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MEDICARE RULE QUESTION
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MobileBasset Offline

Advisory Members

Posts: 198
Joined: May 2015

Machine: ResMed AIRCURVE 10 V Auto
Mask Type: Nasal mask
Mask Make & Model: Fisher Paykel Zest
Humidifier: Integrated
CPAP Pressure: 10 (minE 6,maxI 12, PS 3)
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Female
Location: Florida

Post: #11
RE: MEDICARE RULE QUESTION
(06-27-2015 03:31 PM)ROSIE Wrote:  
(06-27-2015 03:23 PM)MobileBasset Wrote:  When I changed from a CPAP to Bilevel under Medicare, my experience was that the DME claimed they needed a sleep test report with results that met the accepted protocol for prescribing a Bilevel. They also needed the doctors notes before the sleep test, and the sleep test had to meet the required duration for both the first test and the titration. Also they needed an official prescription form signed by the doctor. The DME submitted this package to Medicare for approval. It took 8 weeks for DME & Sleep Dr to organize the package and 1 week for Medicare to approve it.

*****************
Thanks for the reply. You say Medicare "approved it" in 1 week. Does that mean they did not require the re-evaluation after 30 days for adherence to the therapy? Or is changing a PAP unit a 2 step process. Approval to change and then compliance?
To clarify, I didn't say a "new" sleep study was required, just a sleep study with results supporting the Bilevel script. It would seem that since you doctor thinks you need it, there are results that support it. In my case it had been years since my previous study and it was with a different doctor.

And yes, I still need an additional Dr visit to verify compliance with my new machine.

if you can't decide then you don't have enough data.
06-28-2015 09:32 AM
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ROSIE Offline

Members

Posts: 18
Joined: Feb 2015

Machine: ResMed Air Sense 10 Auto Set
Mask Type: Nasal pillows
Mask Make & Model: Resmed AirFit P10
Humidifier: ResMed Air Fit 10
CPAP Pressure: 9 to 12
CPAP Software: Not using software

Other Comments:

Sex: Male
Location: San Francisco

Post: #12
RE: MEDICARE RULE QUESTION
(06-28-2015 12:21 AM)me50 Wrote:  if you have central or complex apnea, you don't need a vpap machine.....you need an asv machine. There are things that can cause central apnea that are not really a dx of central apnea.

Thanks ...Reading the ResMed specifications, I agree ASV is the unit focused on Central. My doctor ordered a VPAP unit in his prescription. DME said sleep study needed. I see the doctor in a week and trying to sort out the pieces prior to visit as doctors are not focused on the insurance aspects. Having Medicare accept payment just adds to the stew pot.
06-28-2015 09:39 AM
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richb Online

Advisory Members

Posts: 543
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #13
RE: MEDICARE RULE QUESTION
Did you have CAs during your original sleep study? If you had HAs your machine might be causing the CAs. Therefore going to an ASV machine will be treating a side effect of the treatment rather than the underlying problem. The original Problem identified during the sleep study needs to be looked at very closely to see if the original problem was related to Obstructive pre obstructive events. Periodic breathing and CAs are different from Obstructive events and often don't respond to CPAP therapy. Use Sleepyhead to identify the kind of events that you are having.

Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here: http://www.apneaboard.com/wiki/index.php...SleepyHead
06-28-2015 12:25 PM
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DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,297
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #14
RE: MEDICARE RULE QUESTION
Some clarifications...

Central apneas might be present in the original (non-CPAP) sleep study, meaning they are with you all the time. These need an ASV machine to treat. Alternatively, they may be caused by CPAP or APAP treatment. It may be that they will go away on their own, or with judicious tweaking of pressure and pressure relief (EPR oe Flex). On the other hand, some people have treatment induced apneas that don't go away no matter what - in this case you still need the ASV.

The current Resmed ASV machine is the Aircurve 10 ASV. http://www.resmed.com/us/en/consumer/pro...0-asv.html
The recently superseded Resmed ASV machine is the S9 VPAP Adapt. http://www.resmed.com/us/en/consumer/pro...adapt.html

Note that the S9 range has a number of VPAP machines, only one of which is ASV (the Adapt). However the VPAP Adapt was also sold as the S9 Autoset CS-A in some markets.(Just to confuse things). http://www.resmed.com/in/en/commercial-p...-cs-a.html

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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.
06-29-2015 06:56 AM
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