Article Detail - JD DME

Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.

Posted February 10, 2011

Recently questions have arisen regarding how suppliers should verify the credentials of the physician interpreting sleep tests when requested during the course of a contractor's claim review. 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:

• Current certification in Sleep Medicine by the American Board of Sleep Medicine (ABSM); or,
• Current subspecialty certification in Sleep Medicine by a member board of the American Board of Medical Specialties (ABMS); or,
• 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,
• 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. The following list contains examples (not all-inclusive) of web sites and organizations that maintain this information:

• For physicians affiliated with an American Academy of Sleep Medicine (AASM)-accredited sleep lab.
• Board certification entities
  • American Board of Sleep Medicine (ABSM) (for those certified prior to 2007) - Certification by ABSM was not time-limited (i.e., lifetime certification) so ABSM still maintains a site with credentials verification information at http://www.absm.org/.
  • American Board of Medical Specialties (ABMS) - ABMS member boards took over administration of the certifying examination in sleep medicine from ABSM in 2007. The ABMS site - http://www.abms.org/ - also has a credentials verification look-up function.
  • ABMS member board sites. Each member board of ABMS that is involved in physician training in sleep medicine and administration of a specialty examination in sleep medicine has credentials verification. Those specific ABMS member sites are listed below:

American Board of Family Medicine
2228 Young Drive
Lexington, KY 40505-4294
Phone: 859-269-5626 or 888-995-5700
Fax: 859-335-7501 or 859-335-7509

American Board of Internal Medicine
510 Walnut Street
Suite 1700
Philadelphia, PA 19106-3699
Phone: 215-446-3500 or 1-800-441-2246
Fax: 215-446-3633
Web site: http://www.abim.org/certification/policies/imss/sleep.aspx

American Board of Pediatrics
111 Silver Cedar Court
Chapel Hill, NC 27514
Phone: 919-929-0461
Fax: 919-929-9255
Web site: http://www.abp.org/

American Board of Psychiatry and Neurology
500 Lake Cook Road, Suite 335
Deerfield, IL 60015
Phone: 847-945-7900
Fax:847-945-1146

American Board of Otolaryngology
5615 Kirby Drive
Suite 600
Houston, Texas 77005
Phone: 713-850-0399
Fax: 713-850-1104
Web site: http://www.aboto.org/