Medicare Denial

[Kidnap]

Agreed that you have a machine that is not new and that was manufactured several years ago and you should get new one.  I base this on the label's date of manufacture, and that you did not receive therapy in 2015 when it was used for 40 days.  

  What I wonder though is about the data shown for the period Fri Oct 21 2016 to  Thu Mar 2 2017  for an Auto CPAP (500X110) set at Min 5 Max 20 (cmH2O).  That looks very much like the day you got your first machine and the settings it was at.  Did the DME transfer the data from that machine to the SD card so that your information was all contained in one place?  I mention it just because when you scream at them you want to be 100% correct and not give them anything to throw back at you.

Thanks to all of you.

 Roberts comment is correct the dates Fri Oct 21 2016 to  Thu Mar 2 2017, were my dates but all of the older dates back to 2015 were not mine as I started on Oct 21 2016. This list just shows the last 5 settings who knows how many more there were.

 I still wonder if I should call Medicare or PA Fraud line first?

Thanks again.

[Sleeprider]

Either one is a good choice, but you could offer them an opportunity to remedy their mistake before you take this action.

It is fraud if it violates section 30 of this CME regulation: https://www.cms.gov/Regulations-and-Guid...104c20.pdf

Note the language infers that you are knowingly accepting used or less expensive equipment and that it was properly invoiced as such to Medicare. I think the DME could lose their contract over this misbehavior, and the "cheap way out" is to dispense the Resmed Aircurve 10 ASV if they are able. If not, let em hang! Go to a reputable DME and at least you will have punished one of the bad guys. At the very least you have "cause" to return this machine. I think letting Medicare have it for prosecution would be immensely satisfying, if they will do it.

[Kidnap]

Thanks Sleeprider

   Maybe giving then a chance would be the easiest way to get the AirCurve.

[robertbuckley]

Enlightened self interest Kidnap!! Get the machine that you want first.

[Kidnap]

Well My Friends

   Round one of my Advacare Fight. To shorten the story. Call 1: I called a lady answered a perky I Advacare I'm LaDeDa how can I help You. I replied that I got my PRS1 AutoSV ADV. on Friday and was having problems. she replied with an Icy What Kind of Problems. I told her that the my software couldn't read the SD Card & it was a  3 1/2 year old used machine. She said "Who said you would get a brand new one?"  I replied "Medicare". She also said " It's probably your software messing up." She said a Sleep Tech would call me.  { my responses will be in ()'s } Later a sleep tech did call and explained it isn't required to give new machines, they often get them back with less than 500 hours on them & recycle them. (This had 950 showing since the last reset. and it is a 2013 model so it probably had a lot of hours before before that.) These machines are very expensive and we're allowed to sell used ones. (I quoted the "Medicare Claims Processing Manual Chapter 20 Sect. 30" that Sleeprider told me about. I said that I should have been told in advance that it was a used unit. Also the Manual gives a reduced payment schedule for used equipment. My receipt says $600.00 a month for 13 months that is $7800.00 dollars for a machine you can buy online for under $4500.00 new.) She said I'll have my boss call you back! Good Bye! They can't stand facts.

Also since I had me sleep study on a PRS1 & that's what the doctor ordered they can't give me a Resmed. What a crock ! ! !

I'm still waiting !

[Sleeprider]

Read this for a boost http://www.apneaboard.com/forums/Thread-...ine?page=5

It can happen.

[Kidnap]

Well Guys & Gals

 The woman from the front office called. Medicare not only doesn't mind them selling used junk but encourages it. The real rent they pay is $278.00 per month for the used machine. I'm defeated !

Thanks to all of you.

[Sleeprider]

Bummer! The only way out is not to accept what you don't want. Still, you were seeing $600/month and the real rate is $238. What a racket that the end-user never even sees a real invoice. Something really wrong here. Anyway, the bottom line is $3094.

It is what it is. Let's do what we can to make it work.

[Kidnap]

Sleeprider

 Yes! I have no other choice.

 So far my AHI numbers are better than the last machine (mostly 15 to 24) but not down enough. The AHI so far is 2.9, 1.0, 10.3, 9.2 & 10.0. That's mostly above the 5.0 mark.  Maybe in time it will go down.

Thanks

[Sleeprider]

Have you been able to see any data yet? What settings are you using?