Questions about Medicare's PAP Adherence Policy

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VPAP
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Questions about Medicare's PAP Adherence Policy

Post by VPAP » Sun Mar 01, 2015 12:17 pm

Hello. How are you all? I have a question. You know, Medicare has a protocol for Adherence. I mean, that is quite obvious.

Patients must use the PAP therapy device, or Medicare is not going to be willing to pay for it. So, the patient has 90 days to prove that they are willing to use their PAP device. During this 90 days, they get three 30 day periods.

The patient must use the PAP therapy device for four hours or greater each night, for at least 70% of the the nights for 30 days. If they do, I believe that Medicare pays for it after 90 days. Now, I was informed that after 13 months of my Therapy device usage, Medicare is actually going to BUY this PAP therapy device. I don't know who all has heard of that. But anyhow, I have some questions.

1: What happens after 90 days?

Let's say after 90 days, the patient stops using it for four hours or greater every night, and Let's imagine that they only use it for one hour every night, or less.

Can Medicare stop paying for it, and When?

2: How often are compliance checks required after that 90 day period?

3: Being that I'm using my device a lot during the daytime, what would Medicare say if they found out that the hours of usage is more than would be calculated for four hours or more every night?

4: Does the S9 have the ability to (NOT), calculate the data if somebody just turned on the PAP device, and then put the mask under the pillows?

Not that I do that, but i was just curious. I mean, obviously with the S9 they can see the Tidal Volume, the Minute Ventilation, the Respiratory rate, and the flow, but could Medicare refuse to pay for it if the person did such a thing?

I'm sure that is not unheard of.

Please note, words I put in all caps are not intended to yell, but to really emphasize what I mean.

I am NOT attempting to yell. I tend to use all caps as a habbit sometimes because I am trying to get my point accross. NOT TO YELL. Thank you, and God bless.

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LSAT
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Re: Questions about Medicare's PAP Adherence Policy

Post by LSAT » Sun Mar 01, 2015 12:44 pm

I'm not positive, but, I don't believe that there are any compliance checks after the 90 days. I think anyone that was compliant during the 90 days would be nuts to quit thereafter.

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VPAP
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Re: Questions about Medicare's PAP Adherence Policy

Post by VPAP » Sun Mar 01, 2015 12:52 pm

I totally agree with you. I use mine a lot during the daytime. What will Medicare say when they see that the hours of usage ismore than calculated? Because Mine's going to be A LOT higher than would be added up to 4 hours or more times the 90 days, so what would Medicare say?

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chunkyfrog
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Re: Questions about Medicare's PAP Adherence Policy

Post by chunkyfrog » Sun Mar 01, 2015 1:00 pm

Are you suggesting you might want to "cheat"?
Why? This is like any medical device or drug. You have to use it for it to work.
Usage will not record unless you wear the mask.
Usage counts no matter when you sleep, even naps (you are allowed a nap--OK)
Each day is from noon to noon, so an afternoon nap will add to the following night.
The four hours a night is a MINIMUM, going over is good, very good!
Sessions are piled together into each day's usage.

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palerider
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Re: Questions about Medicare's PAP Adherence Policy

Post by palerider » Sun Mar 01, 2015 1:13 pm

VPAP wrote:Please note, words I put in all caps are not intended to yell, but to really emphasize what I mean.

I am NOT attempting to yell. I tend to use all caps as a habbit sometimes because I am trying to get my point accross. NOT TO YELL. Thank you, and God bless.

there are plenty of ways to emphasize what you want to say without yelling in ALL CAPS.

be mindful of what you're doing lest your attempt to get your point across ends up with you on many peoples foe lists, where your points will not be seen at all.

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Nick Danger
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Re: Questions about Medicare's PAP Adherence Policy

Post by Nick Danger » Sun Mar 01, 2015 1:13 pm

The machines are smart enough to know when you aren't wearing the mask and will not include time with the mask off toward compliance.

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Pugsy
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Re: Questions about Medicare's PAP Adherence Policy

Post by Pugsy » Sun Mar 01, 2015 1:18 pm

VPAP wrote:What will Medicare say when they see that the hours of usage ismore than calculated? Because Mine's going to be A LOT higher than would be added up to 4 hours or more times the 90 days, so what would Medicare say?
They don't care how many hours it is used as long as the use meets the minimum compliance hours of use.
VPAP wrote:Does the S9 have the ability to (NOT), calculate the data if somebody just turned on the PAP device, and then put the mask under the pillows?
Yes. The machine can tell if you aren't attached to it. If you aren't attached for some reason it will report "breathing not detected" and those hours are NOT included in the compliance usage hours. We used to be able to cheat with the older machines but not with these newer machines.
Now you can use the machine while awake and the machine (and Medicare) won't care because it can't tell if you are asleep or not.
It just records what it senses in terms of your breathing.

As far as I know Medicare doesn't require anything beyond that 90 day initial time period where the first compliance hours of use minimum requirements must be met.
There have been reports where a cpap user has been told by a DME or doctor that Medicare says they must be seen once a year to get cpap supplies...but I have never seen written proof of that statement in any Medicare documents.
I have Medicare...since May 2009...and I have not seen my doctor since Aug 2009 and I still get my cpap supplies just fine.
I suspect that this "rule" is a DME and/or doctor rule because so far no one has shown me Medicare documents stating this new requirement.

