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Medicare DME Help Urgently Needed.
#1
Medicare DME Help Urgently Needed.
Medicare DME Help Urgently Needed.


I obtained a new ResMed BiPap ST two years ago based on a May 2017 sleep study.   Complex apnea was being satisfactory treated for several months.

Following general anesthesia last year the apnea and AHI increase markedly (250%) and has been very unsatisfactory since.  Due to significant and substantial increase in AHI a new sleep study was done one  week ago.  As a result of that sleep study an order has been issued for an ASV machine.

Both BiPap ST and ASV machines fall under Medicare code E0471 - RAD or respiratory assist devices.  According to the DME vendor normal replacement cycle is 5 years.  My BiPap ST is 2 years old.

Sometime in the distant past I recall reading on this Apnea Board that Medicare will move replacement dates forward if there is a substantial change in sleep study or health findings.   I have not found this in formation covered in the Apnea Board WiKi.

I need help from someone
knowledgeable who can direct me to the pertinent regulation or documentation that I can rely on to pursue this.   The local DME does not appear "up to speed" on this issue.   It is very important to me.

Thanks in advance,  c! / biz1219
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#2
RE: Medicare DME Help Urgently Needed.
I've been following your progress. I'm glad that there were no underlying lung issues that need a fixed backup rate and the leaks are getting under control. I'm unable to help with your current question, but I'm sure there will be sound advice on how to go about getting your doctor to script the need.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: Medicare DME Help Urgently Needed.
I am still very interested in confirming the Medicare situation involving a need to upgrade a BiPap RAD code E0471 machine within less than five years of when it was originally supplied or put into service.

The urgency of my request was reduced today.  Today the DME advised that subsequent to when they originally contacted me they have arranged to deliver a new ASV machine exchanging it for the BiPap ST I currently have.   Originally they said the new ASV machine would not be approved by Medicare and I would have to pay for it.  So it is a relief to learn that the DME will make the exchange.

As everyone should recognize that is a significant savings.   I believe that both my pulmonologist and the sleep lab Director were hard a work to bring this about; for which I am very thankful.

c!
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#4
RE: Medicare DME Help Urgently Needed.
biz1219,

Congrats on the progress towards the ASV. My understanding is that if/when medical requirements for DME changes, coverage for that is typically granted and covered if your doctor will issue an updated script and will have to create patient records notation that it’s a medical necessity to change equipment. Documentation needs to be clear and specific as to what and why it needs to be changed. Without knowing your specifics, it sounds like that is what occurred on your behalf via doctors and others.

Coffee
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Medicare DME Help Urgently Needed.
Hi Dave,  That is also my understanding but I'd sure like to see that in some sort of documentation for future backup.   

The situation here was that both a BiPap ST and an ASV are coded the same by Medicare - that they are M0471 respiratory assist devices.

Anyway, I'm thankful this is working out satisfactorily.   I am anticipating much better sleep Monday night and afterwards.

Thanks for your comments,  Clif
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