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Changing Pressure and Medicare
#1
Im on Medicare and have to send the data card every month to my DME. I changed my pressures on my APAP today upon recommendations from other knowledgeable people about to improve my therapy.

How does that impact the info sent to the DME and/or Medicare pertaining to being paid for my machine rental, versus the Dr's prescription pressures?

Thanks all.
Mark
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#2
Medicare only cares about compliance. Days and hours used.

Most DMEs don't look beyond that. And, since they wish to be paid, any fuss will not stop you from getting the machine paid for.
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#3
Medicare is most likely looking at compliance, not your pressure settings. If I remember correctly, Medicare requires that you are using the machine no less than 4 hours a night for 30 consecutive days within the first 3 months rental period.

Some DME's or Doctors may get their feathers ruffled a bit about you taking charge of your therapy, but again they may not. I think their main concern is that you are compliant, because if not, Medicare will stop paying them rent. I wouldn't worry about it, you have to do what's best for you.
OpalRose
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#4
(12-13-2015, 10:58 PM)justMongo Wrote: Medicare only cares about compliance. Days and hours used.

Most DMEs don't look beyond that. And, since they wish to be paid, any fuss will not stop you from getting the machine paid for.
Thank you, Mongo!

I read in another post elsewhere that you were an Airman? Can I assume you were USAF? I am retired Air Force MSgt.

Mark


(12-13-2015, 11:02 PM)OpalRose Wrote: Medicare is most likely looking at compliance, not your pressure settings. If I remember correctly, Medicare requires that you are using the machine no less than 4 hours a night for 30 consecutive days within the first 3 months rental period.

Some DME's or Doctors may get their feathers ruffled a bit about you taking charge of your therapy, but again they may not. I think their main concern is that you are compliant, because if not, Medicare will stop paying them rent. I wouldn't worry about it, you have to do what's best for you.
OpalRose, My Dr is a pretty decent guy. The DME I have dealt with before, but back before I turned 65 and was on an HMO and Military medical, trying to make an old BiPAP machine work for me (without success).
Thanks!
Mark

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#5
Medicare does not give a rats patooti what your pressure is or who set it as long as you were diagnosed by home study or sleep lab, have a prescription, do the two face to face dr meets and are compliant.
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#6
(12-13-2015, 11:18 PM)GTOdude Wrote: I read in another post elsewhere that you were an Airman? Can I assume you were USAF? I am retired Air Force MSgt.

Mark

USAF NKP Thailand and Da Nang RVN.
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#7
(12-14-2015, 12:27 AM)justMongo Wrote:
(12-13-2015, 11:18 PM)GTOdude Wrote: I read in another post elsewhere that you were an Airman? Can I assume you were USAF? I am retired Air Force MSgt.

Mark

USAF NKP Thailand and Da Nang RVN.
And I thank you wholeheartedly for your service during a bad time in history. Thanks
I spent 4 years in Korea during peacetime. Did 20.5 years.

Mark
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