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What happens to Medicare if DME supplier discovers you've changed settings yourself?
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Gulfbreezey Offline

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Post: #1
What happens to Medicare if DME supplier discovers you've changed settings yourself?
I am struggling a bit getting my AHI numbers down. Lots of folks on this forum are helping me with that and I'm most grateful. I am going to try and get my doctor to write a new prescription to my DME supplier to change the settings "legally" on my machine.

If that doesn't happen I will want to change them myself. My machine has a modem on it and reports to Respironics/my DME supplier.

Does anyone know if the DME supplier is going to blow a cork when they see I've changed the settings and if so does that get reported to Medicare thus making my machine "illegal" as in Medicare will stop paying for it?

Would like Medicare to continue paying but would like to change the setting too.

Thanks!
03-02-2015 05:01 PM
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Mr. Van Winkle Offline

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Post: #2
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-02-2015 05:01 PM)Gulfbreezey Wrote:  I am struggling a bit getting my AHI numbers down. Lots of folks on this forum are helping me with that and I'm most grateful. I am going to try and get my doctor to write a new prescription to my DME supplier to change the settings "legally" on my machine.

If that doesn't happen I will want to change them myself. My machine has a modem on it and reports to Respironics/my DME supplier.

Does anyone know if the DME supplier is going to blow a cork when they see I've changed the settings and if so does that get reported to Medicare thus making my machine "illegal" as in Medicare will stop paying for it?

Would like Medicare to continue paying but would like to change the setting too.

Thanks!

I really don't know, but I told my DME I went in and changed my EPR settings , well it didn't seem to bother them at all, My guess is if you changed something and something went wrong then maybe you might get thrown under the bus. ?? anyone's guess on this.
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03-02-2015 05:16 PM
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OpalRose Offline

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Post: #3
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
I'm pretty sure that all Medicare cares about is that you are compliant by using the machine a minimum of 4 hours a day, but if your not comfortable with that then call your doctor. You have a right to get the best treatment.

When I told my doctor I changed my own settings, he didn't seem to care. My DME doesn't seem to care about anything except getting paid, or should I say "overpaid."
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03-02-2015 05:41 PM
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PaulaO2 Offline
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Post: #4
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
Medicare only cares that you are being compliant and using the machine. They see the use only in the hours it has been used. they could care less that the machine is actually doing you any good.

I doubt the DME even notices you change anything. To them, you are Patient Number $ out of how many?

I'd not even get the doc to get the DME to change it. As long as the doc okays the change, do it yourself.

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03-02-2015 08:04 PM
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Mike1953 Offline

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Post: #5
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
The modem for the most part only sends hours used nothing about your settings. The only time the DME would know that is when you take the machine in to your DME for its yearly cleaning and check-up.

For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/directories/National/SHIP/
or here http://www.medicareinteractive.org/
03-02-2015 09:54 PM
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archangle Offline
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Post: #6
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-02-2015 09:54 PM)Mike1953 Wrote:  The modem for the most part only sends hours used nothing about your settings. The only time the DME would know that is when you take the machine in to your DME for its yearly cleaning and check-up.

Not true. On many machines, the cell modem sends quite a lot of info, including pressure, AHI numbers, etc. Not as much information as the SD card records, but much more than just the on/off hours data.

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.
03-02-2015 11:02 PM
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Mike1953 Offline

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Post: #7
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-02-2015 11:02 PM)archangle Wrote:  
(03-02-2015 09:54 PM)Mike1953 Wrote:  The modem for the most part only sends hours used nothing about your settings. The only time the DME would know that is when you take the machine in to your DME for its yearly cleaning and check-up.

Not true. On many machines, the cell modem sends quite a lot of info, including pressure, AHI numbers, etc. Not as much information as the SD card records, but much more than just the on/off hours data.

Apparently you did not read my previous information. I stated that for the most part only sends hours used.

Medicare compliance is as follows After the patient starts CPAP treatment at home there has to be documentation of patient compliance. This is done after 31 days but before 90 days of usage. They must have a download of the CPAP usage and a face to face re-evaluation with their physician. Their physician must document that the patients symptoms have improved. Adherence to CPAP is defined as usage greater or equal to 4 hours per night on 70% of nights during a consecutive 30 days anytime during the first 3 months of initial usage.

For free Medicare assistance for your state check out this page. http://www.seniorsresourceguide.com/directories/National/SHIP/
or here http://www.medicareinteractive.org/
03-02-2015 11:13 PM
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robertbuckley Offline

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Post: #8
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
My Doctor actually instructed the DME to provide the "provider's" manual so that I could make changes. Got fairly complex sleep problems besides the obstructive and central apneas, and the Dr. wanted to be able to work with me proactively by me sending her data reports as well as subjective/clinical feelings, and making adjustments to see what the results were. They (the doc and the DME "therapist" sent out with the machine) had some words, and I stood my ground in demanding the manual. End of story is Dr. trumps DME. All that said - this board is the best, as it has almost all the manuals you might need. As for Medicare - they don't care as long as you are using. Think of changing the settings in the same way you might a drug - where a doctor might say - double up on the number of pills and see if that helps, or cut the pill in half and see if you react better.
03-05-2015 12:39 PM
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Gulfbreezey Offline

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Post: #9
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-05-2015 12:39 PM)robertbuckley Wrote:  My Doctor actually instructed the DME to provide the "provider's" manual so that I could make changes. Got fairly complex sleep problems besides the obstructive and central apneas, and the Dr. wanted to be able to work with me proactively by me sending her data reports as well as subjective/clinical feelings, and making adjustments to see what the results were. They (the doc and the DME "therapist" sent out with the machine) had some words, and I stood my ground in demanding the manual. End of story is Dr. trumps DME. All that said - this board is the best, as it has almost all the manuals you might need. As for Medicare - they don't care as long as you are using. Think of changing the settings in the same way you might a drug - where a doctor might say - double up on the number of pills and see if that helps, or cut the pill in half and see if you react better.

Thinking on what I've heard here I suppose it's not in the DME's favor for them to get mad at a user and cause them to lose the Medicare money
03-06-2015 08:20 AM
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PsychoMike Offline

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Post: #10
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
As others have said, medicare cares about compliance, while to the DME, you're part of the cash flow. I've found that if you are compliant and below and AHI of 5, neither cares about anything else.

However...If you have a good relationship with your GP, it can be worth having a short discussion with them about some freedom to track and adjust your machine...mine has been very supportive of my being proactive to get the best treatment for me. After all, I'm the one who benefits most from better treatment and know when things aren't working.

For example, my previous DME didn't seem to care that my AHI was over 1. I have UARS and my sleep disruption number is about 9x my AHI....just my events aren't long enough to register as full-blown events...so I had the equivalent of an AHI of 9. By being proactive, I've gotten my AHI down to sub 0.2 consistently, which, even with my multiplier for non-registering events, puts me into a far better treatment and sleep scenario. My GP applauds my efforts and my results and supports them 100%.

If the GP will support you, then even if Medicare or the DME has issues, you've got someone to back you up.
03-06-2015 02:53 PM
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