Post Reply 
Medicare rule? must see doc every 6mo for DME
Author Message
justMongo Offline

Monitors

Posts: 3,853
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #1
Medicare rule? must see doc every 6mo for DME
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.
(This post was last modified: 02-28-2014 02:16 PM by justMongo.)
02-28-2014 02:14 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
me50 Offline

Advisory Members

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: #2
RE: Medicare rule? must see doc every 6mo for DME
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
02-28-2014 02:38 PM
Find all posts by this user Post Reply Quote this message in a reply
justMongo Offline

Monitors

Posts: 3,853
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #3
RE: Medicare rule? must see doc every 6mo for DME
(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.
02-28-2014 03:00 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
me50 Offline

Advisory Members

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: #4
RE: Medicare rule? must see doc every 6mo for DME
(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!
02-28-2014 03:03 PM
Find all posts by this user Post Reply Quote this message in a reply
justMongo Offline

Monitors

Posts: 3,853
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #5
RE: Medicare rule? must see doc every 6mo for DME
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.
02-28-2014 03:26 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
trish6hundred Offline

Advisory Members

Posts: 6,449
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: #6
RE: Medicare rule? must see doc every 6mo for DME
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
02-28-2014 03:58 PM
Find all posts by this user Post Reply Quote this message in a reply
GrammaBear Offline

Advisory Members

Posts: 381
Joined: May 2012

Machine: ResMed S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Air Fit P10
Humidifier: ResMed H5i heated humidifier
CPAP Pressure: 12.2 - 16.2
CPAP Software: SleepyHead

Other Comments: Type 1 diabetes - using Tandem T-slim insulin pump, Dexcom G4 CGM

Sex: Female
Location: northern Illinois

Post: #7
RE: Medicare rule? must see doc every 6mo for DME
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
02-28-2014 04:40 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
cbramsey Offline

Advisory Members

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: #8
RE: Medicare rule? must see doc every 6mo for DME
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.
02-28-2014 05:06 PM
Find all posts by this user Post Reply Quote this message in a reply
Peter_C Offline

Advisory Members

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: #9
RE: Medicare rule? must see doc every 6mo for DME
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."
02-28-2014 05:58 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
archangle Offline
Wiki Editor
Advisory Members

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: #10
RE: Medicare rule? must see doc every 6mo for DME
(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.
02-28-2014 06:02 PM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Medicare Advantage Coverage for APAP Evie 4 230 12-05-2016 09:49 PM
Last Post: Evie
  General rule for tweaking pressure - first post MartinT 7 387 11-15-2016 11:59 PM
Last Post: MartinT
  Medicare Denial Kidnap 48 4,234 10-29-2016 01:46 PM
Last Post: Kidnap
  Changing Medicare Supplier when Moving jrh0 4 351 09-03-2016 01:53 AM
Last Post: srlevine1
Money Medicare changed coverage for ResMed masks Wildfire 8 882 09-02-2016 01:36 PM
Last Post: pavel
  Medicare covered Codes - interesting docs and links for US icyura10 0 247 08-10-2016 12:48 AM
Last Post: icyura10
  When Medicare doesn't pay Sn00zeAlarm 11 676 07-22-2016 06:15 AM
Last Post: justMongo

Forum Jump:

Who's Online (Complete List)