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DME rental charges....
RE: DME rental charges....
(05-14-2021, 03:30 PM)sheepless Wrote: it's a loophole used at our expense that will continue until enough people complain. my experience here:


Thank for sharing your experience... I feel your pain....

Most private insurances closely follow Medicare guidelines, including approved amount, more or less, so do DMEs. They are not wrong stating, that "they're charging everything correctly." As such, one could cynically state, that private healthinsurance companies paying the same rates for proceedures, DMEs, etc., except the monthly premiums for the insurance is multiple times of the current Medicare premiums. Especially, when the deductibles, out of network, etc., are taken into account. One of the reasons why I am very happy with my Medicare coverage, less than 200 bucks deductible is awesome... [Image: wink.gif] [Image: thumbsup.gif]

Contesting the DME charges is not going to go anywhere, this needs to be addressed with Medicare.

After further review of Medicare codes...

Medicare had established a new HCPCS code of E0467 for multi-function respiratory devices on 01.01.2019; short description of the code:

"Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components and supplies for all functions"

The interpretation for "also performs any or all" is questionable, but in my view, the the code E0467 should cover the ResMed A10 CPAP machine and others with integrated humidifier.

The Medicare Learning Network has released the MM10854, that includes the HCPCS code of E0601:, quote:

"Continuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) and related accessories (HCPCS codes E0601, E0470, E0471, E0472, A4604, A7027, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, and E0562)"

I am not certain as to why the Medicare Admistrative Contractors (MACs) had not adjusted their billing software as of yet? Maybe nobody asked them to, the DME is not specifying the model#, or insurance companies and DMEs argued against billing via the E0467.  In either case, this will be included in my Medicare complaint...
"Life is dream, awakening is death..."
- Chinese proverb
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RE: DME rental charges....
I called Medicare once to report my DME and they weren’t very interested. I kind of felt like they wanted me to get of the phone. LOL
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