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CMS-1403-FC
throughout this rule refers to those individuals or
entities that administer and/or interpret the sleep test
and/or furnish the sleep test device, as described below.
The provision of diagnostic sleep testing includes TCs and
PCs related to the administration and interpretation of the
test itself. Commonly one entity will furnish the sleep
test device and another entity, such as a physician, will
furnish the professional interpretation of the result
generated by the device. Depending on the location in
which the test is performed (that is, attended facility-
based PSG or a HST), a sleep test provider may furnish the
sleep test in its own physical facility, that is, the sleep
laboratory, or may furnish the sleep test device and
deliver it to and retrieve it from the beneficiary’s home.
We believe that Medicare beneficiaries and the
Medicare program are vulnerable if the provider of a
diagnostic test has a financial interest in the outcome of
the test itself. This creates incentive to test more
frequently or less frequently than is medically necessary
and to interpret a test result with a bias that favors
self-interest. In the specific context of this rule, we
believe that the provider of a sleep test has self-interest
in the result of that test if that provider is affiliated
with the supplier of the CPAP device that would be covered
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