Will Medicare switch out a machine mid-rental?

[SleepingUgly]

What are the conditions under which Medicare would swap out a machine during a period of rental? Would it an Rx from the doctor saying he wants the patient on Auto-PAP instead of their current CPAP do the trick? Also, what happens to the machine after the 13 months that Medicare rents the machine? Thanks!

[LSAT]

After 13 month rental, Medicare says you own the machine. Good time to switch DME if you are not satisfied.

[SleepingUgly]

After 13 month rental, Medicare says you own the machine. Good time to switch DME if you are not satisfied.

So during the 13 month period, that is when requests should be made, such as wanting to switch from a CPAP to an Auto-PAP?

[OldLincoln]

Or when you first go on Medicare mid contract.

[SleepingUgly]

So what are their options if they want to switch machines from a CPAP to an APAP?

[-SWS]

Would it an Rx from the doctor saying he wants the patient on Auto-PAP instead of their current CPAP do the trick?

I don't know for sure. But I think a letter of medical necessity along with that new RX should do the trick---since by definition CPAP becomes insufficient if APAP is medically necessary.

However, I also think any letter of medical necessity can be readily rejected if the letter's underlying claim of medical necessity is not clearly substantiated. Unfortunately, that's just guesswork on my part. Hopefully someone can offer concrete answers...

Good luck.

[jules]

there have been some cases in the forum

there is something about restarting the contract too in certain cases so the 13 months starts again but I am not familiar with the details on what would trigger that

perhaps one of the RT's can post that information tomorrow

[LinkC]

I successfully switched after one month (but it wasn't Medicare). What they did was extend the "rental" by one month, so I paid an extra month's co-pay, and my insurance paid the extra month. I DID have a new 'script specifying APAP; otherwise I'm pretty sure my insurance would have balked. I did NOT have to show them any data indicating medical necessity, just the 'script. Medicare may be more stringent, however.

But I'm sure it can be worked out...it just has to be stronger than "I just want to upgrade..."

[SleepingUgly]

I'm going to bump this up and see if one of the DME/RTs on this site (or anyone else) knows...

[Slinky]

An APAP is a CPAP. An APAP and a CPAP are the exact same HCPCS code. Medicare pays by HCPCS code, not by brand and/or model. This far into your rental contract even a Letter of Medical Necessity from your doctor will be hard to sway the powers that be given it would be switching one HCPCS code e0601 for another e0601.

[SleepingUgly]

An APAP is a CPAP. An APAP and a CPAP are the exact same HCPCS code. Medicare pays by HCPCS code, not by brand and/or model. This far into your rental contract even a Letter of Medical Necessity from your doctor will be hard to sway the powers that be given it would be switching one HCPCS code e0601 for another e0601.

I don't understand the rationale for this. A new titration would cost more than an APAP. But even if we assume that Medicare doesn't care, if the doctor orders an APAP, and states that it is necessary, doesn't the DME have to do what the doctor says? Is this a matter of how hard the doctor fights for it? Actually, the more I think about it, it seems to be less of an issue for Medicare, as they would just keep paying the same rental fee, and it seems more like the DME could do it if they want to. Am I right? If so, this is purely a function of how the doctor can press on the DME, and how much the DME will yield to the pressure, no?

[oscar98]

I'm going to bump this up and see if one of the DME/RTs on this site (or anyone else) knows...

I'm certainly not and RT but I recently swapped swapped DME's mid rental to get the S9. My husband is on medicare and when I swapped my rental to the new DME they asked me if he had finished his 13 months rental. They were willing to take over what remained of his rental time and give him an S9 as well. Unfortunately he just finished his 13 months and his machine is now considered paid for.

Long story short, if the current DME won't let you swap for what you want then call around and see if you can find a DME that will take over the remaining rental time and give you what you want.

The process for moving to a DME =
1. Find the DME that will be willing to work with you and the remaining rental time.
2. Give them you medicare info, prescription etc so they can confirm what you have left as far as rental and make sure it's a smooth transition.
3. Get new equipment set-up.
4. Return what you currently have to the old DME making sure to get a drop off receipt. It may be necessary to give you old DME a letter stating you no longer what their services. (ask new DME about this)
5. Take the drop off receipt to the new DME so that they can call medicare and prove you returned the other machine and can cancel the prior approval given to the old DME and have it transferred over tot he new company.

Also, double check what the delivery date was for getting your current machine and try to initiate this process before your old DME has a chance to bill medicare for another month of payment and thereby shortening the number of payments the new DME will get.

This is how it was all explained to me by the billing manager at the DME that we just switched to.

Hope it was of some help.

[SleepingUgly]

Thanks, Oscar!

[elena88]

I am not on medicare, but I switched my new system one a flex auto had it sixty days, brought it in, doc switched it to S9 auto.
DME did the switch because I was still right on the two month "rent it switch it, or buy it" timeline.

If I had been a day later, maybe I could not have switched it out.. .. however, the appt for the doc and dme was MADE by them for me on that date
on purpose so I would be in the time line.. Now Im very glad I didnt postpone the appt!

It probably would have been a good idea for newbie like myself to get all the information I could about the contracts with the DME's before I signed on the dotted line, but when you have that "deer in the headlights" experience, its hard to be a critical thinker when they shove that clipboard in your face,
and say... "just sign here please.."

[6PtStar]

Let me see if I can help. I am on Medicare and they bought my machine in 12/06 so it has been a while and rules may have changed a bit. Medicare told me they would pay rental for 13 months at which time all the rental money would be applied to the purchase and I would own it at that time. I received a receipt of ownership after the 13 month rental. They said they would pay this 13 month rental only once every 5 years. They told me the only way they would start the 13 month rental over was if I had a letter of medical necessity to switch to a machine of a diferent code (Bi-Pap, Vpap etc.) Cpap and Apap are the same code e601 so they will not start the rental period over to change from cpap to apap. Same story if you decide to change DME's. I changed DME's and machines after 2 months. The second DME only got paid 11 months rental. They agreed to this before taking me as a patient. The first DME and first machine received 2 months rental. If you can get a script from your doctor and get your DME to make the change they will receive the 13 month rental which must cover both machines. I don't hink this part has changed but I have not talked to Medicare on this in a while.

Jerry