Non-Invasive ventilator treatment is generally covered if treatment is needed for :
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Neuromuscular Disorder
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Thoracic disorder diseases
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Chronic respiratory failure associated with a respiratory illness such as chronic obstructive pulmonary disease (COPD)
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If patient has had repeated hospital admissions due to respiratory failure, make sure that this information is documented because it will help meet coverage. If a ventilator is used, make sure follow-up visits are documented in the medical record by treating practitioner to show there was a decrease in admissions.
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Remember Medicare pays for least costly alternative, which means a BiPap or BiPap S/T needs to be considered, or tried and ruled out. Clinical documentation must be specific to the individual patient's needs.
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Make sure the documentation is very clear and thorough as to why the patient needs a ventilator versus a respiratory assist device such as a BiPap or BiPap S/T. The documentation must reflect that the patient has a condition that is life-threatening. The medical record needs to include discussion of the underlying condition to show that without ventilator support the patient is at a significant risk for death.
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Justifications might include the fact that the only other alternative would be a tracheotomy which would increase chances of infections and adds increased trauma to an already stressed patient and his/her family.
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Monthly rental payments include the payment for supplies and accessories.
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