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Medicare Coverage
#1
If i change my pressure setting, will my resmed air 10 notify Medicare via its automatic transference of compliance data?
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#2
G'day Doug, welcome to Apnea Board.

The consensus seems to be that the communication is mainly just used by your DME to certify compliance (ie that you're actually using the thing) so that they get paid. The DME will want to see the hours used, and won't be interested in pressures unless they are unusually conscientious.

In any case, there's no law against adjusting your pressure if you feel that will improve your clinical outcomes.
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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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#3
Medicare requirements for compliance have 2 parts:
1. Medicare insurance compliance is the measurement of how much you use your xPAP machine and if it is working for you. As far as Medicare is concerned, you are not compliant unless you are using your machine at least 4 hours each night for 70% of the nights. So, if you use your machine 22 days out of 30 for at least 4 hours a night you are compliant. If you use your machine for 3 hours, 59 minutes, and 59 seconds, well, that night you did not use it enough so you were noncompliant.
I think that applies for the first 90 days of use, but I could be wrong about that.

2. That a doctor signs off that yes, the therapy is helping you. This is one good reason for having both a diagnosis with a sleep lab, and, a further test using xPAP equipment, to show that it does have an effect. This is especially true if you have not been diagnosed before, or if you want a new machine after 5 years and have a new doctor who doesn't know your past history.

When I first started, I was told that one reason for the compliance requirements was that when things were kind of new with SA, some people were getting Medicare to provide a machine, then turning around and selling it instead of using it for themselves.

Medicare is not trying to practice medicine by caring one whit about the details of your settings. They only want to know that you're actually using the therapy and that according to a doctor, it's helping you.





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#4
Hi dougwidman,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you with your CPAP therapy.
trish6hundred
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#5
simple answer No settings do not make any difference to Medicare
For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/dire...onal/SHIP/
or here http://www.medicareinteractive.org/
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#6
(05-10-2015, 06:15 PM)dougwidman Wrote: If i change my pressure setting, will my resmed air 10 notify Medicare via its automatic transference of compliance data?


No, Medicare only cares that you are compliant, which means using your CPAP at least 4 hours a day for 30 consecutive days within the first 90 days.
That's how it was explained to me, although I've heard some quote 21 days.



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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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