Original medicare doctor visit requirements

I need some advice or thoughts from those familiar with medicare. I have had a sleep dr. for several years and the only thing he does is look at my readout and tell me I am doing great and then they send a report to my dme and the dme gives me my equipment as they see fit.

Problem is, my sleep dr. was piloting a private plane and flew into the ground and was killed. I just got a call that my appointment for Oct is canceled and they are closing the clinic at the hospital.

So, do I actually need a sleep doctor to keep in compliance with medicare?
I think I have answered my own question. I think my primary care provider can give the order for supplies when needed and I can take my little chip to the dme to let them read out the compliance data.

Am I missing something?

Your primary care doctor can satisfy any requirements that Medicare might have regarding seeing a doctor to continue getting supplies.
He can write a RX if one is needed for something and if any compliance reporting needs to be done he can do that too.

I haven't seen my sleep doctor since Aug 2009. My DME as yet to ask me for anything from any doctor when I get my supplies and I was just there today for mask and couple of other little items. I have Medicare too.

Call the hospital clinic and ask them to send you a copy of your sleep study (both the raw data and your report) as well as a summary of your visits. You should have been getting these all along, but you really need them now. Sleep studies are good for 10 years for Medicare and even longer if you show regular attendance at a doctor's office. So sorry you lost your doc so unexpectedly. But, this happens on a regular basis. My bro lost all 3 of his doctors in one year (retirement and illness) and 2 of his replacements then left (moved to other parts of country).

Until you need a new machine, your primary can write prescriptions for your supplies. My primary won't write one for a machine, but my brother's doc did.

chronic wrote:So, do I actually need a sleep doctor to keep in compliance with medicare?

For compliance you can research it here or on cms gov
But if your DME is kind and they are owed money for things you got from them ask them to guide you & your primary to meet Medicare compliance

Basically, any doc should ask to see your download to confirm you are meeting the >4hrs/day requirement AND the doc has to certify that you are benefiting from its use. I believe the DME needs to have a copy of your download and this certification on file but they should be able to fill you in on that.

I called my dme, asked what they thought about the situation. This particular clerk said, well, we are getting paid for what we bill them, so she thinks I am fine. They do seem to change their mind about stuff. If I called today and talked to someone else, I would get a different answer. Thanks for all the advice and information.

If the same thing happened to my sleep doc, his colleagues in the practice would no doubt pick up the slack.
If it were a one-doc clinic, which closed, I would hope my PCP would be helpful, if only to provide a referral.

This may help...
https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

LSAT, that was very helpful, I think I found the answer there, and, it made more sense of what the dme clerk told me. I think everything is going to be alright.