Complex respiratory HFCWO vest and cough assist expectations

DME provider requirements for high frequency chest wall oscillation vests and cough assist devices: new orders, delivery and setup, member transitions, ongoing management, and resupply.

New orders

Patient and prescriber information

Patient demographics, patient contact information, prescriber contact information, hospital admission and discharge data, specialist contact information, and next planned doctor visits.

Standard written order

Include an SWO specifying settings and equipment type, consistent with the billing requirements for E0483 or E0482.

Qualifying documentation

• Qualifying diagnosis
• Qualifying testing
• History and physical, medical history, or medical summary document
• Documentation that standard treatments have not worked for the patient
• Certificate of Medical Necessity, or an explanation of need

Delivery and setup

• Complete all initial equipment setup training, all setup documentation, patient signatures, education, compliance requirements, and care instruction.
• Confirm equipment settings match the prescriber’s orders.
• Follow up the next day, virtually or in person, then weekly for one week after setup and as needed.

Supplies to provide at setup

• Cough assist interface, tubing, and filters
• Suction equipment and supplies, if applicable
• Correct vest fitting for the patient

Setup documentation

Complete documents in the Synapse Health Delivery portal. Anything not completed there must be uploaded within 2 business days of setup. All documents require patient signature. Documentation includes, but is not limited to:

• Home safety assessment
• Plan of care
• Patient education and training confirmation, with signed training checklists for all equipment
• Itemized delivery sales order with equipment serial numbers

Training requirements

• A licensed respiratory therapist trains caregivers on the equipment until they demonstrate knowledge of use and care.
• Complete and sign caregiver competency checklists in full.
• Provide contacts for questions, malfunctions, supplies, and after-hours support.
• Communicate any barrier to training to Synapse Health, the prescriber, and the case manager so a resolution plan can be put in place.

Communicate any delay or issue with delivery or setup to Synapse Health promptly.

Member transition patients

Provide everything listed under new orders, plus documentation from the previous 90 days:

• Utilization data, if available
• Most current plan of care
• Most current orders
• Most recent visit note, if applicable

Ongoing management

Compliance, adherence, and emergency management

• Provide usage and adherence data on request.
• Reach out to patients individually for troubleshooting and education to improve adherence.
• Follow up on physician visits.
• Notify Synapse Health within 2 business days when a patient is noncompliant or nonresponsive, has a change in status, or needs a device returned.
• Provide 24/7 support covering device troubleshooting, servicing, and replacement.
• Provide loaner equipment during servicing or replacement.

Patient visits

• Conduct in-home evaluations as required by the plan of care or patient need.
• Submit all visit notes to Synapse Health within 2 business days of the completed visit.
• If a visit is missed, notify Synapse Health using the Missed Patient Visit form by fax or email.

What to document at every visit

• Patient name and a second patient identifier
• Date of visit
• Respiratory therapist name and credentials
• Visit modality, virtual or in person
• All equipment settings
• Patient usage hours, as applicable
• Patient or caregiver expresses understanding of the plan of care, proper equipment use, emergency procedures and troubleshooting, and cleaning and maintenance. Address any barriers.
• Clinical assessments and observations
• Resupply recommendations or changes
• Physician orders reviewed and up to date
• Supply replacement schedule reviewed

Resupply

Provide all supplies related to cough assist equipment per guidelines. More frequent supply changes may be needed depending on patient usage, environment, and need.

Questions and escalation

For urgent patient issues, call Synapse Health immediately. For non-urgent questions about visits, documentation, or compliance, email the clinical team and expect a response within 3 business days. If Synapse Health identifies a compliance or clinical concern, you will receive a formal inquiry through the Delivery portal or by email with a request for response within 3 business days.