kcodeblue wrote:You are correct that Medicare reimbursement rates vary by region. In the part of southern California were I am located the rate is $42/month x 13 months. The heated humidifier is a sale item and is not included in the rental. An Auto CPAP (ResMed or Respironic) cost my company over $300
I know Medicare sucks...I used to do the Medicare filing for a walk in clinic that was a non participating provider.
They finally got to the point that all lab was sent outside because reimbursement didn't cover costs.
I wasn't aware that in your region the reimbursement was so low. Sounds like a competitive bid thing.
I also am quite aware of the rules and regulations and the overhead...so I feel your pain but I also see things from the patient's standpoint and the fact of the matter is...suppliers can supply an apap with cpap RX legally anyway....and too many times patients are lied to and that just irritates me to no end. I would rather a supplier be up front and say they lose money and that's why they won't do it. I would appreciate honesty and understand.
My DME wouldn't supply me a mask that I wanted no matter how much I tried to get them to because it wasn't something they could buy in bulk and get a discount and get reimbursed by Medicare (I have Medicare now) to have them make much profit. He was honest and I knew what the masks cost to buy just one and I know the reimbursement rates and he wouldn't have netted much profit...so I really didn't blame him or push the matter.
I do think that if a patient wants an apap for whatever reason....then they should get an apap and if a DME is unwilling to dispense that machine because of the lack of profit margin then the patient needs to be told the truth and the patient given the choice as to what they wish to do...get a full data CPAP or go elsewhere to get their machine from a supplier that will give them what they want. Be honest and up front with people and they will understand....but when patients are flat out lied to...that is something that will make or break a business deal with me. I fired my first DME because I was lied to....and kept my current DME because they were honest with me.
Does everyone who thinks that they want an apap really need an apap...of course not but the mind is a powerful drug and when patients start "what iffing I would feel better with apap" it can potentially impact the perception of the effectiveness of their therapy.
And of course there are people like me who actually found that apap mode was better suited for their needs.
In REM sleep my pressure needs are substantially higher than it is in non REM...
Let's see...I can use APAP with minimum of 9 and maximum of 20 and maybe see 18 cm during REM sleep or I could use CPAP mode with fixed pressure of 18 cm to cover my REM based pressure needs but I would have to use 18 cm all night. Not something that is high on my want list.
Oh...dispensing non data machines...I just imagine you already know what my feelings about that will be so I won't get on that soap box.
BTW, welcome to the forum.
I am sorry that where you live that you can't make money on apaps...I really am because I know that places need to make money to stay in business but if that loss can't be recouped elsewhere...then either tell the patient the truth and offer them a choice as to how they want to proceed if you are unwilling/unable to supply what they want.
Edit...I see that you mention you are in a competitive bidding area...that's tough I know. Not one of Medicare's finest moments but it's all about saving Medicare dollars and the government never has been known to have any common sense.
I may have to RISE but I refuse to SHINE.
If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.