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Medicare rule? must see doc every 6mo for DME
#1
I just called my DME for supplies. I generally see my doc every 6 months; but, I have over-run the clock by a month.

My DME told me there's a US Medicare rule that I must see my doc every 6 months to get DME under medicare.

Is that true?

edit: Let me ask a second question -- if the above is true, can a general med doctor write the Rx for DME supplies instead of my sleep doc?
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.
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#2
I have never had that info and I have been on medicare since Feb 2013 and I never saw a sleep doc or any other doc for OSA every 6 months. I think your DME is uninformed or just plain wrong
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#3
(02-28-2014, 02:38 PM)me50 Wrote: I have never had that info and I have been on medicare since Feb 2013 and I never saw a sleep doc or any other doc for OSA every 6 months. I think your DME is uninformed or just plain wrong

Actually, I think there is an incestuous relationship between my DME and my sleep doc. When I see him, the DME is right next door; but, I can go though an internal door and be at the DME.

I know my doc gets paid to read their sleep studies.
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.
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#4
(02-28-2014, 03:00 PM)justMongo Wrote:
(02-28-2014, 02:38 PM)me50 Wrote: I have never had that info and I have been on medicare since Feb 2013 and I never saw a sleep doc or any other doc for OSA every 6 months. I think your DME is uninformed or just plain wrong

Actually, I think there is an incestuous relationship between my DME and my sleep doc. When I see him, the DME is right next door; but, I can go though an internal door and be at the DME.

I know my doc gets paid to read their sleep studies.

Yep, I think you got it right! I would call your doc's office, speak to the nurse or medical assistant (most doctors' office don't have a real nurse anymore) and tell them that you need a script for all supplies so you can get them. I wouldn't pay for an appt. just for a script. that is just me though. Hope you get it resolved without having to spend money. Stand your ground!

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#5
I found this -- perhaps this is what they are basing their 6 month visit on:

"Section 6407 of the ACA established a face-to-face encounter requirement for certain items of DME. The law requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME."

I did find that I am in a Medicare competitive bid area; and my DME is on the competitive bid winner list.

@me50: I too find that very few doctors have a real nurse these days. The process for becoming a nurse has become long and difficult. Most doc's employ medical assistants who likely went to a trade school. Some medical assistants are better than others -- in fact some are quite good.
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.
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#6
Hi justMongo,
To answer your other question, From what I have read here on the board, any doc can write a prescription for your supplies, you don't necessarily need to go to a sleep doc.
Hang in there for more answers to your questions.
trish6hundred
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#7
I've been on Medicare since July 2010 and I got my cpap in 2009. I've never heard of the rule where I had to see my sleep doctor every 6 months. When I see my sleep doctor yearly, he downloads my machine's card and then we discuss the results. Since I am 100% compliant he tells me "I only need to see you once a year." This approach by the sleep doctor is fine with me. The farther I stay away from a doctor office, the better I like it. Smile
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#8
That is news to me. I thought an annual visit was all that was required. Need to look into this further. Thanks
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.
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#9
Well, most DMEs consider a 'script' to be good for 12 months. Read the wording carefully, it does not say you must see your doc every six months, just that you need a face-to-face within 6 months of a script being written.

FYI? My pain MGNT doc wrote my current script that Supplier #1 has on file for supplies and such...
*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."
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#10
(02-28-2014, 03:26 PM)justMongo Wrote: I found this -- perhaps this is what they are basing their 6 month visit on:

"Section 6407 of the ACA established a face-to-face encounter requirement for certain items of DME. The law requires that a physician must document that a physician, nurse practitioner, physician assistant, or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME."

I did find that I am in a Medicare competitive bid area; and my DME is on the competitive bid winner list.

@me50: I too find that very few doctors have a real nurse these days. The process for becoming a nurse has become long and difficult. Most doc's employ medical assistants who likely went to a trade school. Some medical assistants are better than others -- in fact some are quite good.

That's before the prescription is written, not after.

Call up medicare and ask. The DME and doctor will lie to you.

Also, medicare takes a very dim view of close relationships between doctors and DMEs.

Allways write your congresscum when you get screwed by Medicare. Voters are the only ones in the process who have an incentive to get it right, and nothing will happen if we don't complain.

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.
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