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Medicare compliance
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Eleong2 Offline

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Posts: 60
Joined: Dec 2013

Machine: Respironics System One DS460 and Transcend EZEX CPAP
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Activa LT
Humidifier: Respironics System One DS6
CPAP Pressure: 12
CPAP Software: SleepyHead Other Software

Other Comments: Moderate to severe Sleep Apnea, started treatment Nov 13, 2013

Sex: Male
Location: Alhambra, CA

Post: #11
RE: Medicare compliance
(02-25-2014 04:54 PM)mjbearit Wrote:  Not to over simplify things, but when I go to bed at night, every night, I take my meds, put on my mask (my machine comes on automatically), turn off the light and go to sleep. In the morning I wake up, take off my mask, turn off my machine, get out of bed. That is 100% compliance and that is the most beneficial way to use a CPAP machine. I have data going back 603 days for this machine and I have 100% compliance for 603 days. On the downside, I am so used to the machine that is the power goes out I am awake within a minute or so and I can't go back to sleep until I get power!
Mike

I am not on Medicare (yet), I have a few more years to get there. It seems like the compliance requirement is similar for regular ins. I made my 90 days with 100% compliance a couple weeks ago and got a call from the provider saying the machine is mine. I am posting a little off topic, but I wanted to comment on what mjbearit said in his post about not being able sleep if the machine was off. I find that I cannot get to sleep if I am not hooked up and the machine is running. The sound of the machine lulls me to sleep within 15 minutes. Curious to know if others have the same issue with CPAP.

Sorry for going off topic
Ed
02-26-2014 10:28 PM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #12
RE: Medicare compliance
I could probably go to sleep without my machine but I won't ever test it to see. My machine is one of my security items, at least while I am sleeping. I usually fall asleep right away unless I am trying to sleep on my side and for some reason, I can't fall asleep on my side and I wish I could b/c that is my preferred way to sleep.

EDIT: Some members are not on medicare b/c of age but because of disabilities.
(This post was last modified: 02-27-2014 12:27 AM by me50.)
02-27-2014 12:25 AM
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Doc J Offline

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Posts: 199
Joined: Dec 2013

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed AirFit P10
Humidifier: resMed H5i Dumped and dry daily
CPAP Pressure: 10-15
CPAP Software: ResScan SleepyHead

Other Comments: Knowledge is King and this is the place to find it! Thanks everyone.

Sex: Male
Location: Central Nebraska

Post: #13
RE: Medicare compliance
I also don't do without as I have documented proof what a mess that is. Lucky for me I took to cpap well and since changing to nasal pillows I don't mind at all. I'm 10 months in and near 100% use. When the DME said they had to check compliance for insurance I tossed it down and said "what's the record". All they would say is I was well within compliance.
On the use of ups backup systems the problem with them is by the time you need them the battery is cooked from sitting and charging. Maybe they have done something with that, or at least your doing something. I'm still gonna rig a system using a deep cycle boat battery for camping that I could use if power was off for too long. At least then I can keep a good battery for the little fishing boat not just sitting there.
02-27-2014 12:41 AM
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archangle Offline
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Posts: 3,159
Joined: Feb 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed S9 H5i
CPAP Pressure: 16-20
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments: Happy PAPper

Sex: Undisclosed
Location: USA

Post: #14
RE: Medicare compliance
As with most insurance things, you never know for sure what the answer is, but almost always, if there's a compliance requirement, it's in the first 30 to 90 days and insurance doesn't check up on you after that.

However, if you have a good doctor, he will check your data regularly and at least warn you if you're not using it enough.

If the DME threatens you with compliance requirements after the initial 30-90 day requirement, he's probably wrong.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
02-27-2014 02:40 AM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #15
RE: Medicare compliance
I was able to opt out of the sleep program. My doctor sent the insurance company a note and I was not subject to compliance monitoring or the rental process. The machine was treated as a straight purchase and was mine from day one. I'm lucky that I was able to use it and had good results right away so I use it every night.

