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IS THIS REPORTABLE FRAUD?
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srlevine1 Offline

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Posts: 229
Joined: Sep 2015

Machine: ResMed Airsense Autoset (S10)
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: Internal to S10
CPAP Pressure: 12-15.6
CPAP Software: ResScan SleepyHead Other Software

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Sex: Male
Location: Westlake Village, California USA

Post: #11
RE: IS THIS REPORTABLE FRAUD?
(08-23-2016 06:57 PM)justMongo Wrote:  Didn't you mention that your DME lost it's medicare contract? Perhaps the machine is grandfathered in if you took possession prior to 01 July 2016.

Yes, my machine was delivered on March 21, 2016 and I did receive notification that my account was grandfathered until the machine became my property.

I was wondering if I should establish an account with the Medicare-approved vendor now and use it for supplies to keep everything flowing? Great timing because my DME just called me from the Philippines to "remind me" that my supply order was due and that they would be pleased to take the order while I was on the line.

And, while you are writing letters, don't forget to cc Ezekiel (aka E-Z KILL) Emanuel for his efforts in theoretically justifying denials, delays, and death panels.

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
08-24-2016 01:03 AM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #12
RE: IS THIS REPORTABLE FRAUD?
Q: How should an integrated device be billed since it has only one serial number?

The provider should enter the same serial number for both the CPAP (E0601) line item and the humidifier (E0562) line item. These items are still separately billable and the same serial number is used for both line items. For billing software that asks for two separate serial numbers/ codes for the humidifier and PAP device, the provider may choose to add an “H” to the end of the humidifier‘s serial number to differentiate between the two components. http://www.resmed.com/us/dam/documents/a...gories.pdf
08-24-2016 01:15 AM
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justMongo Offline

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Posts: 3,853
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: #13
RE: IS THIS REPORTABLE FRAUD?
(08-24-2016 01:03 AM)srlevine1 Wrote:  I was wondering if I should establish an account with the Medicare-approved vendor now and use it for supplies to keep everything flowing?

Yes. It may take you a while to get that setup. The remaining ones don't have the phone capacity for all the transferring patients. Plus, they seem to be leaving it up to the patient to get all the documents to them.

Add to that, the fact that I will be limiting the scope of medical information to they may disclose and for what purpose; and they may just reject it. (Although I doubt it, if one is specific as to type and purpose.)

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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.
08-24-2016 07:03 AM
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Marthajoy7 Offline

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Posts: 67
Joined: Jun 2015

Machine: aircurve 10 auto set to bipap S mode
Mask Type: Full face mask
Mask Make & Model: resmed mirage full face or Clear view full mask
Humidifier: Resmed built in humidifier
CPAP Pressure: 18.4/12 clearview or 18/13 mir
CPAP Software: ResScan SleepyHead

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Sex: Female
Location: Seattle

Post: #14
RE: IS THIS REPORTABLE FRAUD?
It looks from the above statement, that the s10 is rented but the humidifier is purchased. Then why did I need to return the humidifier part when I upgraded from cpap to bipap?
08-24-2016 12:40 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: #15
RE: IS THIS REPORTABLE FRAUD?
If I remember correctly, Medicare does not pay rent on the humidifier, only the Cpap. They usually purchase the humidifier and that's why the billed charge is higher for the humidifier.

OpalRose
(This post was last modified: 08-24-2016 12:54 PM by OpalRose.)
08-24-2016 12:49 PM
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kwhenrykerr Offline
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Posts: 245
Joined: May 2016

Machine: DreamStation Auto, AirSense 10 Auto
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Philips, AirSense 10
CPAP Pressure: 12-20
CPAP Software: SleepyHead

Other Comments: 2L added oxygen with CMS50F to check usage

Sex: Male
Location: Florida

Post: #16
RE: IS THIS REPORTABLE FRAUD?
(08-24-2016 12:49 PM)OpalRose Wrote:  If I remember correctly, Medicare does not pay rent on the humidifier, only the Cpap. They usually purchase the humidifier and that's why the billed charge is higher for the humidifier.

