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DME and Medicare
#11
RE: DME and Medicare
Thanks again, Rose, for the wealth of info in a concise manner; keeping the important FAQs all together!!

And the clarification on trying out masks in initial period being more about DME than medicare.  I also see how all those mask components can add up over time.

Kind of annoying that Medicare can't just give you the mask in month 4 if you've been compliant.  But understand the 13 month schedule, Sleeprider.

And nice to know that most DMEs keep you posted when you're eligible for supplies, Homer.

It's been a journey, educating myself, just to get to the beginning :-)  And your help has been invaluable!

Remember2Breathe
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#12
RE: DME and Medicare
Forgot to mention that you can also find masks and mask parts on Amazon if self paying.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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.
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#13
RE: DME and Medicare
There is a zip file on CMS.gov - January 2021 DME Fee Schedule (DME21-A) which I thought others might find useful.  

Within that zip file, there is an excel doc.  If I am interpreting it correctly, by putting in the code for the DME item, you can view the Medicare approved amount in each state (rural or non-rural).

I think we are not supposed to post links but perhaps you can copy same into your browser and if not, just go to cms.gov and search for DME21-A and click on the first file that comes up.

https://www.cms.gov/medicaremedicare-fee...dule/dme21

I phoned Medicare to confirm that I am interpreting the information correctly; but as has been my experience, they are utterly useless on the phone.
They were unable to access the document on their end (even the supervisor), had monitors that kept going black etc., etc.
All they were able to tell me was that of a medicare approved amount, medicare pays 80% (and if you have a supplement plan, it should cover 20%, less any deductibles and copays if applicable).  They also said that a non participating provider can charge up to 15% more (but I'm not sure that this applies to DME as I think they can charge more if they don't accept assignment).

Anyway, since the doc was too big to upload here, instead I uploaded the information that I extracted from the excel doc for Non-rural California.  In case anyone else here lives in a CA city and has Medicare.  Seems we have a large AZ contingent here and the rest of you are all over the map, perhaps enjoying some winter weather.

Remember2Breathe


.docx   MEDICARE APPROVED AMOUNT DME 2021 NonRuralCA.docx (Size: 136.61 KB / Downloads: 4)
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#14
RE: DME and Medicare
You can post non-commercial links to your heart's content. Links relevant to healthcare and Medicare are always welcome to help members.
Sleeprider
Apnea Board Moderator
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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.
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