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Changing Pressure and Medicare
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GTOdude Offline

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Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #1
Changing Pressure and Medicare
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
12-13-2015 10:54 PM
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justMongo Offline

Monitors

Posts: 3,854
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #2
RE: Changing Pressure and Medicare
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.

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.
12-13-2015 10:58 PM
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OpalRose Offline

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Posts: 3,181
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #3
RE: Changing Pressure and Medicare
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
12-13-2015 11:02 PM
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GTOdude Offline

Preferred Members

Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #4
RE: Changing Pressure and Medicare
(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
(This post was last modified: 12-13-2015 11:21 PM by GTOdude.)
12-13-2015 11:18 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #5
RE: Changing Pressure and Medicare
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.
12-13-2015 11:34 PM
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justMongo Offline

Monitors

Posts: 3,854
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #6
RE: Changing Pressure and Medicare
(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.

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.
12-14-2015 12:27 AM
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GTOdude Offline

Preferred Members

Posts: 94
Joined: Dec 2015

Machine: RemStar Auto APAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFIT P10
Humidifier: Unsure
CPAP Pressure: 7-14
CPAP Software: SleepyHead EncoreBasic

Other Comments: Other Dx: cabg x3 '94. Hypothyroid '15 and other maladies.

Sex: Male
Location: Central Valley, Left Coast

Post: #7
RE: Changing Pressure and Medicare
(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
12-14-2015 08:36 PM
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