What Happens If You Fail Compliance?

With Medicare, If you fail to meet compliance, you need to have a repeat study. Under Medicare a drs note stating what issues you are having doesn't cut it. Yes this was posted above. Some private insurances will give you longer than the 90 day trial others will not. And yes, if you don't meet the compliance the pap has to be returned or the user has to pay for it out of pocket. DME's are the ones involved and keeping track of all of this, not the physicians.

Rtrtrt wrote:With Medicare, If you fail to meet compliance, you need to have a repeat study. Under Medicare a drs note stating what issues you are having doesn't cut it. Yes this was posted above. Some private insurances will give you longer than the 90 day trial others will not. And yes, if you don't meet the compliance the pap has to be returned or the user has to pay for it out of pocket. DME's are the ones involved and keeping track of all of this, not the physicians.

LOL

Rtrtrt wrote:With Medicare, If you fail to meet compliance, you need to have a repeat study. Under Medicare a drs note stating what issues you are having doesn't cut it. Yes this was posted above. Some private insurances will give you longer than the 90 day trial others will not. And yes, if you don't meet the compliance the pap has to be returned or the user has to pay for it out of pocket. DME's are the ones involved and keeping track of all of this, not the physicians.

I agree 100%.


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In the case that a CPAP is either repossessed or paid for by the patient, I wonder if the Medicare contract price assignment is still valid, or the the DME is then free to charge their full retail rate? If the latter, this would seem to be a lot of incentive for the DME to fail the patient for non compliance. Is the patient credited for prior rental payments, or is full payment or rental due?

It's incredible the bureaucracy that has grown around the provisioning of CPAP equipment. The documentation of compliance adds a lot of professional labor costs on top of the equipment costs, and the DME ends up being between a rock and a hard place to satisfy government regulation and patient desires for effective low-cost, equipment with extra features.

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