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chunkyfrog
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Re: Questions about Medicare's PAP Adherence Policy

Post by chunkyfrog » Sun Mar 01, 2015 1:21 pm

If your machine choice is correct, the 13 month capped rental may not apply for your bipap.
Often these advanced machines are a forever lease, and compliance may be more stringent.
I have to check. I'll be back later.

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Pugsy
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Re: Questions about Medicare's PAP Adherence Policy

Post by Pugsy » Sun Mar 01, 2015 1:24 pm

With straight Medicare the 13 month capped rental applies to pretty much all cpap machines...even the high end ASV machines.
Now with some Medicare Advantage plans it's a perpetual monthly rental and never capped....not a good deal.
So it depends....regular Medicare or Medicare Advantage plan?

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chunkyfrog
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Re: Questions about Medicare's PAP Adherence Policy

Post by chunkyfrog » Sun Mar 01, 2015 1:27 pm

Thank you, Pugs.

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VPAP
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Re: Questions about Medicare's PAP Adherence Policy

Post by VPAP » Sun Mar 01, 2015 1:34 pm

Pugsy wrote:With straight Medicare the 13 month capped rental applies to pretty much all cpap machines...even the high end ASV machines.
Now with some Medicare Advantage plans it's a perpetual monthly rental and never capped....not a good deal.
So it depends....regular Medicare or Medicare Advantage plan?
Thank you so much Pugsy.

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VPAP
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Re: Questions about Medicare's PAP Adherence Policy

Post by VPAP » Sun Mar 01, 2015 2:31 pm

chunkyfrog wrote:Are you suggesting you might want to "cheat"?

NO. I would NOT want to cheat. The reason that I am asking thie very serious question is, because I have a Neuromuscular disease, and my Pulmonary function is very low. I use this machine at night, because otherwise, my oxygen levels would drop into the 30s and 40s or even lower.

I use it during the daytime, due to the fact that It helps me to rest my lungs. I use a VPAP so it is providing me with pressure support. My Dr. knows that I use it during the daytime because she knows that I have very very low pulmonary function. I had only asked this, because you know, there is a certain amount of hours that will be calculated. I was just wondering what Medicare would say if I used it during the daytime too. The reason being, since I use it ALL NIGHT, EVERY NIGHT, they will see that, but being that I use it during the daytime, they would see additional hours. I had just asked this, to know what they would say when their required hours were lower than the hours that I had used it. I would NOT WANT TO CHEAT. This device only helps, WHEN YOU USE IT. THAT IS QUITE OBVIOUS! A toothbrush only keeps your teeth clean if you use it. Otherwise, its as if you never had it. Same thing with a PAP therapy machine. If you don't use it, it does absolutely, NO GOOD!

Why? This is like any medical device or drug. You have to use it for it to work.
Usage will not record unless you wear the mask.
Usage counts no matter when you sleep, even naps (you are allowed a nap--OK)
Each day is from noon to noon, so an afternoon nap will add to the following night.
The four hours a night is a MINIMUM, going over is good, very good!
Sessions are piled together into each day's usage.

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chunkyfrog
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Re: Questions about Medicare's PAP Adherence Policy

Post by chunkyfrog » Sun Mar 01, 2015 2:57 pm

Sorry I mentioned cheating--every now and then some fool wants to do it, glad you are not one of those;
but sorry your situation is the one you mention, as you don't have much choice.
As I mentioned, there is no maximum. Thank goodness, as extra sleep can assist in healing.
Cats know best.

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VPAP
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Re: Questions about Medicare's PAP Adherence Policy

Post by VPAP » Sun Mar 01, 2015 3:10 pm

chunkyfrog wrote:Sorry I mentioned cheating--every now and then some fool wants to do it, glad you are not one of those;
but sorry your situation is the one you mention, as you don't have much choice.
As I mentioned, there is no maximum. Thank goodness, as extra sleep can assist in healing.
Cats know best. Thank you so much for your support. Its ok. yes. I do think that it is sad. Its sad when people who NEED to use their CPAP machines, choose to just turn them on and not use them like they are suppose to. I mean, Sleep Apnea is a VERY VERY DANGEROUS DISEASE. It is known to cause Diabetes, Heart problems, Weight Gain, Serious Neurological problems, STROKE, A HEART ATTACK, Also known as Myocardial Infarction, can lead to accidents when people who are running on very little sleep attempt to drive, etc. YES.I'm mentioning driving accidents, because I have heard of people who have gotten incar accidents NUMEROUS times, and the problem was they fell asleep in front OF THE WHEEL! That's scary to even think about. This disease is NOT TO PLAY AROUND WITH. IT CAN KILL A PATIENT! So, I am also educating patients in regards to Sleep Apnea, because after the hours and hours of research that I do, I know, IT CAN DO SOOOOOOO MUCH DAMAGE! Snoring isn't the only thing it can cause. While snoring is sometimes loud, and annoying, and the gasping and choking noises are rather annoying to SOME patients, like their partners, the Snoring is just the beginning of what can be A VERY DESTRUCTIVE DISEASE. So, now when I hear somebody snoring, I can't help but really pay close attention to their breathing, and worry a lot about them. I want to thank you for your support.

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