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Medicare rule? must see doc every 6mo for DME
#11
I think I will call Medicare on Monday. Just to see what they say.

It would seem not be in the DME's best financial interest to lie. They don't get paid unless they send supplies.
I see my general med doctor often... perhaps I'll just have him write for CPAP supplies.
They have been very good at getting my supplies; but, I am now in a competitive bid area (phase II); and perhaps they lose money supplying my metro area.

It's not in Medicare's best interest to require that I see the sleep specialist every 6 months; as they have to pay him.

Yes, I have written my Congress-critter before regarding Rx meds. I actually got a followup phone call.
(I had cc'd the AG Holder, the FTC, and Secretary Sebelius.)
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#12
I found out that medicare will not pay for vit d when a patient is deficient. that is frickin crazy. Yea, I know this is indirectly related to OSA but we are talking about medicare too so......
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#13
When I needed to upgrade my S7, my GP wrote the script. The DME was fine with it.

And it gave me the chance to educate my GP on how the CPAP racket works. She was shocked that I needed a prescription for the mask. The machine, sure, that happens a lot, but the mask?

Over the years, I've had to get a lot of equipment and stuff for chronic pain and the like. Some things that used to be prescription only aren't any more. Why? Because someone saw the chance to sell to the General Public, a chance to make a buck. So they pushed to have stuff removed from the prescription list. Like the hot water pump heating pad. Used to be ghastly expensive and needed a prescription. Now the price is half that or less and anyone can get it. Same with TENS units. Granted, the TENS units sold without a prescription are wimps compared to the real deal.

So until someone finds a way to make a better buck from CPAP machines, I don't see them going off the prescription only list.
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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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#14
I verified the initial post with Medicare -- they did say any physician who has seen me in the past 6 months can write a script.
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#15
I haven't seen a doc every 6 months while on medicare and I always got my supplies no problem.
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#16
Perhaps it's because I'm in a metro area that's now a competitive bid area (phase 2.)
[Image: pBt22Od.jpg]
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#17
I've been in one of those competitive bid zones since I started on Medicare in June of 2011 and have never been told I need to see my sleep doc every 6 months. And I haven't been to see him in over 2 years!

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 OPINIONS ONLY AND NOT NECESSARILY STATEMENTS OF FACT.
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#18
(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.

Competitive Bidding only affects those on Original Medicare, not Medicare Advantage Plans.

I read the document and while it isn't really clear, it made it sound as though they were talking about equipment like the CPAP machines, not the supplies. It is a given that if one has a machine that the supplies are needed and it sounded like the supplies were considered accessories.

If you look at the part that talks about powered mobility devices, it said that accessories are not included in the requirement.

As always, government speaks a different language and I am not sure that even government knows how to speak the language fluently!

Your guess is as good as mine and YMMV
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#19
(03-04-2014, 04:34 AM)me50 Wrote:
(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.

Competitive Bidding only affects those on Original Medicare, not Medicare Advantage Plans.

I read the document and while it isn't really clear, it made it sound as though they were talking about equipment like the CPAP machines, not the supplies. It is a given that if one has a machine that the supplies are needed and it sounded like the supplies were considered accessories.

If you look at the part that talks about powered mobility devices, it said that accessories are not included in the requirement.

As always, government speaks a different language and I am not sure that even government knows how to speak the language fluently!

Your guess is as good as mine and YMMV

I've stayed with Original Medicare. I get to keep my former doctors that way. I just feel I have more flexibility than going with a Medicare advantage plan.

I get a Medigap and Rx drug plan from my former employer.
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#20
I don't qualify for supplemental insurance or Medigap. My medicare advantage plan has RX drug plan included. We couldn't afford Original Medicare and we wanted to stay with a PPO.
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