Type II, III, IV, Other) must be interpreted by a physician who holds either:
1. Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or,
2. Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or,
3. Completed residency or fellowship training by an ABMS member board and has completed all the requirements for subspecialty certification in sleep medicine except the examination itself and only until the time of reporting of the first examination for which the physician is eligible; or,
4. Active staff membership of a sleep center or laboratory accredited by the American Academy of Sleep Medicine (AASM) or The Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations – JCAHO).
For PAP devices with coverage based on a facility-based polysomnogram (Type I) performed on or after January 1, 2010, the interpreting physician must meet one of the requirements listed above (1-4) for credentialing.
There are multiple methods for confirming the interpreting physician’s credentials. One method is to request a copy of the board certificate or other documentation provided by the certifying entity directly from the physician. Alternatively, there are several web sites that have credential verification information. Suppliers may provide screen prints from one of these sites with information about the interpreting physician’s credentialing status.
