07-23-2019, 12:42 PM
(This post was last modified: 07-23-2019, 12:50 PM by sheepless.)
RE: Any tips or warnings around DME appointment?
"It's not a double charge. Humidifier is always charged separately. The fact that it is incorporated in the Airsense doesn't make any difference as there is no code yet for an integrated system that provides a higher payback."
it most certainly is a double charge because it's already included in the retail price of the machine. the humidifier is standard equipment and isn't user replaceable. the chamber is replaceable but the first one is included in the retail price. the exhalation port I'm being charged for is molded into the p10 mask frame, cannot be replaced and cannot be purchased.
your point about higher payback is the problem. just because there's a code for something doesn't make it okay to charge separately for these things. it made sense when humidifiers and exhalation ports were separate and optional, but no more. apparently it's small potatoes to the insurers and they haven't caught up. just because it's always been done that way doesn't make it right now.
RE: Any tips or warnings around DME appointment?
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Any tips or warnings around DME appointment?
(07-23-2019, 12:42 PM)sheepless Wrote: "It's not a double charge. Humidifier is always charged separately. The fact that it is incorporated in the Airsense doesn't make any difference as there is no code yet for an integrated system that provides a higher payback."
it most certainly is a double charge because it's already included in the retail price of the machine. the humidifier is standard equipment and isn't user replaceable. the chamber is replaceable but the first one is included in the retail price. the exhalation port I'm being charged for is molded into the p10 mask frame, cannot be replaced and cannot be purchased.
your point about higher payback is the problem. just because there's a code for something doesn't make it okay to charge separately for these things. it made sense when humidifiers and exhalation ports were separate and optional, but no more. apparently it's small potatoes to the insurers and they haven't caught up. just because it's always been done that way doesn't make it right now.
Not your finest moment but it's confusing and you're not the first to get it wrong. It would be better to just link the wiki
http://www.apneaboard.com/wiki/index.php...6_Medicare . We are not talking about retail price here. The insurance companies negotiate a price for DME, and in this case a CPAP is a constant or auto positive pressure device E0601 or E0470/E0471 for BPAP. When the humidifier is provided, it is invoiced separately under a separate HCPCS code EO562. The DME also invoices for filters, tubing, mask cushion, mask frame and mask headgear. What DMEs invoice is not what they get reimbursed. They are reimbursed based on the contract prices, not the invoiced or list prices. Any copay or deductible by the patient is paid based on the contract price. The entire medical industry is this way and you could be invoiced $20,000 for a hospital procedure that insurance pays $600 to obtain. It's the system and it's opaque.
Note, this is ONLY when you deal through insurance. If you are buying equipment out of pocket, then retail and your best discounts apply, and this kind of itemization would be subject to competitive comparisons. If you don't compare prices when you buy in the free market, that is could get you burned pretty bad.
07-24-2019, 11:33 AM
(This post was last modified: 07-24-2019, 11:35 AM by sheepless.)
RE: Any tips or warnings around DME appointment?
not my finest moment is a bit condescending. obviously the point is that I disagree with the position as you present it. I understand it's the conventional position but times change. just because there's a code for it doesn't make it right to charge for things that are included in both the retail and the insurer allowed amount and are not purchasable or user replaceable or not replaceable at all. there used to be a rationale for it but no longer in most cases. btw, it's my understanding dme providers may use medicare as a guide but are not governed by it, at least for non medicare customers. also, I'd have no argument if the provider would simply show me that they reduced the price I paid for the autoset by the price of the humidifier before charging for the humidifier and similarly reduced the price of the p10 by the price of an exhalation port. but they can't / won't.
it's not likely anyone is going to change anyone else's mind so I'll leave it with this.
RE: Any tips or warnings around DME appointment?
It’s just the way it is, and until Medicare catch up, things will be billed their way. I suspect there is a memorandum out there with guidelines on this specific issue. Anyway if a humidifier is included it is billable, whether it is a component add-on or integrated.
I apologize for the condescending tone. It’s been discussed as nauseam in the past.