Medicare's New Law

[jwerley]

I heard yesterday in talking to a nurse at the sleep lab that Medicare is now requiring all sleep apnea patients be seen in follow-up every six months.......and that most other insurance companies will probably follow these guidlines. If you don't do this, they will not pay for your supplies.

I was wondering if anyone else had heard this?

Janice

[muchojo]

My New (Sleep )Doctor since 2010 wants to see me Once a year or they don't want to order my supplies.

The Previous Doctor ( Nurse Practioner ) just took my call on the phone and had the supplies Ordered ( six years ). Of course she was my Primary Care Physician, not just Sleep Doc.

Just saw my Doctor today so he could make the Order. They couldn't read the SD card but didn't care, they just gave me a new one. I came home and the old one works fine. I would think they can just call my PCP and ask her about my health, why they need to see me when it make no difference to them. I could have just answer their questions over the phone or email.

[Julie]

Your PCP can't report on your health (in good conscience) unless she's actually seen you. If something were wrong, whether or not you're actually aware of it when seen, she could lose her license!

[Rob108]

I just had my 1st follow up with my sleep doc & dme (also my first on medicare insurance coverage) and when I scheduled my next follow up I was given an appointment one year out.

[muchojo]

Yes, Julie. I saw my PCP once a year for the yearly checkup. So she always just ordered my supplies when I call her.

My current PCP also sees me once a year so she can relate the info to my Sleep Doc who are both in the same Medical Clinic now that the service is divided.

I order every six Months so they don't see me but once a year they don't really know my health at the precise order time, they just go by the Calendar.

[helene]

I got the same notice from my clap supply provider. They implied that I needed a sleep study at a sleep center (which I can't do- see previous post). It sounds like it was enough to get a prescription from you pcp without a new study. That would be a godsend if true. I'll definitely call medicare.

[ems]

I saw my sleep doctor a few weeks ago. I then called my DME to order supplies and a new mask. Was told that they had to get a script from my doctor before they could send anything; it had been more than a year since I saw her. They had the office fax over a script and the DME said today the supplies would be in the mail and that I'm good to go for another year.

They are still waiting on the Nano mask (not sure what that's all about) and will send it "soon'. I'm sure I'll get it... they have been good in the past and that's how they make their $$$$.

Curious about medicare and the six month requirement. I'm sure I'll find out soon enough.

[bobbi4272]

I saw my sleep doc today. As I was leaving, I had to sign a form stating I agreed to see the doctor once a year due to compliance issues. The form was for Medicare and all other insurance companies. It's the first time I've been asked to sign anything like that.

[VikingGnome]

Medicare requires you to have an annual face-to-face visit with your sleep doctor in order to have CPAP supplies covered.

[chunkyfrog]

It seems that Medicare needs a sleep study within 5 years before joining Medicare, otherwise a new one must be done.
I was told that mine, done in 2010, is acceptable, even though the lab/DME is not a Medicare provider.

[Sleep2Die4]

It seems that Medicare needs a sleep study within 5 years before joining Medicare, otherwise a new one must be done.
I was told that mine, done in 2010, is acceptable, even though the lab/DME is not a Medicare provider.

Are you sure about that?

My last study was over 15 years ago and Medicare pays for my supplies regularly. In fact I made an appointment with the doc because my CPAP is 7 years old and the doc said at the appointment he will write a letter to Medicare and they will pay for another machine without needing to have another sleep study.

I guess I will find out soon.

[StuUnderPressure]

It seems that Medicare needs a sleep study within 5 years before joining Medicare, otherwise a new one must be done.
I was told that mine, done in 2010, is acceptable, even though the lab/DME is not a Medicare provider.

Medicare does NOT require another Sleep Study if yours is over 5 years old.

Medicare only REQUIRES that your Sleep Study meets their current requirements. Basically, uses the right current terminology.
Any Sleep Study that meets those requirements would be accepted by Medicare not only for supplies, but also for a new machine.

My Sleep Study done over 15 years ago was acceptable to Medicare.

[chunkyfrog]

Sleep2die4: According to your stated age, your sleep study was when you were 68.
I assume you were on Medicare at the time? --or started within 5 years of that age?
I was informed that if my last sleep study was within 5 years of when I started Medicare, that it would be accepted.
Of course, the "gubmint" changes some rules every year; and my information was for this year's enrollment.

[ClayL]

My wife started on CPAP about three days ago. She was told she will have to see a doctor within 32 days after her start date. They said it was a Medicare requirement.
We will be wintering in Bouse AZ in our motor home. We will need to find a doctor near there that can see her I guess.

The DME said that it does not have to be asleep doctor. That doesn't sound right but since it will much easier for us we will go with that. We are about 50 miles round trip from doctors in Parker where there are no sleep doctors and about 120 miles round trip from sleep doctors in Lake Havasu.

When I started using CPAP seven years ago they didn't check compliance - just took my word for it. Now they are serious about checking it. Her Resmed S9 has a wireless monitor that can put the data on a web site for the DME. That's the good news for here in CO. The bad news it uses a GSM data net connection and I believe that pretty much means we will need to be in an AT&T or partner coverage area.

Where we spend the winter in AZ there is no AT&T coverage but there is 2G (very slow) partner coverage. If that doesn't work we will have to send the SD card back and forth I guess.

[Pugsy]

The DME said that it does not have to be asleep doctor. That doesn't sound right

It doesn't have to be a sleep doctor. The main reason for the visit is that there is documentation that the patient says they are using the machine and that they are doing well....coming from a doctor. ...any doctor will do.
It's called a face to face interview discussing the therapy. I think that all is needed is for the DME to get a copy of that doctor visit and they do the rest. It's not highly technical...or doesn't really need to be.
The requirement is for a "face to face" interview with doctor somewhere between the 31st and 90th day after receiving the equipment and sometime during those 90 days there needs to be 30 consecutive nights where compliance hours of use is met which is 4 hours a night for 70% of those 30 nights.