Documentation for MediCare Policy and Apria

Hi everyone my name is Eric and my first time meeting with my doctor a month and a half after receiving my machine I learned that I was not in compliance, and knowing the machine was monitoring me I thought it pretty stupid to have to wait a month and a half to find out I wasn't complying. I drove to my local Apria and asked them why I wasn't receiving the information the machine was storing on me, after all I am the person who needs to make changes in order to comply. I don't know why I wasn't instructed on how to set up personal monitoring in the beginning. After setting up personal monitoring I began utilizing the machine more. Apria tells me they need my help obtaining the clinical paperwork that Medicare requires them to keep on file. This documentation is required in order for Medicare to pay for my CPAP system and supplies. Specifically documentation of the in-person meeting with my physician for the PAP re-evaluation. So I guess Apria is looking for documentation from my doctor that states on such and such date I was seen by him for a PAP re-evaluation and I had been compliant with using the machine bla bla bla. This needs to be completed and if I have to, I'll type something out and get the doctor to sign it or I will be billed. Am I understanding this request from Apria correctly?

Nope. You need a copy of the doctors notes for your face to face visit about your need for a cpap. A separate letter won't cut it if they are audited. In addition, they need a copy of your sleep study.

Medicare requires that you use the machine for at least 4 hours a night for 70% of the nights out of a consecutive 30 day period. That is the hours of use requirement.
The second requirement is a face to face interview/visit/office call with the doctor at sometime between the 31st and 90th day after you got the machine and started therapy...and that visits consists of him saying mainly that you are using the machine and it is working for you.
Those are the 2 main important requirements to get Medicare to pay for the machine and any continued supplies.
If it has been over 90 days...you will need to contact Medicare and do some begging and request extension or whatever they want you to do.

I don't believe that the face to face has to be with a sleep doctor....a visit and statement from your primary care physician should also work. They just want proof that you are using it and it's working and a doctor knows about it. I copy of the office notes would be sufficient as long as the cpap use is mentioned and that you are benefiting from its use...like feeling better, sleeping better, etc.