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Medicare Coverage
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dougwidman Offline

Members

Posts: 4
Joined: May 2015

Machine: resmed air10
Mask Type: Full face mask
Mask Make & Model: F&P simplus
Humidifier: unsure
CPAP Pressure: 16
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #1
Medicare Coverage
If i change my pressure setting, will my resmed air 10 notify Medicare via its automatic transference of compliance data?
05-10-2015 06:15 PM
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DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,296
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: #2
RE: Medicare Coverage
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.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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05-10-2015 08:03 PM
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AirSign Offline

Preferred Members

Posts: 85
Joined: Mar 2015

Machine: ResMed Airsense A10 for her
Mask Type: Nasal pillows
Mask Make & Model: Nuance / Airfit P10
Humidifier: Airsense A10
CPAP Pressure: 9-16, average under 14
CPAP Software: SleepyHead

Other Comments: Seasons here: Wintah, Mud, Road Repair, Wintah

Sex: Female
Location: Road Repair Season, New England

Post: #3
RE: Medicare Coverage
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.
05-10-2015 08:17 PM
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trish6hundred Offline

Advisory Members

Posts: 6,450
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #4
RE: Medicare Coverage
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
05-10-2015 08:42 PM
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Mike1953 Offline

Preferred Members-2

Posts: 134
Joined: Aug 2014

Machine: Resmed S9 Escape Auto
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Resmed Hi5
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Kansas USA

Post: #5
RE: Medicare Coverage
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/directories/National/SHIP/
or here http://www.medicareinteractive.org/
05-10-2015 09:04 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: #6
RE: Medicare Coverage
(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.

OpalRose
05-11-2015 07:24 AM
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