Did I fail compliance???

[Sonnyboy]

Hi,

I tend to worry a lot and have been worried ever since the DME office called on Friday.

I received the cpap machine on 11/25/2014 and started treatment on 11/28/2014 so my 90 day testing period ends on 2/22/15 or 2/25/2015.

I had my first MD appointment since starting cpap on 1/15/2015.
I met the 21 day [70%], over 4 hours rule during within a 30 consecutive day period last night. [The delay was due to no treatment 12/11 -12/26 d/t a severe sinus infection with bronchitis necessitating antibiotics.]

The best I can tell excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia are the symptoms used to determine if I am benefiting from therapy.
When the doctor asked if I thought cpap was helping I said no mostly because I would like to feel a whole lot better than I do right now in terms of lifting this morning brain fog I wake up with.

At the appointment I told the doctor I would have no difficulty achieving the 21 day compliance rule by today and could deliver the sd card tomorrow to show this.
She wanted me to make a second MD appointment before the end of the 90 day period and I have done this.

Friday the DME office called to verify my correct address to complete their 30 day Medicare billing.

Does this mean I have failed compliance?? Seems like they should wait until compliance is achieved. To submit a bill now will only result in a Medicare denial.

Past discussions with the DME office staff show me they understand the 30 day rule but not the 90 days allowed to achieve this goal.

I thought I had 90 days to show compliance. Is there a rule that says I can not have a second MD re-eval during this 90 day period???

My insurance is Medicare/capped bidding.

My MD had no comment on my data other than to say that everything looked good and the settings did not need to be changed.

My computer skills are limited but I am going to try to post my data next hoping someone on this site will provide me with some specific feedback regarding the data and

current settings.

Thank you

[squid13]

Here is Medicares compliance, Medicare Coverage of CPAP at Home

After the patient starts CPAP treatment at home there has to be documentation of patient compliance. This is done after 31 days but before 90 days of usage. They must have a download of the CPAP usage and a face to face re-evaluation with their physician. Their physician must document that the patients symptoms have improved. Adherence to CPAP is defined as usage greater or equal to 4 hours per night on 70% of nights during a consecutive 30 days anytime during the first 3 months of initial usage.

[Rtrtrt]

You've met only 1 part by meeting the usage compliance. By telling the physician you do not feel any better after using cpap, the physician more than likely documentated that you were not benefitting from the therapy. This results in you having to go back for another appointment.

Yes on paper it looks like one should wait until they've compliance to see the dr, however a lot of patients assume it is easy to get used to pap and schedule their appointments 6 weeks out and forget to reschedule.

[Sonnyboy]

Hi

I scheduled this appointment according to when the MD wanted to see me which was 30 days after starting therapy.
No one told me to achieve compliance in 30 days.
No one told me to it was important to reschedule if I had not achieved compliance in 30 days.

I did not have detailed instruction on compliance issues when they scheduled the MD appointment other than what I read in my internet searches which is 90 days.
I had no way to know to reschedule the appointment.

I have had many questions since November. The DME tech who trained me never responded to even one request for a phone call.

Have I failed compliance????

Would medicare really agree to pay for a second sleep study if I achieved compliance within 90 days.

That seems like a waste of medicare money.

Kathy

[Rtrtrt]

You didn't fail. You have 90 days to meet both the usage and physician portions. You just need to have another physician visit before your 90th day. Dme cannot submit bill for 4th month until both components are met. Months 1-3 are paid.

[Sonnyboy]

Thank you very much that makes me feel better.

I have no faith in the DME office staff completing the medicare forms correctly.

They just seem to understand even less than me which is not very good.

[cphilip]

So... let me get this straight... You so NO benefit at all from therapy? None? I

mean... thats what you told your doctor.

However you explain that to us as, as I read it, "I didn't see as much as I wanted". Am I reading that right?

[Sonnyboy]

Hi,

Thank you for your response.

My main complaints that led to a sleep study are abnormal excessive fatigue/naps, concentration/focus/memory issues, lack of productivity.

My lab work is normal. I am not overweight. A cardiac work-up shows a right bundle branch block, nothing more, and this is essentially not significant.
I was also getting up 3-4 times a night to use the restroom. This has decreased to 0-1 trips and this symptom improved with the Gabapentin prior to starting cpap.

The sleep study showed severe OSA and severe PLMD [periodic limb movement disorder]. I was totally unaware of the PLMD prior to the study. I started on Gabapentin 300mgm for the PLMD which is considered a low dose but I would not increase the dose because I have used Gabapentin in years past for a nerve pain related to ulnar neuropathy and discontinued use at that time due to severe fatigue.

Maybe I need to consider stopping the Gabapentin?

Going back to your question, my main concern is the excessive fatigue/naps, concentration/focus/memory issues/lack of productivity and this has not changed so I addressed the doctor's questions in terms of my main concerns only.

Maybe there are other symptoms I can address at the next MD appt???

[Sleeprider]

Have you tried looking at your sleep results for nights you've used the machine? What kind of sleep are you getting? The data should be pointing you towards what needs improved and a means to get there. The Airsense 1 for her that you got is capable of detecting AHI as well as other sleep disruptions (RERA). Without looking through your post history, I don't know if you've tried to improve the therapy by looking at the data and getting help. The efficacy of treatment is going to be adversely affected by leaks, mouth breathing, high AHI, RERA, flow limitations and other things you can see in the data. Have you looked?

[Sonnyboy]

Hi,

Thank you,

I have two posts going right now. The other is -how to post a screen shot. My computer skills are limited.

People on this site are helping me and I am working right now on trying to post.

I have not attempted to make cpap adjustments to date because I wanted the doctor to have first shot at this. She had no suggestions.

If you think adjustments are needed I can do it and am willing to but need to get that screen shot up for you first.

[Sleeprider]

Sounds like a plan. I saw the other thread a minute ago. F12 for screenshot, upload to hosing site, post link or image here.

Compliance is a pretty easy issue. The more important one is fine-tuning things to make your therapy work well, which makes it rewarding and improves your life. The data tells us if there is a problem, and can give us insights as to how to approach it. It still amazes me how few professionals actually are aware of the data produced by modern machines, and the value it can have in optimizing therapy.

[Sonnyboy]

Hi

Here is a screen shot from today's statistics.
Is there anything I can do to improve?

If daily shots would be more helpful let me know that too.

Thank you

[Sleeprider]

Two threads now with the same content. I'll copy my post from the other one since you said you wanted to use this as your ongoing thread.

Your average AHI is still high enough to be disruptive to sleep, but below the acceptable threshold of 5.0. Your AHI is mostly OA and H with a bit of CA....don't worry too much about the CA at this point. Your pressure range is 7-9 and the machine is pushing the average pressure to 8.8 and your 90% pressure equals your maximum pressure setting of 9.0. You've hit the ceiling and not completely stopping OA. You need to move that max pressure up to 11 or more, and see how it goes. I would also suggest dropping EPR to 2 or 1. All of these things will help stabilize an airway that is still obstructed at your current pressure.

[LSAT]

Hi

Here is a screen shot from today's statistics.
Is there anything I can do to improve?

If daily shots would be more helpful let me know that too.

Thank you

I don't see your graphs, but off hand I would raise your max pressure. Maybe to 11 or 12. By setting yours to 9 the machine cannot go higher even though there may be an apnea occurring.

[Sonnyboy]

Hi,
Thank you
I will make the suggested setting changes tonight and post graphs in a few days for your review.