Yearly Sleep Doctor Appointments?

I've been on a CPAP machine now for about 3 years. Around that time I ended up in the hospital and was diagnosed with an irregular heartbeat probably caused by sleep apnea. I was released from the hospital and an hour later had an appointment with a sleep doctor they had set up. This sleep doctor setup a sleep study (actually ended having two) and then prescribed a CPAP machine.

After prescribing the CPAP machine a year went by without any contact with the doctor until one day his nurse called and said he wants to see his patients once a year... been going every year since then.

Ok here's want I want your input on. Do you think it's necessary to keep seeing him since I already have my CPAP machine? I don't want to burn any bridges by quit going, but on the other hand is it necessary? Is this just another doctor wanting that steady income by seeing their patient every 6 months or every year or would there be a medical reason for these yearly appointments?

By the way I actually like this doctor so that's not an issue. Can you foresee anything in the future where it would pay off to be in good standings with this doctor?

countryboy wrote:I've been on a CPAP machine now for about 3 years. Around that time I ended up in the hospital and was diagnosed with an irregular heartbeat probably caused by sleep apnea. I was released from the hospital and an hour later had an appointment with a sleep doctor they had set up. This sleep doctor setup a sleep study (actually ended having two) and then prescribed a CPAP machine.

After prescribing the CPAP machine a year went by without any contact with the doctor until one day his nurse called and said he wants to see his patients once a year... been going every year since then.

Ok here's want I want your input on. Do you think it's necessary to keep seeing him since I already have my CPAP machine? I don't want to burn any bridges by quit going, but on the other hand is it necessary? Is this just another doctor wanting that steady income by seeing their patient every 6 months or every year or would there be a medical reason for these yearly appointments?

By the way I actually like this doctor so that's not an issue. Can you foresee anything in the future where it would pay off to be in good standings with this doctor?

Some health insurers may have requirements for regular visits, not sure. But if you like this doctor, and he knows his stuff, I would personally continue seeing him once a year. If you encounter problems with your treatment, you would have a doctor already familiar with your case who could help.

Why not use Sleepyhead software to see every night what takes place - you'll then know more than your MD ever will about your state of state!

If your insurance pays and the doctor gives solid advice, do it.

countryboy wrote:Ok here's want I want your input on. Do you think it's necessary to keep seeing him since I already have my CPAP machine? I don't want to burn any bridges by quit going, but on the other hand is it necessary? Is this just another doctor wanting that steady income by seeing their patient every 6 months or every year or would there be a medical reason for these yearly appointments?

I've been on cpap for 10 years, with stable treatment for about 9.5 years. I buy my equipment without insurance through cpap.com. I've got a very good sleep doctor, and still go to my annual appointments. They're pretty boring at this point because nothing has changed in my treatment, and I'm 100% compliant with my cpap usage. The annual appointments keep my prescription current so I can keep getting equipment. You never know when you'll need to replace something. Just recently, the cpap I had been using for nearly 9 years started getting a burning smell whenever I turned it on. With a current prescription, I was able to just order a new one without having to see my doctor again, which is important since it's a 2 day drive from my winter residence.

The annual visits aren't cheap, but for me, it's worth it.

I'm on MediCare, which requires an annual visit with the sleep doc. Without it, they won't continue paying for supplies. For my last visit, he asked that I bring my machine, and the highlight of our 15 minute together was his excitement at seeing the "end cover" I had purchased to replace the humidifier on my Airsense machine.

Thanks for all the replies that was the Input I was looking for. You’ve made many valid points for keeping my yearly appointments so that’s what I’ll do. I’ve debated the last couple of years whether to quit or not but your posts have made it an easy choice.

Plus I too have Medicare and I never realized yearly appointments are required so that is good to know... learned something.

Thanks again!

The only place I have been able to find the yearly requirement is in the Medicare Program Integrity Manual, paragraph 5.8.2. The manual states "However, documentation from the physician or treating practitioner that indicates the CPAP or RAD which requires replacement accessories continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy."

Okie bipap wrote: ↑

Fri Nov 10, 2017 8:57 pm

The only place I have been able to find the yearly requirement is in the Medicare Program Integrity Manual, paragraph 5.8.2. The manual states "However, documentation from the physician or treating practitioner that indicates the CPAP or RAD which requires replacement accessories continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy."

Thank you so much for this specific detail! Googling the words you quote, i was able to find the citation:
https://www.cms.gov/Regulations-and-Gui ... R672PI.pdf

"I. SUMMARY OF CHANGES: The purpose of this change request (CR) is to provide guidance to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) when conducting medical review of DMEPOS claims for replacement of essential accessories for beneficiary-owned CPAP Devices and RADs.
EFFECTIVE DATE: July 1, 2016
*Unless otherwise specified, the effective date is the date of service.
IMPLEMENTATION DATE: November 2, 2016

"For example, even though a face-to-face encounter is required for the initial provision of the CPAP device, it is not needed for replacement of a CPAP mask for a patient-owned CPAP device covered by Medicare in the past. However, documentation from the physician or treating practitioner that indicates the CPAP or RAD which requires replacement accessories continues to be medically necessary is required. For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy."

This is of interest to me because when my DME recently asked me to make an appointment with my Sleep Center, and I called to do so, I was rudely scolded by the lady at the other end of the phone, who indicated that she was outraged to learn that I had not been back since my machine was issued in 2011 and that I had broken the law which required that I must make an appointment with the doctor every year from 2011 on; when I tried to explain to her that no one had ever told me to come back every year, she cut me off and accused me of "arguing" with her.

