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Compliance for Medicare supplies
#1
I know 70% compliance is required for Medicare to buy a CPAP machine.  But how much compliance is required to keep getting supplies paid by Medicare?  No one at Medicare, Supplier, or ResMed seems to know!
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#2
Not that logic ever had anything to do with Medicare, but I would guess if you don't have a Medicare authorized machine, they won't be paying for supplies for one.
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#3
I have been getting supplies under Medicare for several years. The compliance requirement is the same. Up until lately my DME has asked me to verify my compliance for at least 21 of the previous 30 days. Now that I have a data capable wireless machine they have told me that big brother will be watching. They will monitor compliance and not provide supplies if I don't meet the requirement. They told me that many private insurers are now doing the same.

Medicare also requires a followup visit with your Dr. at least annually.

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#4
Also, I got my original machine before I went on Medicare. Medicare covered supplies but required confirmation of a "face to face" visit with my Dr. before providing coverage.

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#5
It doesn't matter to MC how the machine was provided. Example: Could have been provided under a private insurer before the person became MC eligible. I bought my current machine out-of-pocket from one of the listed suppliers. I did give the DME who provides supplies the serial numbers. In the 6+ years of CPAP, I have never been asked to show compliance data.

I've been getting my supplies from a MC approved DME. I get different stories on how often a doc must be seen to continue to receive supplies. One source says 6 months; another says annually.

It has become a pain to get supplies under MC since they went to Competitive Bid on 01 July 2016.
I can no longer get supplies form my local sleep center. They come mail order from the east coast.
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#6
Medicare Compliance requirement changed recently. You have to provide a new prescription and doctor's notes that indicate discussion of the cpap/bipap use ANNUALLY. Now, I say recently because before, they accepted lifetime prescriptions. My bro has a 99 year prescription from his previous primary, so we're waiting to see what will happen on that. He will have had his current machine for 2 years in May. If all they need is his data card, that's a no brainer - I can print from Sleepyhead and it shows he used it virtually every night.

If your supplier is ragging on about 6 months, ask them to email you a copy of the requirement because Medicare says once a year.

I'm just getting some extra supplies in the meantime for myself so that I can stretch it out to my regular visit with my doc and have the supply train come from his office. I don't want to go to the sleep clinic anymore. I see no point in paying for an extra visit with someone who doesn't actually do anything (I never see the doc now).
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#7
Hi jrh0,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy.
trish6hundred
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