Complex respiratory invasive ventilation INV expectations

DME provider requirements for invasive ventilation patients: new order documentation, delivery and setup standards, 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 E0465, E0467, or E0468.

Qualifying documentation

• Settings demonstrating the need for invasive ventilation
• Qualifying diagnosis with tracheostomy
• History and physical, medical history, or medical summary document
• 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 ventilator and equipment settings match the prescriber’s orders.
• Follow up the next day, virtually or in person, then daily for one week after setup.

Supplies to provide at setup

• Back-up airway at the bedside
• Suction equipment and supplies
• Tracheostomy care supplies
• Ventilator circuit, tubing, and filters
• Humidification
• Ambu bag

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
• Ventilator flow sheet, including all settings
• Patient education and training confirmation, with signed training checklists for all equipment
• Itemized delivery sales order with all equipment serial numbers

Training requirements

• Schedule equipment training at the hospital, in the home, or a combination of both, and deliver equipment to the training location.
• A licensed respiratory therapist trains caregivers on all equipment until they demonstrate knowledge of use and care.
• Complete and sign caregiver competency checklists in full for every piece of equipment.
• Provide contacts for questions, malfunctions, supplies, and after-hours support.
• Communicate any barrier to patient or caregiver education to Synapse Health, the prescriber, and the case manager so a resolution plan can be put in place.

Tag Synapse Health in the cloud platform

Tag Synapse Health as part of the patient’s care team in the ventilator cloud platform so we have real-time access to data for clinical monitoring and compliance tracking. Platforms include:

• ResMed AirView
• React Connect
• Respironics Care Orchestrator
• BREAS EveryWare
• Movair Prisma Cloud

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
• Ventilator flow sheet
• Most current plan of care
• Most current orders

Tag Synapse Health in the patient’s ventilator cloud platform as described above.

Ongoing management

Maintenance documentation standards

Maintenance and service logs must record:

• Ventilator make, model, and serial number
• Date of maintenance or service
• Description of maintenance performed
• Name or identifier of the technician who performed the service
• Verification that the maintenance aligns with manufacturer-recommended intervals

Compliance, adherence, and emergency management

• Monitor adherence daily.
• 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 emergency support for ventilator-dependent patients, covering device troubleshooting, servicing, and replacement.
• Establish and manage the patient’s emergency preparedness plan, including notifications to local emergency services.
• Provide loaner equipment during servicing or replacement.

Patient visits

• Conduct routine in-home evaluations for therapy adjustments, at the frequency and in the medium required by regulation.
• Conduct visits at a minimum of every 90 days, based on state requirements and patient acuity.
• 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
• Ventilator type, model, and serial number
• Ventilator settings including mode, parameters, comfort settings, and alarm settings
• Date and hours of the last preventative maintenance, and when the next is due
• Usage hours, whether the patient is compliant (more than 4 hours per night daily), and leak value in L/min
• Power supply and battery checked
• Alarms tested and functional
• Circuits intact
• Filters checked and replaced
• Ambu bag present at the bedside
• Humidification: water chamber filled appropriately, no contamination or excessive condensation
• Interface assessment: no skin breakdown at the tracheostomy site, tracheostomy tube secure and free of obstruction, back-up airway present at the bedside
• Patient or caregiver expresses understanding of the plan of care, proper equipment use, emergency procedures and troubleshooting, alarm recognition and response, 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
• Next visit due

Resupply

Provide all supplies related to ventilator use and tracheostomy care 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.