Now, based on the above, it is clear that she is wrong on every count:
1) The rule was not implemented until November 2, 2016;
2) It does not require a "face-to-face encounter" but leaves it to the physician to determine what he/she requires in order to be satisfied that replacement supplies continue to be medically necessary. (Which may or may not require an office visit depending on the physician's professional judgment.
3) Since the doctor who replaced my original doctor now wants me to come in, that is perfectly understandable and I am happy to do so, but I will certainly also take that opportunity to be sure he/she is aware that their front office phone person is misinforming their patients as to the law and is falsely accusing their patients of being lawbreakers!


Thank you Okie and cpap-talk!

Best wishes, Nate

countryboy wrote: ↑

Fri Nov 10, 2017 7:20 am

...Do you think it's necessary to keep seeing him since I already have my CPAP machine? I don't want to burn any bridges by quit going, but on the other hand is it necessary?...

I used to haul all my machines in and the techs ran pressure checks on them to ensure they were blowing the right pressure. I would go in every 4 or so years for this. Haven't been since 2013, so I'm overdue.

NateS, good for you telling the doc about the lies put out by the front office! Makes you wonder what other lies they have been telling patients.

Except for having your insurance/Medicare pay for your stuff, IMHO there is no reason for an annual visit to a sleep doctor unless you have chronic problems, your primary refuses to write prescriptions for supplies or your employment requires a sleep doc to sign off. This is especially true if you've had no health changes and you have an auto machine. I never saw the doc after the first visit, so it was a complete waste of my time (my questions were never answered). Nothing wrong with seeing the doc annually if s/he actually looks at your data, but my visits were sloughed off to a nurse or PA and they could never answer my questions nor called me back with answers.

Since I have a machine primarily because of low oxygen caused by my heart rather than apnea, my doc has recommended another place for me to go for occasional follow-up where an actual doctor sees you. He will continue to sign off on my supplies, so no urgency.

An annual visit doesn't seem like a scheme to get money out of you...now if he asked you to do repetitive sleep studies, when therapy is clearly working, or come in every 3 months, that would be another story! It doesn't sound like they are threatening to take your equipment away if you don't come in. If you like the guy, I say just continue to go. It never hurts to have a second pair of eyes. And if on good terms, you never know when a favor could come in handy - quicker to write an updated prescription, get you in to test a new machine or mask that comes out, etc,.

Muse-Inc wrote: ↑

Sun Jul 08, 2018 3:33 am

countryboy wrote: ↑

Fri Nov 10, 2017 7:20 am

...Do you think it's necessary to keep seeing him since I already have my CPAP machine? I don't want to burn any bridges by quit going, but on the other hand is it necessary?...

I used to haul all my machines in and the techs ran pressure checks on them to ensure they were blowing the right pressure. I would go in every 4 or so years for this. Haven't been since 2013, so I'm overdue.

The techs at my former sleep clinic AND DME didn't even know what a manometer was, so I had no reason to bring the machine. My current DME does work on machines and test pressures if you just show up with a machine. He just checked my brother's backup bipap (bought in 2007) which didn't seem to blow the same pressure as his 3 year old bipap. Seems my brother didn't know what this little plastic thingie on the humidifier was so now that it's installed, the pressure is fine. Please note: if you have Medicare, they cover this stuff (like pressure checks) until your machine is 5 years old, so going in every 4 years is a good habit, IMHO.

you are the doctor's patient. he has to see you or hear from you periodically to know that you are still alive and his patient and to keep the dme honest. for instance the dme contacts him and says they need a prescription for a mask for you and you haven't seen the doc for 3 yrs. If the doc doesn't know your status, he can't reasonably be expected to send a prescription. that's what my first doc said to me. he said if all is going well there is no need for an appointment, just call in every year or 2 so he knows i'm still his patient and all is going well. my present pulmonologist is my sleep and copd doctor, so i see him pretty regularly for one or the other.

Maybe I did not make myself clear, as it seems as if the conversation has drifted off into the benefits or advisability of an annual doctor's office visit.

I personally have no objection to the concept of an annual visit with my sleep lab doctor. It could even be helpful. My heart doctor sends me a notice every 6 months to go in and have myself pacemaker checked and I gladly comply. My internal medicine doctor always checked me out every 3 months and annually.

My point was that neither my original sleep doctor nor his replacement nor any member of their staff ever informed, instructed or notified me to schedule a followup office appointment after my three sleep tests and my followup meeting with the doctor when I was issued my machine in 2011 and instructed in each use by a then local DME; yet now, when my current national DME instructed me to call and schedule an appointment with said lab, and I make the call, the lady at the other end of the phone in the doctor's office chastises me and tells me that I was supposed to have made an appointment for an office visit in 2012, 2013, 2014, 2015, 2016, 2017 and now in 2018 and that I had broken "the law" in each of those previous years by failing to have made an appointment and come in to see the doctor; and when I tried to defend myself against this seemingly serious accusation by simply explaining that "No one ever told me to do that." she cut me off with a haughty "I'm not going to argue with you."

when the fact is that none of her assertions and accusations are based in fact or law, as per my recitation from the Medicare regulations quoted above; and her attitude towards me, a patient and likely other patients, was totally uncalled for. If someone working in a doctor's office is going to set themselves up as an authority on, and enforcer of, the Medicare regulations governing sleep apnea patients and cpap users, maybe they should start by learning what the regulations actually say. Even then, a total attitude adjustment would be in order.

Best wishes, Nate