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Resmed S9 Autoset Compliance
#1
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Hello all! I just had a quick question about compliance and how it's counted. Is the compliance counted by the percentage? Or by how many days over 4hrs? What is the percentage threshold? Thanks guys! Smile
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#2
(10-15-2014, 11:09 PM)H4X0R46 Wrote: Hello all! I just had a quick question about compliance and how it's counted. Is the compliance counted by the percentage? Or by how many days over 4hrs? What is the percentage threshold? Thanks guys! Smile

Hi H4X0R46,
Your profile doesn't indicate your location, but if you are in the USA, I believe that compliance is usually set by the Medicare system. As it was recently explained to me, the initial compliance check is looking for usage of 4 hours or more per day, for 70% of the days within any contiguous 30-day period, anytime during the first 90 days.

This would amount to 21 days out of any 30-day window. I have recently seen references to other checking for compliance, for example, to get a replacement machine, but I know nothing about those regs, if there are any. Such checking might be initiated by some individual insurers, and the rules would not likely be uniform.

Good luck on your CPAP journey.
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#3
(10-16-2014, 12:34 AM)becker44a Wrote:
(10-15-2014, 11:09 PM)H4X0R46 Wrote: Hello all! I just had a quick question about compliance and how it's counted. Is the compliance counted by the percentage? Or by how many days over 4hrs? What is the percentage threshold? Thanks guys! Smile

Hi H4X0R46,
Your profile doesn't indicate your location, but if you are in the USA, I believe that compliance is usually set by the Medicare system. As it was recently explained to me, the initial compliance check is looking for usage of 4 hours or more per day, for 70% of the days within any contiguous 30-day period, anytime during the first 90 days.

This would amount to 21 days out of any 30-day window. I have recently seen references to other checking for compliance, for example, to get a replacement machine, but I know nothing about those regs, if there are any. Such checking might be initiated by some individual insurers, and the rules would not likely be uniform.

Good luck on your CPAP journey.

Yes, I am in the USA! Does this go for all insurances? And you're saying it's basically only monitored for 90 days?
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#4
It's set by the insurance company. Most of them use the Medicare rules, but they're technically free to use what they want. I've heard of few cases of other rules in terms of hours. However, there does seem to be more variation in how many months you have to be compliant. Medicare also requires some specific things in terms of an in-office followup visit, a doctor exam, and statement. Insurance is often less strict on this.

Sometimes a particular DME or doctor will misunderstand the rules. Some people have had to do battle over this.

A "day" according to most CPAP machines is Noon to Noon. Sometimes, the machine is not set to local Noon. This sometimes confuses the issue. The machine's compliance numbers on the screen may not match reality.

However, if you're really using the machine, 4 hours a night and 70% of the days is not that hard to achieve.

If you're having trouble sleeping with the CPAP, you can try to adapt by using the machine when you're awake by using it while reading or watching TV. The machine DOES count these hours in the compliance time.

The machines usually won't count hours if you just let the machine run with no one wearing the machine.
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#5
(10-16-2014, 04:24 AM)archangle Wrote: It's set by the insurance company. Most of them use the Medicare rules, but they're technically free to use what they want. I've heard of few cases of other rules in terms of hours. However, there does seem to be more variation in how many months you have to be compliant. Medicare also requires some specific things in terms of an in-office followup visit, a doctor exam, and statement. Insurance is often less strict on this.

Sometimes a particular DME or doctor will misunderstand the rules. Some people have had to do battle over this.

A "day" according to most CPAP machines is Noon to Noon. Sometimes, the machine is not set to local Noon. This sometimes confuses the issue. The machine's compliance numbers on the screen may not match reality.

However, if you're really using the machine, 4 hours a night and 70% of the days is not that hard to achieve.

If you're having trouble sleeping with the CPAP, you can try to adapt by using the machine when you're awake by using it while reading or watching TV. The machine DOES count these hours in the compliance time.

The machines usually won't count hours if you just let the machine run with no one wearing the machine.

Thanks! Very helpful! Thanks So would I just call my insurance company to get the specific guidelines on CPAP compliance? Because from what I understand, they are all really different?
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#6
Yes, techically you must find out what YOUR insurance requires.

It is common however to have the insurance companies (in the US) follow the Medicare requirements Archangel mentioned.

Since those requirements are typically worded in a very confusing manner, it helps to understand those typical requirements before calling.

70% is 21 days of 30. 30 days continuous time is ANY time period in the (typically) 90 day window, could be 1-30, 61-90, or 22-51 or 49-78.

But as you said, your insurance may be different, especially for those outside the U.S.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#7
(10-16-2014, 12:34 AM)becker44a Wrote:
(10-15-2014, 11:09 PM)H4X0R46 Wrote: Hello all! I just had a quick question about compliance and how it's counted. Is the compliance counted by the percentage? Or by how many days over 4hrs? What is the percentage threshold? Thanks guys! Smile

Hi H4X0R46,
Your profile doesn't indicate your location, but if you are in the USA, I believe that compliance is usually set by the Medicare system. As it was recently explained to me, the initial compliance check is looking for usage of 4 hours or more per day, for 70% of the days within any contiguous 30-day period, anytime during the first 90 days.

This would amount to 21 days out of any 30-day window. I have recently seen references to other checking for compliance, for example, to get a replacement machine, but I know nothing about those regs, if there are any. Such checking might be initiated by some individual insurers, and the rules would not likely be uniform.

Good luck on your CPAP journey.


So you're saying most insurances in the USA are going for 70% compliance per 30 days? So, if i check in sleephead and my percentage is over 70% for the 30 day period, I'm likely okay? Thanks for the explanation! Is this correct? Smile
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#8
(10-25-2014, 08:27 PM)H4X0R46 Wrote: . . .
So you're saying most insurances in the USA are going for 70% compliance per 30 days? So, if i check in sleephead and my percentage is over 70% for the 30 day period, I'm likely okay? Thanks for the explanation! Is this correct? Smile

Hi H4X0R46,
What I quoted was represented to me as the Medicare requirements, when I picked up my S9 in January. Many or most insurance companies in the US use the Medicare rules, although they are not required to do so. To be absolutely sure, you would have to contact YOUR insurance company and ask.

Good Luck,
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#9
I have a related question.

I started using a ResMed S9 Autoset last month. It was to replace an earlier machine that I have had since 2007. I am 100% compliant and have been since I started 7 years ago.

My new machine came with the cell phone modem attachment. I has been causing a problem with my clock radio. Whenever it tries to send info my clock radio make a disturbing noise. I only use my clock radio from 6:40am to 7:00am. Is there a way to tell the modem or the CPAP machine to not send data during this time?

For now I've taken the cell phone thingy off of the machine. My CPAP was billed as a purchase, not a rental and the claim has already been paid in full. Would they still need compliance info?

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#10
My current and previous Medicare Advantage plans never checked complience as far as I n
Know. I have been 100% compliant since I joined the current plan. I did miss some days while I was moving.
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