So it could be resold ? Thinking-about
Double your pleasure
Double your fun
Chew Doublemint Gum
Or sell the same thing two times

Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
08-24-2016 02:25 PM
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OpalRose Offline

Monitors

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: #17
RE: IS THIS REPORTABLE FRAUD?
(08-24-2016 02:25 PM)kwhenrykerr Wrote:  
(08-24-2016 12:49 PM)OpalRose Wrote:  If I remember correctly, Medicare does not pay rent on the humidifier, only the Cpap. They usually purchase the humidifier and that's why the billed charge is higher for the humidifier.

So it could be resold ? Thinking-about
Double your pleasure
Double your fun
Chew Doublemint Gum
Or sell the same thing two times

According to Medicare, they pay outright for the humidifier, usually within that first 3 month period. It is yours, you shouldn't have to return it.

Rental on machines continues until the 13th month has been reached.

And I don't put anything past a DME.

OpalRose
(This post was last modified: 08-24-2016 03:02 PM by OpalRose.)
08-24-2016 03:01 PM
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robertbuckley Offline

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Posts: 99
Joined: Mar 2013

Machine: Resprionics BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F-10 Full Face
Humidifier: Resprionics System One
CPAP Pressure: EEP 15; PS 4 - 10
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: New York, NY

Post: #18
RE: IS THIS REPORTABLE FRAUD?
xPaps are "rented" - i.e. sold to you - with payments over a 13 month period. The humidifier is a one time thing.
xPaps and humidifiers were separate units until recently, and not everyone got/received a humidifier. In fact for those of us old enough, we remember when you would choose between no humidifier, a passive Passover humidifier, and a heated humidifier. Thus the separate codes.
Think of it this way - In 1957 you bought your new '57 Chevy, which did not come with factory air, added an after sale A/C (remember those? sat on the transmission hump under the dash) and you then totaled the Chevy on a levy driving through Louisiana. You would put in an insurance claim for the Chevy and for the A/C separately. The health insurance industry has not progressed much since 1957, except they have refined the ability to say no.
08-26-2016 03:13 PM
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kwhenrykerr Offline
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Advisory Members

Posts: 245
Joined: May 2016

Machine: DreamStation Auto, AirSense 10 Auto
Mask Type: Full face mask
Mask Make & Model: Amara View
Humidifier: Philips, AirSense 10
CPAP Pressure: 12-20
CPAP Software: SleepyHead

Other Comments: 2L added oxygen with CMS50F to check usage

Sex: Male
Location: Florida

Post: #19
RE: IS THIS REPORTABLE FRAUD?
Say no and delay till you die. They are not in business to pay out. That job is taken by taxpayers...

Just my personal opinion. My posts are not medical advice or a statement of fact. Please consult a qualified physician or other qualified medical personnel. Please comply with all applicable laws, codes, regulations, and protocols.
08-26-2016 06:16 PM
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pupcamper Offline

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Posts: 401
Joined: Nov 2015

Machine: PR DreamStation CPAP Pro
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 Pillows; Quatro Air FFM
Humidifier: DreamStation Heated Humidifier
CPAP Pressure: 10.5 cmH2O; no ramp; no C-Flex
CPAP Software: SleepyHead EncorePro

Other Comments: Lung cancer survivor since 11/2004; CPAP since 11/2015

Sex: Male
Location: Van Buren, Arkansas, USA.

Post: #20
RE: IS THIS REPORTABLE FRAUD?
(08-26-2016 06:16 PM)kwhenrykerr Wrote:  Say no and delay till you die. They are not in business to pay out. That job is taken by taxpayers...

like

"....respiration,—a troublesome practice, but one which custom has rendered necessary to our easy existence...." Oliver Twist, Charles Dickens- 1837

I use FlashPAP to load data from a FlashAir III wifi sd card in my machine to my computer and display it with SleepyHead .
robysue's Beginner's Guide to SleepyHead
08-26-2016 06:24 PM
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