Will Medicare switch out a machine mid-rental?

[oscar98]

They said they would pay this 13 month rental only once every 5 years.

Jerry do you know if the 5 years starts when you take delivery of the machine or if it starts when the 13 months is up? I've gotten conflicting answers from 2 dif DME's.

[6PtStar]

They said they would pay this 13 month rental only once every 5 years.

Jerry do you know if the 5 years starts when you take delivery of the machine or if it starts when the 13 months is up? I've gotten conflicting answers from 2 dif DME's.

As I remember They said the 5 years was from the time the machine was received. They did tell me that if the machine broke after the 2 year warrenty they would pay to have it fixed unless it could not be fixed or that it cost more to fix than a new one would cost then they would start the 13 month rental even if the 5 years was not up. "Honest it fell off the table and the car that ran in my back door ran over it and it broke!!"

Jerry

[akcpapguy]

They said they would pay this 13 month rental only once every 5 years.

Jerry do you know if the 5 years starts when you take delivery of the machine or if it starts when the 13 months is up? I've gotten conflicting answers from 2 dif DME's.

Oscar,

According to Medicare the 5 years starts from the date of purchase, so this would be the end of the 13th month of rental.

Many DME's will tell you they will accept what is left on your 13 months of rent, however they will take you "unassigned". DO NOT, DO NOT do this, you will have to pay upfront for the BILLED amount and than you will recieve a check rom Medicare after the DME courtesy bills on your behalf. You will only recieve a check for the ALLOWED amount only, which will be much less than the billed amount.

[6PtStar]

According to Medicare the 5 years starts from the date of purchase, so this would be the end of the 13th month of rental.

Opps, you are right, I did not get then to define date of purchase!! Made an assumption that it was when I got it and it was over 3 years ago. You never make an assumption with Medicare.

When I switched DME's and machines I did not have any problems nor did I have to pay anything to the second DME they just received the remaining 11 rental payments from Medicare. I was not billed the entire bill. I don't know if this is a change but I did not have any problems with this billing. They were a Medicare Contractor not just a Medicare Provider.

Jerry

[akcpapguy]

Yup you are correct Jerry, I should have explained a little more.

There are (like in Jerry's case) companies who will accept you as "assigned" and you will only be responsible for the copay. I just wanted you to be aware of the "unassigned" situation and not jump into anything. It does not matter if the company is a Medicare contractor or supplier or anything else Medicare, they have the right to take you on as "assigned" or "unassigned", and you have the right to promptly say NO in the later case.

[oscar98]

akcpapguy, can you explain the assigned / unassigned thing to me? We have not encountered this before so I'm not sure what it means.

sorry about the hijack maybe I should start my own thread titled a million and one dumb questions cause I sure have plenty of dumb questions to ask.

[Slinky]

No, no, Oscar!! NOT a dumb question. I, too, would like an explanation of Medicare "assigned" and "unassigned".

[akcpapguy]

There is no dumb question when dealing with Medicare Oscar. I don’t think SU will mind the Medicare questions here since this discussion directly relates to the original question.

Ok, so on to “Assigned” vs “Unassigned”

“Assigned”
If you get equipment from a Medicare contractor/provider and they take you on as “Assigned”, you are only responsible for your Medicare copay. The only time this would change is if you sign an ABN, at that point you become responsible for the complete bill IF Medicare denies payment for the item.

“Unassigned”
If you get equipment from a Medicare contractor/provider and they take you on as “Unassigned”, you are automatically responsible for the complete billed amount. Depending on the DME you may be required to pay the whole amount upfront and they will courtesy bill Medicare, you would than receive a check reimbursing you for 80% of the Medicare allowable. The DME may only require you to pay the difference between the billed amount and the 80% of allowable amount, the DME would than courtesy bill Medicare and they would get the check for the 80% of allowable.


In the above example I was speaking about equipment in general, not specifically PAP equipment. This rule applies to all DME equipment, with a few exceptions, so if you are in this situation run the numbers and see what would be more economical for you.


Sorry it took so long for me to respond, hockey game is on!!!

[akcpapguy]

Bump for those who were interested.

[Slinky]

Thank you, AKCPAPGuy.

[provider]

Hi, I'm actually one of those dreaded DME providers. Medicare unfortunately views a CPAP and Auto CPAP as the same billing code. If your equipment is not yet purchased and you've met the 90 day compliance guidelines then you can exchange to an Auto without issue. If your equipment is purchased an Auto CPAP will be out of pocket. If you're wanting one for permanent placement you may want to consider that or a BiPAP Auto. A BiPAP Auto is a different billing code so if it works for you it would be covered if you meet Medicare guidelines. As of April this year they've added some new guidelines to Bilevel coverage as well. However, if your goal is just for titration and you want to avoid a lab you might consider asking a local DME what the private pay cost would be for a 2 or 3 week rental for a home Auto CPAP titration if that would be easier than going to another study.

[Slinky]

THANK YOU for the clarification, Provider. It is appreciated.