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Staying "active" with your DME
#1
Please share your experience about keeping "active" (on Medicare) with your DME in order to continue to order masks, filters, etc from them. For the past couple years, my pulmonologist sleep doc has suggested to me that I come to see him once a year in order to remain an "active pt." However, on my most recent visit to the doc, he suggested that I don't have to return to see him for 18 months and still will remain "active" as a pt. on Medicare.
Is this 12 to 18 mo. return doc visit requirement from Medicare? If so, why is there a time window of 12-18 months, which when told to me sounds like a ballpark period, rather than fixed in stone?
When I visit the doc, I give him a ResScan printout summary of my treatment. He used to keep these, but recently said that it's no longer required for him to do so, which sounds to me like a Medicare rule change. Since my therapy is and has been going well, these doc visits are almost social calls. We chat and he tells me all is going well and asks how I feel. My only problem with them is that they cost me $50 a pop co-pay plus a later billing from his pulmonology group.

David
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#2
That's exactly how my recent "yearly" visit went with my Pulmonologist/sleep doctor.

It felt like a social visit. He's happy my AHI is usually under 1.0, and no, he didn't need to see any reports either from sleepyhead or encore.

He went into great detail about the low carb diet he's been on, and told me I should try it. His wife interuppted our visit to being him a salad. Sad

He then proceeded to say that it wouldn't work for me, unless my hubby went on same diet. Ok, my husband has never had a weight problem. But I intend to prove this doctor wrong, I've been on that low carb diet now for 3 weeks, and have dropped 8 pounds. I do have to cook differently for hubby though.

Sorry, getting off subject. Smile

I don't think Medicare changed any rules. I think it's probably safe to make a yearly visit. I worry that if I don't, then when my 5 years is up and I may need another machine, I'll have to jump through hoops to get one.

Plus the fact, that my DME won't let me purchase supplies without proof of a yearly visit. Sad

It's just a game we have to play...or not. Dont-know

OpalRose
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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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#3
You no longer need a specialist. Another approach that I use is to discuss my sleep apnea and therapy effectiveness with my primary care physician during my annual wellness exam. I provide a 2-page summary of my compliance and efficacy data from Encore, and ensure he includes in his notes a summary of our discussion. I then inform the DME that my annual physician review is available from my PCP.

He actually writes any prescription needs for me and I just got a new bilevel machine approved last week. If you don't need a sleep study, it's time to move your therapy off of the specialist and start to deal with this as a routine health maintenance issue. If in the future you have an issue that needs specialist help, get a referral. This is perfectly acceptable to Medicare and your DME.
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#4
So, I'm asking myself, where was I when the no-longer-specialist-needed rule change came from Medicare. Was it actually ever announced? I never heard it from the pulmonology group that staffs the hospital's sleep center, the hospital sleep center or my DME. (Just any doc writing scripts for CAP sounds a little scary to me, but that's not the main topic here.)
OpalRose, I did hear something about Medicare no longer automatically approving a new machine after five years. It's now something like them requiring the DME to show the pt's machine was hit by a train or messed up or something like that before they will authorize a new one.
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#5
I've been on Medicare (disability) since 1998. There IS no rule such as you describe on original Medicare. This is more of an office procedure thing. If you are not an active patient, your chart would be stored offsite. They often needed up to a week to recall your chart before your appointment and it cost money to retrieve it. Most current specialists use all electronic charts and the recall is much faster (hours, not days) from offsite storage. I have one specialist I see every 5 years, another every other year and still another only when I have a problem. None have suggested a required time period for Medicare. It's just to evaluate ongoing medical problems that are beyond my primary's abilities or equipment.

My primary is unwilling to deal with the cpap stuff because he knows nothing about it, but my brother's doctor (an internist) handled all his most recent stuff. You have to be active to get a new machine. That's it. And that is done when you NEED a new machine. Supplies? You just need that prescription, but you have have it written for 99 years and it's valid (but some DME's give you crap that you need it annually - NOT TRUE in most states, not for supplies).

