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Medicare compliance - 21 or 30 days?
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MAPnea Online

Advisory Members

Posts: 182
Joined: May 2013

Machine: ResMed S9 AutoSet - currently "set" on CPAP mode
Mask Type: Other
Mask Make & Model: ResMed AirFit F10 and P10 - varies
Humidifier: ResMed H5i
CPAP Pressure: 8
CPAP Software: SleepyHead

Other Comments: New Sleep Doc + New DME = Trying new approach to PAP therapy.

Sex: Female
Location: near Great Basin National Park, Nevada

Post: #1
Medicare compliance - 21 or 30 days?
New DME Lady came out yesterday with a new ResMed S9 AutoSet and "we" set it up like my old ResMed S9 AutoSet. Only one difference. I'm now on CPAP mode with a pressure setting of "9". When new DME Lady leaves she says, "Return your memory card to me in this envelop on August 8th…" so she can check it for Medicare compliance (using machine at least 4 hours a day, 70% of the time).

When I did this two years ago I sent the card back to the old DME after 30 days, not 21 days. I checked online for Medicare compliance requirements and find "30 days", so I called the DME Lady back and she said, "No, it's only 21 days."

Has this requirement changed in the past two years from 30 days to 21 days? Can any verify the 21 days for Medicare compliance?

Thanks
07-19-2014 06:46 PM
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retired_guy Offline

Preferred Members-2

Posts: 2,744
Joined: Jan 2014

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: ResMed
CPAP Pressure: 10.6/14, EPR 3
CPAP Software: ResScan SleepyHead

Other Comments: Is it bedtime yet?

Sex: Male
Location: Beautiful, albeit very wet Oregon Coast

Post: #2
RE: Medicare compliance - 21 or 30 days?
30 days time .70 equals 21 days.

So she's figuring you'll use it the full 21 days and she can qualify you early, and get paid a little earlier.
07-19-2014 06:52 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,057
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: Medicare compliance - 21 or 30 days?
I couldn't find anything except some spam sites wanting me to click their links.

Call another DME and ask them. I'm interested in how long it is now. I need to call mine on Monday and I'll ask then, too.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
07-19-2014 06:56 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: Medicare compliance - 21 or 30 days?
The DME lady got her facts wrong
30 days of compliance ... 4 hours per night on 70% of nights during the first 30 days = 21 days
07-19-2014 07:00 PM
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MAPnea Online

Advisory Members

Posts: 182
Joined: May 2013

Machine: ResMed S9 AutoSet - currently "set" on CPAP mode
Mask Type: Other
Mask Make & Model: ResMed AirFit F10 and P10 - varies
Humidifier: ResMed H5i
CPAP Pressure: 8
CPAP Software: SleepyHead

Other Comments: New Sleep Doc + New DME = Trying new approach to PAP therapy.

Sex: Female
Location: near Great Basin National Park, Nevada

Post: #5
RE: Medicare compliance - 21 or 30 days?
Thanks, retired_guy, PaulaO2 and zonk,

THAT's what she's doing. She asked me if I thought I would use my CPAP every night. Well, dah? Of course. So that's why she's going to read my card after 21 days. Get paid earlier. And I'm "up" for that, too.

Big Grin
07-19-2014 07:27 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #6
RE: Medicare compliance - 21 or 30 days?
From USA Medicare document dated Sept 2013:

The treating physician must perform a clinical re-evaluation after the 31st day, but before the 91st day after initiating therapy, which documents the following:
• A face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of OSA are improved; and
• Objective evidence of adherence to use (defined as use of PAP devices for 4 or more hours per night on 70% of nights during a consecutive 30-day period anytime during the first 3 months of initial use) of the PAP device, reviewed by the treating physician.

http://www.cms.gov/Outreach-and-Educatio...905064.pdf

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 07-19-2014 08:00 PM by vsheline.)
07-19-2014 07:59 PM
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trish6hundred Offline

Advisory Members

Posts: 6,424
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: #7
RE: Medicare compliance - 21 or 30 days?
(07-19-2014 07:27 PM)MAPnea Wrote:  Thanks, retired_guy, PaulaO2 and zonk,

THAT's what she's doing. She asked me if I thought I would use my CPAP every night. Well, dah? Of course. So that's why she's going to read my card after 21 days. Get paid earlier. And I'm "up" for that, too.

Big Grin
Hi MAPnea,
I don't blame you, the sooner she gets paid, the better it will be for you.
Glad to hear that you got an S9Autoset, I know that was a concern for you a while back, CONGRATULATIONS.

trish6hundred
07-19-2014 08:08 PM
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MAPnea Online

Advisory Members

Posts: 182
Joined: May 2013

Machine: ResMed S9 AutoSet - currently "set" on CPAP mode
Mask Type: Other
Mask Make & Model: ResMed AirFit F10 and P10 - varies
Humidifier: ResMed H5i
CPAP Pressure: 8
CPAP Software: SleepyHead

Other Comments: New Sleep Doc + New DME = Trying new approach to PAP therapy.

Sex: Female
Location: near Great Basin National Park, Nevada

Post: #8
RE: Medicare compliance - 21 or 30 days?
Hi, vsheline and trish6hundred,

I already have an appointment with my sleep doc toward the end of September and I have no fear that I'll qualify because the ONLY reason I wouldn't sleep with my PAP machine is when the electricity goes out or I'm so sick I just can't "get it together". That's only happened two nights in 22 months.

Yes, THANKS to everyone on this Board who encouraged me to STAND UP for myself and get exactly what I wanted. Which, of course, was the ResMed S9 AutoSet. I'm "dealing" with the old DME for a good price on my old S9 AutoSet. Would be nice to have two of them. And I love my new Nuance Pro. Next mask I'm going to try will be the ResMed AirFit F10 because I like having a "back up" full face mask.

I feel so empowered - and getting stronger - because of all the encouragement I've gotten here.


I-love-Apnea-Board
07-19-2014 10:12 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,057
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #9
RE: Medicare compliance - 21 or 30 days?
Glad we could help. And glad you are sticking around to pass that along to others.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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.
07-19-2014 10:28 PM
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DNB128 Offline

Preferred Members

Posts: 37
Joined: Feb 2014

Machine: Resperonics System One A-flex
Mask Type: Full face mask
Mask Make & Model: AirFit F10
Humidifier: Resperonics System One
CPAP Pressure: 9-18
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location: Rochester, MN

Post: #10
RE: Medicare compliance - 21 or 30 days?
(07-19-2014 10:12 PM)MAPnea Wrote:  Next mask I'm going to try will be the ResMed AirFit F10 because I like having a "back up" full face mask.

I purchased an AirFit F10 a while back, and it has become my primary mask... Quattro Air is now my backup. They both use the same cushion. I switched the F10 to primary because it doesn't have the forehead arm and strap around my forehead... I feel so free without that particular headgear strap.
07-24-2014 08:16 PM
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