Better to use Medicare for new apap, or buy used/new?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
PopIsGettingGrumpy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by PopIsGettingGrumpy » Tue Aug 17, 2021 12:50 pm

I'm quickly trying to get our sleep doc to add "mask of patients choice" to my father's rx. In the process they forwarded the text of his rx. It is normal for them to list quantities and refill allowances on a cpap rx?
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Pressure: 5-9 cmH2O. (Minimum can be adjusted to patient comfort.)
Flex/EPR setting to patient comfort.
Ramp to patient comfort.

_____________________________________________________________________

CPAP - E0601 - QTY: 1 - Replaceable after 5 years
Humidifier - E0562 - QTY: 2 - Replaceable after 5 years

Nasal Mask - A7034 - QTY: 1 - Every 90 days - refills 3
Nasal Cushion - A7032 - QTY: 2 - Every 30 days - refills 12
Nasal Pillows - A7033 - QTY: 2 - Every 30 days - refills 12
Headgear - A7035 - QTY: 1 - Every 180 days - refills 2
Chinstrap - A7036 - QTY: 1 - Every 180 days - refills 2

Pressure Filters - A7038 - QTY: 2 - Every 30 days - refills 12
Foam Filter - A7039 - QTY: 1 - Every 180 days - refills 2

Water Chamber - A7046 - QTY: 1 - Every 180 days - refills: 2
Heated Tubing - A4604 - QTY: 1 - Every 90 days - refills 3
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ChicagoGranny
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Re: Better to use Medicare for new apap, or buy used/new?

Post by ChicagoGranny » Tue Aug 17, 2021 1:40 pm

Some blooming bureaucrat that set up the form in their system had multiple orgasms doing it.

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Pugsy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Pugsy » Tue Aug 17, 2021 1:55 pm

The doctor's RX has very sneakily made it so you have to come see him again in a year and get a new RX.
The way he did it...not usual way.
My RX says

"cpap with heated humidifier at 8 cm pressure....masked of patient's choice"
Duration....99 months which is code in the medical world for a lifetime RX.
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SleepGeek
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Re: Better to use Medicare for new apap, or buy used/new?

Post by SleepGeek » Tue Aug 17, 2021 1:56 pm

PopIsGettingGrumpy wrote:
Tue Aug 17, 2021 12:50 pm
I'm quickly trying to get our sleep doc to add "mask of patients choice" to my father's rx. In the process they forwarded the text of his rx. It is normal for them to list quantities and refill allowances on a cpap rx?
Yes it is. The more supplies we buy from them the larger their revenue stream. Just like doctors, your next appt will be when your insurance will pay, it's that simple.
Why folks dont like it when you treat em the way they treat you?
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PopIsGettingGrumpy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by PopIsGettingGrumpy » Tue Aug 17, 2021 2:19 pm

That was my gut instinct about that RX as well. I suppose there isn't anything we can do about that, is there? Are we stuck having to see the doctor in a year just to get a new rx to reorder supplies? That seems bogus considering medicare determines how often supplies can be given and my father is now diagnosed with sleep apnea.

For even more fun... the doc is refusing to put "mask of patients choice", stating that medicare insists that a specific type of mask is listed. I said we didn't want to have to jump through hoops anytime my father wanted to try a different type, and they are holding their ground. They said if my father wants to try a different type of mask the supply company can contact the doctor to let them know at that time.

We leave for our appointment in an hour and a half and I'm already feeling discouraged with this whole process.
Resmed Airsense Autoset 10: Pressure 5-9
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SleepGeek
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Re: Better to use Medicare for new apap, or buy used/new?

Post by SleepGeek » Tue Aug 17, 2021 3:14 pm

But this is a sign its time to find another doc. Is this a sleep doc?
PopIsGettingGrumpy wrote:
Tue Aug 17, 2021 2:19 pm
For even more fun... the doc is refusing to put "mask of patients choice", stating that medicare insists that a specific type of mask is listed. I said we didn't want to have to jump through hoops anytime my father wanted to try a different type, and they are holding their ground. They said if my father wants to try a different type of mask the supply company can contact the doctor to let them know at that time.
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
AC VAuto 20/14
palerider aka GrumpyHere wrote: What exactly do you think you're adding to this thread?

PopIsGettingGrumpy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by PopIsGettingGrumpy » Tue Aug 17, 2021 3:36 pm

Yes, my father is going through Medicare and hoped to do so for supplies. Is that the reason for the 1 year rx?

We went through Asante Sleep Specialists in Medford, Or. The doctor states that medicare requires a type of mask to be listed, although I was simply asking him to include "mask of patients choice".
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SleepGeek
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Re: Better to use Medicare for new apap, or buy used/new?

