does Medicare require doctor visits every 6 months?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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StuUnderPressure
Posts: 1378
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Location: USA

Re: does Medicare require doctor visits every 6 months?

Post by StuUnderPressure » Wed Jan 13, 2016 10:03 am

Admittedly, I have not looked at this for quite a while.
But, I have done extensive research on this in the past.

What I determined was that Medicare not only does not require a face to face meeting with your Sleep Doctor, they also do not even require that you periodically need a new Rx for Supplies.

But, Medicare does acknowledge that the DME and or the Sleep Doctor may have their own requirements.

For me (in a non-compete area), my Sleep Doctor requires a yearly face to face appointment.
They read my SD Card with the very same ResMed ResScan Software I use.
They put an Oximeter on my finger.
And then, they write me a new Rx for Supplies - which my DME requires for me to continue getting Supplies.

I sometimes can get that extended to 2 years as follows:
I call my Sleep Doctor & tell them the DME needs a new Rx.
The Sleep Doctor says I need to come in.
I say I can't at this time but please write the Rx & set up an appointment for me for later.
I give the new Rx to the DME.
When it gets close to my appointment time with the Sleep Doctor, I just cancel that appointment & do not reschedule it.

There is absolutely no reason why an appointment with your Sleep Doctor is needed just to buy supplies.
It is just another way for the Sleep Doctor to bill for something when they actually do nothing.

Medicare should insist that they will not pay for such nonsense.
Medicare could then use the money they save to let one purchase a new APAP more often.

I have not read anything in the information that was included in prior posts above that would even come close to convincing me that I am not correct.

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drdigital1
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Joined: Sat Aug 29, 2009 10:49 pm
Location: Evanston, IL

Re: does Medicare require doctor visits every 6 months?

Post by drdigital1 » Wed Jan 13, 2016 10:42 am

Update
I called the DME and they told me that the original prescription didn't itemize exactly the supplies and the frequency and they sent a fax with a detailed prescription form to the doctor. If the prescription they receive back says LIFETIME, then the DME will not require anything else in the future. I should find out shortly from the DME what prescription they got. If anything other than LIFETIME then I will just switch doctors as the current doctor just bought the business from the one who did all the testing and prescribed the CPAP machine; maybe he needs patients and having an office visit every time a patient needs a cushion would make a nice revenue stream

nanwilson
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Joined: Tue Apr 13, 2010 10:35 am
Location: Southern Alberta

Re: does Medicare require doctor visits every 6 months?

Post by nanwilson » Wed Jan 13, 2016 11:55 am

Digital.. the new doc is trying to pay off the loan on his Mercedes, or needs/wants to get a new one, and You are helping him to achieve his plan.
Its all about the almighty $$$$$$$$$$$$$$$$$$, the more patients he sees the more money he gets either from you or your insurer
Cheers
Nan
Started cpap in 2010.. still at it with great results.

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drdigital1
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Joined: Sat Aug 29, 2009 10:49 pm
Location: Evanston, IL

Re: does Medicare require doctor visits every 6 months?

Post by drdigital1 » Wed Jan 13, 2016 10:38 pm

nanwilson wrote: You are helping him to achieve his plan
drdigital1 wrote: If anything other than LIFETIME then I will just switch doctors .... maybe he needs patients and having an office visit every time a patient needs a cushion would make a nice revenue stream
So how exactly am I helping him??