I am not surprised, however, that Medicare won't automatically allow a machine given that more than 50% of people don't use their cpap beyond one year. But, it doesn't mean that you need another sleep study nor does it mean you have to be an 'active' patient given that 'active' patients have to go through the same hoops to get a new machine. Get a copy of both your raw study and report. Sleep Centers close - you don't want another study unless you NEED one and Medicare will use a sleep study that is 10 years old.
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#6
Excellent reply by Mosquitobait! I'll just add, that your general doctor's willingness to take this on may be related to his confidence that you know what you're doing. If you're self-sufficient, knowledgeable and not having any problems, many doctors are willing to support this by discussing your therapy and including that contact in their encounter notes. That is all that is needed. When I started this, i actually wrote the encounter note and prescription parameters for my doctor, and he passed that along to his staff to include in the record.
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#7
My primary doctor wont deal with cpap issues either. I did ask him, and he prefers I talk to my Sleep Specialist. He states he's not comfortable writing scripts since he knows very little about it.
So not everyone has that option.

Agree, that Medicare hasn't changed rules concerning cpap, at least none that have been published, but DME's often set their own rules, mainly to protect themselves in case they are audited.

I have to give them a new scrip every year if I want to order supplies. I get most online now....less stress to put up with. I wouldn't even get a new cpap from them in 5 years, unless Medicare pays.
So we will see what happens then. Have a few years to go.
OpalRose
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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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#8
Thanks for the replies; they have given me food for thought. Re: having to provide a script to the DME annually, that isn't the case with mine, at least I don't need to hand them one each year. I believe they check their record of when the pt. last visited a doc (apparently my sleep doc or the hospital sleep center provides this info to the DME).
Also helpful to know about the permanent nature of the doc's script. I have never been given a copy, nor have I received a copy of either of my sleep studies' raw data. Do you think it would be easier to obtain a copy of my script from the sleep doc's group or from the hospital sleep center? I'm concerned about moving and having to start over; I certainly don't want that to happen. If PAP therapy is at all like other medical treatment, the new doc's office would simply contact my old one and my records would be transferred. Am I being too optimistic when the subject is xPAP?

David
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#9
(02-28-2016, 12:55 PM)Dawei Wrote: Thanks for the replies; they have given me food for thought. Re: having to provide a script to the DME annually, that isn't the case with mine, at least I don't need to hand them one each year. I believe they check their record of when the pt. last visited a doc (apparently my sleep doc or the hospital sleep center provides this info to the DME).
Also helpful to know about the permanent nature of the doc's script. I have never been given a copy, nor have I received a copy of either of my sleep studies' raw data. Do you think it would be easier to obtain a copy of my script from the sleep doc's group or from the hospital sleep center? I'm concerned about moving and having to start over; I certainly don't want that to happen. If PAP therapy is at all like other medical treatment, the new doc's office would simply contact my old one and my records would be transferred. Am I being too optimistic when the subject is xPAP?

David

I think you should get the records from BOTH places. You want the raw data and summary from the sleep center, but also the notes from the sleep doctor's office. You are entitled to copies of all patient data for your records. Be sure to get a copy of the prescription as well so that you have the option to buy online or go to another DME. Don't just let them tell you 'we can fax it.' Too many people on this board have been held hostage for their prescription by uncooperative office staff. You are right to feel optimistic, but from my experience, the original office may only send the summary or report, but not the data. When I had new vision problems, my old office no longer had the slides of my retina, which were more crucial than the notes - fortunately, I had a copy of them. Eventually, the slides were found in storage, but that came 2 months later. That is why, when I had all these CT scans and MRIs in 2014, I got copies of everything (and they didn't think that was weird in the least).
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#10
I appreciate your advice, Mosquitobait. Thank you. I know what you wrote about a pt. being entitled to copies of his/her data, scripts, etc. is correct, but I suspect it's going to be a real battle to get same.

David
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