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What happens to Medicare if DME supplier discovers you've changed settings yourself?
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PositiveMe123 Offline

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Post: #11
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
[/quote]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[/quote]



Exactly! The DME couldn't care less if you change your pressures. They only care about getting their money!

You have to carefully check the EOB for what they charge... even the best DME. I carefully explain what I want to purchase from them and if they send anything I haven't ordered, back it goes. Unfortunately, you have to be ten steps ahead of them at all times and call them on anything that is incorrect. Took me awhile to catch on to this.
03-06-2015 02:56 PM
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Ghost1958 Offline

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Post: #12
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
Some DMEs won care but alot will. They get to charge quite a fee to medicare for that minute and half to change pressures which is why they usually promote dire warnings of you doing it being illegal and medicare stopping payment. Which is all hogwash.

Medicare out of their own mouth directly to me could care less what the machine is set at or who set it. They actually prefer you to set your own if you know how so they dont have to pay out an fee for a DME to do it. Or a Doc to charge for ordering the change.

All they care about is your compliance hours, your face to face visit requirements in the first 90 days and if the machine is doing any good for you. Thats it and thats all. The rest is medical mafia secret agent horse feathers.
03-07-2015 01:24 AM
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novatom Offline

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Post: #13
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-06-2015 02:53 PM)PsychoMike Wrote:  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.

That's interesting. I hope my Doctor is not like that. I have my 2nd follow up visit in 10 days, I've been on CPAP since Jan. 1. In my first 3 week follow up, my AHI was averaging around 6 and the Dr. decided to keep my pressure the same (also at 6). Since then, my AHI is averaging 2-3 and I anticipated that my Dr. would raise the pressure to bring my AHI below that. Now I'm wondering if he will, after all. I'd like to get it below 1 eventually. FYI, I'm not on Medicare.
(This post was last modified: 03-07-2015 07:12 AM by novatom.)
03-07-2015 07:10 AM
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Gulfbreezey Offline

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Post: #14
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
Met with my GP yesterday and he agreed to a new pressure setting. He sent it to the DME today so I'm hopeful to get my machine reset tomorrow. He seemed quite understanding. I hope this lasts In case I need another change! Else I'll be back to considering making my own changes. He's a nice guy so I think we're ok and hope new setting will work well!

Thanks for all the help and info!!
03-11-2015 10:08 PM
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trish6hundred Offline

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Post: #15
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-11-2015 10:08 PM)Gulfbreezey Wrote:  Met with my GP yesterday and he agreed to a new pressure setting. He sent it to the DME today so I'm hopeful to get my machine reset tomorrow. He seemed quite understanding. I hope this lasts In case I need another change! Else I'll be back to considering making my own changes. He's a nice guy so I think we're ok and hope new setting will work well!

Thanks for all the help and info!!
Hi Gulfbreezey,
It's great to hear that your doc was understanding and I hope your settings changes work, sleep well.

trish6hundred
03-11-2015 11:21 PM
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ClarkK Offline

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Post: #16
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
My deductible is so high, not sure it matters if insurance has an issue with me changing my settings -- so I decided not to worry on it.

First time I asked for a pressure change, it took weeks to get it done -- although in that case, an RT at the DME actually helped get a better setting than I asked for. Since then, I've made my own adjustments based on the data -- and there has been improvement with every one. Right now I'm sleeping longer and my AHI is below 1. I think I found my bottom number (auto-CPAP), but may still narrow my range by lowering the upper number.

It would make a lot of sense if patients were encouraged to make adjustments and given guidance on how to do so. I suspect a lot more people would be compliant and continuing therapy if that were the case.

______________________________________
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05-09-2015 02:59 PM
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Terry Offline

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Post: #17
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-02-2015 05:01 PM)Gulfbreezey Wrote:  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?

They might get angry and make up some BS story to try to scare you. The proper response (or at least my response) to this is say "blow me" and walk out the door.

Medicare only requires "compliance" which they define as 4 or more hours/night for 70% of the nights. The DME would have to be staffed by morons to want to take your machine back because you changed the pressure, since they would lose money, and it's possible you could sue them, since the machine was ordered by your doctor.

What's more likely is that they will just ignore the change or not notice it.
(This post was last modified: 05-11-2015 10:33 AM by Terry.)
05-11-2015 10:27 AM
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antdroid Offline

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Post: #18
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
I dont have medicare so I dont know how that all works - I have insurance through work, but my DME provider tech sat down and showed me how to change every setting on my device and said that I probably don't need to change it but just in case. And then she said that these are what the doctor prescribed but here's how you can modify it if you need. I came back a second visit to change masks, and again, she told me if I tried changing random settings to get better results and so on. Again, YMMV, as with everything that involves insurance and health care.
(This post was last modified: 05-12-2015 12:58 AM by antdroid.)
05-12-2015 12:55 AM
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archangle Online
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Post: #19
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
(03-02-2015 05:41 PM)OpalRose Wrote:  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."
Coffee
OpalRose

I think Medicare also requires the doctor to verify that the device is helping you or something like that. I guess some doctors might throw a hissy fit and decide they can't certify that if they want to be a jerk.

(03-02-2015 11:13 PM)Mike1953 Wrote:  
(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.

I don't see your point. If you change your settings, the DME can see that with the wireless modem data. For "the most part," it sends hours used, pressure settings, pressure levels, AHI, and several other things.

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.
05-12-2015 03:52 AM
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bwexler Offline

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Post: #20
RE: What happens to Medicare if DME supplier discovers you've changed settings yourself?
I believe they may do one of two things
Put you in front of a firing squad
Yawn

I sa my PCP yesterday and he asked how my CPAP therapy was going. I told him I had seen the sleep doc who recommended I increase my pressure which I did for one day. It made things worse, so I decreased it the next day and things have been better since. He said great and moved on.
05-12-2015 02:41 PM
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