BTW, at least 30 people told me that it HAD to be treated as a rental with compliance monitoring. I kept asking until I found someone that knew about opting out.
02-27-2014 10:19 AM
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Eleong2 Offline

Preferred Members

Posts: 60
Joined: Dec 2013

Machine: Respironics System One DS460 and Transcend EZEX CPAP
Mask Type: Nasal mask
Mask Make & Model: Resmed Mirage Activa LT
Humidifier: Respironics System One DS6
CPAP Pressure: 12
CPAP Software: SleepyHead Other Software

Other Comments: Moderate to severe Sleep Apnea, started treatment Nov 13, 2013

Sex: Male
Location: Alhambra, CA

Post: #16
RE: Medicare compliance
(02-27-2014 10:19 AM)JohnNJ Wrote:  I was able to opt out of the sleep program. My doctor sent the insurance company a note and I was not subject to compliance monitoring or the rental process. The machine was treated as a straight purchase and was mine from day one. I'm lucky that I was able to use it and had good results right away so I use it every night.

BTW, at least 30 people told me that it HAD to be treated as a rental with compliance monitoring. I kept asking until I found someone that knew about opting out.

I was told it was a rental for 90 days and compliance is > 4 hours 70 % of those days. First week was tough, now it rocks me to sleep, can't sleep without it.
Ed
(02-27-2014 10:53 AM)Eleong2 Wrote:  
(02-27-2014 10:19 AM)JohnNJ Wrote:  I was able to opt out of the sleep program. My doctor sent the insurance company a note and I was not subject to compliance monitoring or the rental process. The machine was treated as a straight purchase and was mine from day one. I'm lucky that I was able to use it and had good results right away so I use it every night.

BTW, at least 30 people told me that it HAD to be treated as a rental with compliance monitoring. I kept asking until I found someone that knew about opting out.

I was told it was a rental for 90 days and compliance is > 4 hours 70 % of those days. First week was tough, now it rocks me to sleep, can't sleep without it.
Ed

Forgot to mention, the Dr. ordered a wireless modem to keep track of me for the 90 day period.
Ed
(This post was last modified: 02-27-2014 10:56 AM by Eleong2.)
02-27-2014 10:53 AM
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me50 Offline

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Posts: 2,559
Joined: Aug 2013

Machine: resmed S9 VPAP Auto
Mask Type: Nasal mask
Mask Make & Model: Wisp and Silicone Head gear
Humidifier: resmed H5i
CPAP Pressure: 18/8
CPAP Software: SleepyHead

Other Comments:

Sex: Undisclosed
Location: USA

Post: #17
RE: Medicare compliance
(02-27-2014 10:19 AM)JohnNJ Wrote:  I was able to opt out of the sleep program. My doctor sent the insurance company a note and I was not subject to compliance monitoring or the rental process. The machine was treated as a straight purchase and was mine from day one. I'm lucky that I was able to use it and had good results right away so I use it every night.

BTW, at least 30 people told me that it HAD to be treated as a rental with compliance monitoring. I kept asking until I found someone that knew about opting out.

That is how it worked for me with my first machine. Medicare is different though and my insurance company wants to rent it for 13 months.
02-27-2014 11:54 AM
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #18
RE: Medicare compliance
(02-24-2014 04:46 PM)DNB128 Wrote:  Kristen and Peter C,

70% of the days used must be greater than 4 hours for Medicare compliance.

Am not worried so much about compliance, more so all the other gibber-goo and hoops we must go through.

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
02-27-2014 02:50 PM
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cbramsey Offline

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Posts: 900
Joined: Mar 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: ResMed H5i with ClimateLine
CPAP Pressure: 6 - 12
CPAP Software: ResScan

Other Comments: Supreme Overlord of Web Darkness

Sex: Male
Location: NC, USA

Post: #19
RE: Medicare compliance
I can second what others have said about the first 90 days being the "compliance period". Medicare requires that you use the XPAP greater than 70% of the days greater than 4 hours a night.

I was also told by my sleep doc that a visit to the doc was required under Medicare annually.

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.
02-27-2014 07:41 PM
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JJJ Offline

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Posts: 751
Joined: Apr 2012

Machine: ResMed S9 Autoset
Mask Type: Nasal mask
Mask Make & Model: Most recent: Wisp, Pilairo, Mirage Vista
Humidifier: ResMed S9 Autoset
CPAP Pressure: 17-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: USA 97217

Post: #20
RE: Medicare compliance
(02-27-2014 07:41 PM)cbramsey Wrote:  I can second what others have said about the first 90 days being the "compliance period". Medicare requires that you use the XPAP greater than 70% of the days greater than 4 hours a night.
I was also told by my sleep doc that a visit to the doc was required under Medicare annually.

I hope no one tells Medicare about me. They have been paying for masks and supplies right along, and I never completed the 90 days (or even 30 days) of compliance testing, and the last time I saw my sleep doc was over a year and a half ago.
02-27-2014 07:56 PM
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