No CPAP Supplies DME says under audit

It is the DME who is responsible to submit compliance data to get paid by Medicare. It sounds to me not like an audit by Medicare but that Medicare had denied payment to the DME for lack of compliance data. Either that or the DME just never submitted because they could not find the data (did an internal audit for the data) needed so did not want to send supplies until they were certain they could get paid.

Get the data yourself from Sleepyhead just make sure it is on the right machine cuz the serial # is on the report, just as a cya for you. Send or bring the reports to your doc when you go in so it is documented.

This sounds like Apria to me?

klm49 wrote:You can see medicare at medicare any time you want.

and that is the way it should be.

Plug in your phone when calling Medicare.
Not all calls are excessively long; but it can happen.

Pap-Daddy wrote:It is the DME who is responsible to submit compliance data to get paid by Medicare. It sounds to me not like an audit by Medicare but that Medicare had denied payment to the DME for lack of compliance data. Either that or the DME just never submitted because they could not find the data (did an internal audit for the data) needed so did not want to send supplies until they were certain they could get paid.

Get the data yourself from Sleepyhead just make sure it is on the right machine cuz the serial # is on the report, just as a cya for you. Send or bring the reports to your doc when you go in so it is documented.

This sounds like Apria to me?

No Apria. Doctor retrieved compliance data when I took machine in. DME can retrieve data via modem in machine they say. Dme claimed thay were missing data from Dr., Dr. claimed they had it all. I dont know who the problem was but apparently its fixed. Ill know for sure if I get my supplies next week.

klm49 wrote:No Apria. Doctor retrieved compliance data when I took machine in. DME can retrieve data via modem in machine they say. Dme claimed thay were missing data from Dr., Dr. claimed they had it all. I dont know who the problem was but apparently its fixed. Ill know for sure if I get my supplies next week.

While that is true and is the way it is sposed to work.
Apria customers BEWARE :
I had a case where Apria didn't put a modem on my cpap and never called or attempted to get compliance data from me. Lucky for me I brought the compliance data to my doc at each visit.

So this is what Apria's new business model works like. They know what is needed to get paid by Medicare, they are not new at this. But they submitted to get paid anyway. What happens is Medicare denies it. If you see this on your statements call Medicare to find out why and then file an appeal. So then Medicare repeatedly denies payment, and in the words of Medicare they sent info to them making them aware of what is needed yet they never heard back from Apria.

So if you let it go on without appeal and without the required dr face-to-face visits then Apria will demand payment from you the customer esp. if you signed their ABN Form to say you will pay if Medicare does not. Worse yet if you gave them your credit card - there will be no discussion they will just slam your credit card (I did neither). I suspect they won't do this again.

So they will bill you for I think it was $862 they bill Medicare - that is $862 times 13, right. So even if they say they will settle out of court (if like me you didn't sign their form or provide a credit card) for half of that they will still get more than Medicare would have paid them. I think Medicare pays them something like $96/month but that is what they signed up for.

So BEWARE of their new business model if you have to do business with Apria do NOT give them a credit card or sign their ABN Form which allows them to collect directly from you once Medicare denies payment.

You have been warned.

When a DME gets a Medicare audit, it is not because they did anything wrong. Medicare does so many audits a week for every company to cut down on fraud. Once the claim is billed, it takes about 2-3 weeks to get a response from Medicare. You then sometimes get an audit where you have to fax tons of paperwork to the audit dept. It then takes anywhere from 3 weeks to 3 months depending on who gets your audit. In the meantime, it is up to the dme to put our supplies that they may not get paid for. You can always pay in advance and if medicare agrees with you needing a cpap, they can then bill medicare for supplies and reimburse you. If medicare looks at paperwork and does not agree with you needing said equipment, it must be picked up or appealed.

Worth reading.

Guest wrote:

klm49 wrote:No Apria. Doctor retrieved compliance data when I took machine in. DME can retrieve data via modem in machine they say. Dme claimed thay were missing data from Dr., Dr. claimed they had it all. I dont know who the problem was but apparently its fixed. Ill know for sure if I get my supplies next week.

While that is true and is the way it is sposed to work.
Apria customers BEWARE :
I had a case where Apria didn't put a modem on my cpap and never called or attempted to get compliance data from me. Lucky for me I brought the compliance data to my doc at each visit.

So this is what Apria's new business model works like. They know what is needed to get paid by Medicare, they are not new at this. But they submitted to get paid anyway. What happens is Medicare denies it. If you see this on your statements call Medicare to find out why and then file an appeal. So then Medicare repeatedly denies payment, and in the words of Medicare they sent info to them making them aware of what is needed yet they never heard back from Apria.

So if you let it go on without appeal and without the required dr face-to-face visits then Apria will demand payment from you the customer esp. if you signed their ABN Form to say you will pay if Medicare does not. Worse yet if you gave them your credit card - there will be no discussion they will just slam your credit card (I did neither). I suspect they won't do this again.

So they will bill you for I think it was $862 they bill Medicare - that is $862 times 13, right. So even if they say they will settle out of court (if like me you didn't sign their form or provide a credit card) for half of that they will still get more than Medicare would have paid them. I think Medicare pays them something like $96/month but that is what they signed up for.

So BEWARE of their new business model if you have to do business with Apria do NOT give them a credit card or sign their ABN Form which allows them to collect directly from you once Medicare denies payment.

You have been warned.