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Does Medicare Require a Yearly Visit with Sleep Doctor?
#1
Does Medicare Require a Yearly Visit with Sleep Doctor?
My sleep doc said I need to check in once a year--Medicare guidelines.  I see him next month--trying to get him to sign off on my medical release so I don't have to deal with the Dept. of Motor Vehicles anymore.  He said last year he needed to see me anyway and left my recertification at 12 months.  Need some ammunition to convince him!  I have 100% compliance for 2.5 years, last years AHI under 1.0, currently 30 day AHI 0.3, thanks to the help gained on this forum.  No more sleepy driving!
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#2
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
when the doctor (re)certifies you he is assuming responsibility against his medical license and financial well-being. instead of trying to convince him to do something different, talk to him and see why he does what he does.
First Diagnosed July 1990

MSgt (E-7) USAF (Medic)
Retired 1968-1990
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#3
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
Thank you. Last year he smilingly said it was because I had to come in anyway for Medicare.we'll see this year.
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#4
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
Medicare does not require a yearly visit. Why would they? The machine is paid for by then. Or has just a month left. I've not seen my sleep doc in...wow, I guess 8 yrs? Ten? My GP writes my once-every-six-years script for the machine and gear. I have Medicare and Medicaid.
PaulaO

Take a deep breath and count to zen.




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#5
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
Thanks, Paula--that's what I thought. Tried called Medicare but was on forever hold and gave up!
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#6
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
Your primary doctor can assume all of your CPAP care. Although this is not required for Medicare, it can be helpful to have an annual discussion as part of your wellness exam, and you can even drop a compliance report for the past year for him to add to your records. What keeps your Medicare account active is the continued ordering of supplies and mask replacements through your DME. Once you have a machine, Medicare is not going to take it away. Having copies of past sleep reports, and an ongoing medical record in the form of an annual discussion with your primary doctor is more than enough to avoid hassles when you need to replace the machine. I have not seen a sleep doctor since 2008. This sounds like someone looking to make work.
Sleeprider
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#7
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
if you have a CDL license you will need to verify cpap compliance every year at your physical... but medicare doesn't care once your initial compliance is met. If this is the dr. you use for supplies then he will want to see you each year before blindly giving out prescriptions.
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#8
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
What is it you are trying to get him to do?
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#9
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
I sympathize but certification is a different issue entirely from Medicare requirements. So long as I don't need a machine paid for by Medicare, my primary signs off on my supplies. If I needed a machine, then I have to see the sleep doc. Presuming Oregon law has not changed, a valid prescription for a non-controlled substance is valid for 2 years. You could call the DME and find out. If that is covered for two years, then ask your doc to instead schedule every other year. The best argument I know of is that you pay out of pocket so you don't want to have unnecessary visits. However, like I said, certification is a different ball of wax.
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#10
RE: Does Medicare Require a Yearly Visit with Sleep Doctor?
I just had my second sleep study in 18 years, and only because my PCP changed practice and the group he previously belonged to lost my original sleep study (probably because it was never digitized) and the sleep clinic moved and destroyed all their old records (grrrr!).  Needed the study only because it was time for Medicare to pick up the tab on a new machine.  BTW, an 18+ year old study was fine with them.  I had asked my PCP a couple of times whether it was time for a new sleep study and his response was, "Why?".  I have been keeping him appraised of my usage for the past 8-1/2 years with reports from ResMed's software and, more recently, SleepyHead.  The reports show annual average AHI is 0.61 and, most importantly. my Obstructive Index is 0.06.  No wonder he asked "Why?".  The new study confirmed that I continue to have severe obstructive apnea with life-threatening blood oxygen levels, but I am a diligent and fully compliant patient who really doesn't want a heart attack (like friends who "couldn't get used to the damn mask".

As others have stated, my PCP provides necessary scripts when I need to order new equipment.  Took a week for my PCP to get the sleep study.  Took him 15 minutes to send me a copy.  No need to wait 2 weeks for an appointment with the sleep doc.  Don't need no stinkin' sleep doc!   Wish Medicare would just reimburse me for an online equipment purchase so that I could avoid the DMEs too.  First Medicare approved provider sat on my script for 3 whole weeks and never did anything,  Second one took 5 business days to order my machine.  Will tell me when it comes in.  Given the hassle, you'll understand why I paid out-of-pocket for my last 3 machines and 18 years worth of masks.
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