Monthly Data Download Charges

[D.H.]

I wondered who he was directing this comment to?

At least this will prevent new charges from accruing while your dealing with this.

What was preventing new charges?

Removing the modem (per the "subject" line that I changed). It seems that there is no modem, so therefore any data charges are 100% illegit!

[D.H.]

Her machine does not have a modem. . . .

If there is no modem, then there's not way data charges can be legit!

[paprt]

In 2007, Medicare established a HCPCS code specific to a
monitoring feature device that is billable by DME suppliers.
HCPCS code A9279
Description: Monitoring feature/device, stand-alone or integrated,
any type, includes all accessories, components and electronics
not otherwise classified
This code applies to
pap equipment including remote monitoring software and
wireless monitoring devices, as well as the SD card. Suppliers
should bill A9279 when providing the equipment to the patient,
including the SD card at setup or when providing and using the
wireless monitoring device to remotely transfer compliance data.
Since there is no payment attached to the HCPCS code A9279
at this time, suppliers can bill commercial payors and payment
will be at their discretion, or consider negotiating payment with
payors directly.

Can a DME supplier bill for using wireless monitoring?
HCPCS code A9279 can be used to bill for wireless
monitoring. Medicare does not currently reimburse for
this code, but suppliers can try billing and/or negotiating
payment with commercial payors. HCPCS code A9279 does
not have a recommended frequency schedule, but should
be billed when the equipment is provided to the patient (ie,
in the first month of setup) and on an ongoing rental basis if
the patient continues to use the wireless monitoring device
equipment.

Sounds like your DME is billing you for something that most (if not all) insurances don't pay for. They are billing you legitimately but, that said, the vast majority of DMEs don't do this to their patients.

[GTOJim]

Thank you for this information. If I'm reading this correctly, the DME should only bill on a ongoing basis (monthly) when wireless is being used?

In 2007, Medicare established a HCPCS code specific to a
monitoring feature device that is billable by DME suppliers.
HCPCS code A9279
Description: Monitoring feature/device, stand-alone or integrated,
any type, includes all accessories, components and electronics
not otherwise classified
This code applies to
pap equipment including remote monitoring software and
wireless monitoring devices, as well as the SD card. Suppliers
should bill A9279 when providing the equipment to the patient,
including the SD card at setup or when providing and using the
wireless monitoring device to remotely transfer compliance data.
Since there is no payment attached to the HCPCS code A9279
at this time, suppliers can bill commercial payors and payment
will be at their discretion, or consider negotiating payment with
payors directly.

Can a DME supplier bill for using wireless monitoring?
HCPCS code A9279 can be used to bill for wireless
monitoring. Medicare does not currently reimburse for
this code, but suppliers can try billing and/or negotiating
payment with commercial payors. HCPCS code A9279 does
not have a recommended frequency schedule, but should
be billed when the equipment is provided to the patient (ie,
in the first month of setup) and on an ongoing rental basis if
the patient continues to use the wireless monitoring device
equipment.

Sounds like your DME is billing you for something that most (if not all) insurances don't pay for. They are billing you legitimately but, that said, the vast majority of DMEs don't do this to their patients.

[Pugsy]

If I'm reading this correctly, the DME should only bill on a ongoing basis (monthly) when wireless is being used?

No, wireless is just an example they used for the billing code (that covers all forms of data download evaluation from wireless to bringing in the SD card) that is supposed to be used for this service....which Medicare won't pay for and won't allow any charges for and when a provider is a participating provider with Medicare if Medicare disallows something then they can't bill the patient for it. Most DMEs will be Medicare participating providers.

Now some other private insurance outside Medicare might "allow" it and pay something for this service but that's up to the particular insurance. Most will follow Medicare's lead though. If Medicare doesn't allow it....they won't either.

[chunkyfrog]

As usual, your mileage may vary (YMMV). For example BCBSNE had no problem with upcharges,
and coding a Quattro cushion as a MASK KIT (without headgear) to get paid for more than delivered.
Small wonder they continued to send me reminders to get supplies, MONTHS after I was using cpap.com for all my cpap stuff.
Can anyone say, "kickbacks"?

[paprt]

If I'm reading this correctly, the DME should only bill on a ongoing basis (monthly) when wireless is being used?

No, wireless is just an example they used for the billing code (that covers all forms of data download evaluation from wireless to bringing in the SD card) that is supposed to be used for this service....which Medicare won't pay for and won't allow any charges for and when a provider is a participating provider with Medicare if Medicare disallows something then they can't bill the patient for it. Most DMEs will be Medicare participating providers.

Now some other private insurance outside Medicare might "allow" it and pay something for this service but that's up to the particular insurance. Most will follow Medicare's lead though. If Medicare doesn't allow it....they won't either.

This is not a case of disallowance but, rather, denial.

Disallowed Amount — A disallowed amount is the difference between a charge and the amount an insurance company approves. In some cases the patient is required to pay this difference.

Denial — When an insurance company decides not to pay for part or all of a medical bill, it’s called a denial. Denied amounts may be charged to the patient.

In a nutshell, the DME bills many different codes when a PAP is set up. Each code either has an allowed amount (an amount that is agreed upon to be paid by the insurer, assuming participation), or is simply not a covered code (denied). The HCPCS code for the monitoring feature/device is not a covered code and billing can be passed on to the patient for payment.

But again, this is the first I've heard of a DME actually billing the patient for this.

[paprt]

Thank you for this information. If I'm reading this correctly, the DME should only bill on a ongoing basis (monthly) when wireless is being used?

They can legitimately bill this code simply for providing a unit with monitoring capabilities, ie: wireless or SD card, even if they never check the transmission or data. The billing is for the "monitoring feature/device", not the actual monitoring of that feature/device. In most cases, the DME doesn't monitor beyond the 90 day compliance requirement but the doctor may use the monitoring feature/device throughout the patient's care. Just like the DME can bill for a cpap even if the patient isn't using it (assuming compliance is met, of course), they can bill for the monitoring feature/device even if it's not being utilized.
Think of the billing code as being for a thing, not a service.

[chunkyfrog]

But if Medicare will not pay it, I consider it a scummy, dishonest thing to do,
and said DME would immediately LOSE my business and that of anyone I can influence.

[paprt]

But if Medicare will not pay it, I consider it a scummy, dishonest thing to do,
and said DME would immediately LOSE my business and that of anyone I can influence.

I remember the days when Medicare did not pay for humidifiers and the patient had to pay out of pocket if he/she wanted one. A humidifier was considered an unnecessary optional accessory.
I agree that the DME should not bill the patient for the "monitoring feature/device". But I'm also of the opinion that Medicare, BCBS, or any other insurance that requires compliance monitoring should pay for the technology that makes the monitoring possible.

[chunkyfrog]

Abso-freakin'-lutely!
Medicare should refuse to cover "bricks".
Insurance companies should be forbidden to cover them as well.
Then they would be limited to travel and bong use.