Post by SleepGeek » Tue Aug 17, 2021 3:41 pm

PopIsGettingGrumpy wrote:
Tue Aug 17, 2021 3:36 pm
Yes, my father is going through Medicare and hoped to do so for supplies. Is that the reason for the 1 year rx?

We went through Asante Sleep Specialists in Medford, Or. The doctor states that medicare requires a type of mask to be listed, although I was simply asking him to include "mask of patients choice".
YES.
Medicare has rules but don't care which mask we use ever.
Or cpap or anything else.

Time to ask, maybe someone on here knows a sleep doc in your area. Finish today but keep eyes wide open.
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
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Janknitz
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Janknitz » Tue Aug 17, 2021 6:23 pm

This appears to be a sleep doctor--a Primary Care Doctor wouldn't put the HCPCs codes and quantities on an RX.
Any doctor (or dentist for that matter) can write a prescription for CPAP and supplies. So ask the Primary Care Doc to write a prescription for "mask of patient's choice".
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Okie bipap
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Okie bipap » Tue Aug 17, 2021 6:34 pm

My wife and I are both on Medicare, and our prescriptions stated "Mask of patient's choice (HCPC A7030 or A7034)".
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Pugsy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Pugsy » Tue Aug 17, 2021 6:36 pm

PopIsGettingGrumpy wrote:
Tue Aug 17, 2021 2:19 pm
the doc is refusing to put "mask of patients choice", stating that medicare insists that a specific type of mask is listed. I
Bold faced lie.

Medicare pays by HCPCS billing code. They could care less what brand or type of mask someone uses.
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PopIsGettingGrumpy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by PopIsGettingGrumpy » Tue Aug 17, 2021 11:16 pm

Thank you for the additional replies. I will definitely ask his primary care provider if they can write the rx for supplies down the road. As it stands now, we got the machine but they would not budge on requiring a card on file. I used a credit card that I'm prepared to cancel if it looks like we'll have any trouble with compliance or billing (didn't have time to get a prepaid card). I also read the paperwork carefully and there was no ABN included.

We got the Resmed 10 Autoset and a nasal mask that fits well - he liked the AirFit N20 and will try a chinstrap. I tried it as well and it seems pretty comfortable.

I see that there is a sleep report function on which we can choose to change the frequency. Does doing so affect the compliance data collected to verify his compliance, or is it purely informational for us? Also, I see mentions of using MyAir, Oscar and SleepyTime on the forum - are those resources we can use without interfering with compliance data collection for Medicare? I'll research as well, I'm just honestly overwhelmed by so much research at this point.
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Pugsy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Pugsy » Tue Aug 17, 2021 11:41 pm

PopIsGettingGrumpy wrote:
Tue Aug 17, 2021 11:16 pm
see that there is a sleep report function on which we can choose to change the frequency. Does doing so affect the compliance data collected to verify his compliance, or is it purely informational for us? Also, I see mentions of using MyAir, Oscar and SleepyTime on the forum - are those resources we can use without interfering with compliance data collection for Medicare?
OSCAR is based off the old no longer updated SleepyHead software....so just look at OSCAR.

Nothing you do in regards to looking at the data the machine collects will impact any compliance requirements at all and in fact no one will know you even looked if you don't tell them.
MyAir is an online website portal for patients to view their data. Not nearly as detailed as OSCAR but it is available and some people find it is enough.
DMEs and doctors use something similar to MyAir to monitor compliance usage, etc. It's called AirView. I have never seen one of those reports but I hear it has more details available than what the patient has on MyAir.

The Sleep Report that you can see on the LCD screen each morning and has different parameters for what it shows...1 day, 1 week, 1 month, etc...Looking is just looking and again no one will know unless you tell them.

If you want to use OSCAR you will need a SD card in the machine to get the data so you can download the SD card contents to the OSCAR program. I don't know if the machine will have a SD card already inserted. If it doesn't you can get one from WalMart...cheap generic will work. Just don't get anything larger than 32 GB or OSCAR will have a problem....and actually 2 GB is sufficient but it's hard to find 2 GB anymore. I think the last I saw at WalMart was 16 GB minimum.

Note the SD card MUST be inserted in the machine to get the detailed data files to show all the graphs and there is nothing anyone can do. I have had occasions where I download to OSCAR and then forget to remove the SD card from the computer and put it back in the cpap machine....then remember it the next morning....too late. We can still get summary numbers but no detailed data files. The machine doesn't store anything but summary numbers on its internal memory.
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PopIsGettingGrumpy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by PopIsGettingGrumpy » Wed Aug 18, 2021 12:20 am

Fabulous, thanks. Ours came with a 4gb SD card in it. I'll start researching OSCAR as we'd love to have as much info as possible.
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Pugsy
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Re: Better to use Medicare for new apap, or buy used/new?

Post by Pugsy » Wed Aug 18, 2021 12:26 am

Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.