If you provide pap equipment to patients, utilizing compliance rules can help drive efficiency for your processes and billing workflow. 

Within a patients profile you will see under the patients therapy data both usage and clinical information available. 

If you have a compliance rule defined the system will indicate if the patient has met compliance according to the rule for the patients primary payer. If a patient has not met compliance after the evaluation period a "compliance not met" tag will appear on any invoice generated after this evaluation period and the invoice will be placed on a hold status for further review.
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The first step prior to defining your compliance rules is to make sure your account has been configured with the integrations offered for Philips Respironics and Resmed. If you have not done so yet, please reach out to your account representative to learn more about these integrations. 

If your integration has been completed you can proceed to begin using the compliance rules. 

To create a new compliance rule, navigate to the payer rules section, click on "Add Rule" under the compliance tab. 

Rules can be applied to the payer as a whole or you can make rules plan specific by selecting the plan(s) to apply for this rule.

You can search for the HCPCS codes you would like to add to this rule. You can select multiple HCPCS for a single rule. When you select the HCPC code be sure to click the small blue + button. 

Now you will enter into the required areas with the asterisks: “Evaluation Period”, “Best Usage Period”, “Min. Usage Per Day”, & “Percentage”.  

You can define the rule for compliance according to your need however many payers follow Medicare compliance requirements. 

(For example with CPAP therapy, it would be an Evaluation period of 90 days, Best usage period of 30 days, minimum usage per day of 4 hours, &  percentage of 70%.) 

Please remember to click Save when you are finished creating your rule.