General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Mike@TibroMedical
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by Mike@TibroMedical » Fri Apr 24, 2009 1:26 pm
DreamStalker wrote:Mike@TibroMedical wrote:... snip ...
which means even if you use it every night if your data doesn't show you benefiting in a report they wont cover it. which means it's not just compliance.
... snip
Which means that it is just a tool for the insurance companies to boost their profits by finding a reason not to cover the treatment ...
However, they are.
O.[/quote]
That's what ins company's do best
ozij wrote:If that were true, machines that only tracked compliance would no longer be handed out by DME's since they don't show that those hours were beneficial.
You would assume that but again you don't deal with it day in and day out. Medicare requires 2 Parts to this puzzle...
1. Objective evidence of adherence to use of the PAP device reviewed by the treating physician.
Adherence to therapy is defined as use of PAP > 4 hours per night on 70% of nights during
a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.
2. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved.
the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy.
to get #2 the Download is required some DME providers are just getting the Dr to sign it without the download cause the compliance only machine's are cheaper. so yes they are trying to make a buck but they wont get away with it for long cause when the get audited medicare will take all there money back so they will get whats coming to them. I think this all hits home cause I don't like be grouped in under the tarp of normal DME's but I can't defend them either lol most of them are shady.
Evil DME guy with bad Grammer
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6PtStar
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by 6PtStar » Fri Apr 24, 2009 1:32 pm
You would assume that but again you don't deal with it day in and day out. Medicare requires 2 Parts to this puzzle...
1. Objective evidence of adherence to use of the PAP device reviewed by the treating physician.
Adherence to therapy is defined as use of PAP > 4 hours per night on 70% of nights during
a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.
2. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved.
the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy.
to get #2 the Download is required some DME providers are just getting the Dr to sign it without the download cause the compliance only machine's are cheaper. so yes they are trying to make a buck but they wont get away with it for long cause when the get audited medicare will take all there money back so they will get whats coming to them. I think this all hits home cause I don't like be grouped in under the tarp of normal DME's but I can't defend them either lol most of them are shady.
I'm on medicare but to the best of my knowledge I did not have either 1 or 2 done!! Survived it and doing great anyway, Thanks to this board!!
Jerry
Last edited by
6PtStar on Fri Apr 24, 2009 1:34 pm, edited 1 time in total.
Life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting: "Wow what a ride!"
I still play Cowboys and Bad Guys but now I use real bullets. CAS
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nobody
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by nobody » Fri Apr 24, 2009 1:34 pm
Mike@TibroMedical wrote: instead of a card slot it's a modem that is wired into your home phone and automatically uploads every morning to the web based queue they set up, for DME providers.
Are you sure that is newer and not older? Because I can't see that lasting, unless it can work with mobile phones. I don't have a hardwired phone in my house, and haven't for years. I use a cellular phone only and I'm pretty sure more and more people will be going this route as well.
found at encoreanywhere.com
this link did not work.
I use the data to track how my therapy is going. Obviously I know how much I use the machine.
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cflame1
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by cflame1 » Fri Apr 24, 2009 1:41 pm
Mike@TibroMedical wrote:.... I think this all hits home cause I don't like be grouped in under the tarp of normal DME's but I can't defend them either lol most of them are shady.
Welcome Mike... nice to have you. You'll find a lot of interesting information around here.
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JeffH
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by JeffH » Fri Apr 24, 2009 1:42 pm
they are paying for equipment that they want to make sure is benefiting the Pt.
I would reword that to they are paying for equipment that they want the Pt. to use. They don't give a shit whether or not it is benefiting the Pt. or they would only give out machines that were completely data capable, have classes to help pt's learn about the data and how to work with it, etc. This forum does what the industry should be doing. You call it BIG BAD, I call it reality.
JeffH
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sam1234
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by sam1234 » Fri Apr 24, 2009 1:42 pm
Mike@TibroMedical wrote:I've noticed that there are ALLOT of you guys that have there own card readers and the encorepro or resscan programs, my question is, do you guys keep track of this stuff for any certain reason? like personally? I have thousands and thousands of pt's with company's i work for and not one of them has there own reader's. cause we do all that for them when the Dr or ins need it for compliance.... Mike
When I read this my first thought was... How do you know that your patients don't have readers?
My physician and my DME do not know that I have a reader. I haven't shared data with either one nor have I been asked about data. I have been asked by the physician if the therapy is making me feel better. I track my data on occasion, just to see what is happening. If I had trouble sleeping one night, I look at the data to see if there are signs as to why. Perhaps my mask is leaking a lot.
You may have more patients with readers then you know.
Have great success providing customer service. We all could use DME's that care about the effectiveness of our therapy.
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DreamStalker
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by DreamStalker » Fri Apr 24, 2009 1:43 pm
Mike@TibroMedical wrote: ... snip ...
2. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved.
the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy.
... snip ...
For me the "clinical re-evaluation" consisted of a question and answer session by the head nurse practitioner. The doc never saw or talked to me and they still charged me a "specialist" copay and who knows how much to the insurance company. They sent a copy of the so-called "clinical re-evaluation" report to my primary care doc who then gave me a copy. It stated something to the effect of ... patient appears to be doing well with his therapy and was told not to change his pressure settings. One sentence, that included a reprimand against my changing my own pressure.
I have not gone back to that clinic since.
President-pretender, J. Biden, said "the DNC has built the largest voter fraud organization in US history". Too bad they didn’t build the smartest voter fraud organization and got caught.
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jnk
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by jnk » Fri Apr 24, 2009 1:49 pm
Mike@TibroMedical wrote:. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved.
the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy.
So patient fills out an Epworth Sleepiness Scale, gets a pat on the back from the doc, and everybody's register goes: Cha-Ching!
Better. Much better.
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Snorebert
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by Snorebert » Fri Apr 24, 2009 2:36 pm
This thread has got me stoked. I keep looking for information that the quality of therapy is considered as part of compliance and not just 4 hours 70% of the nights. I haven't found any.
http://www.sleepreviewmag.com/issues/ar ... -10_01.asp Can you?
There are two rules of life. The first is don't tell everything that you know.
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Mike@TibroMedical
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by Mike@TibroMedical » Fri Apr 24, 2009 2:41 pm
6PtStar wrote:You would assume that but again you don't deal with it day in and day out. Medicare requires 2 Parts to this puzzle...
1. Objective evidence of adherence to use of the PAP device reviewed by the treating physician.
Adherence to therapy is defined as use of PAP > 4 hours per night on 70% of nights during
a consecutive thirty (30) day period anytime during the first three (3) months of initial usage.
2. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved.
the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy.
to get #2 the Download is required some DME providers are just getting the Dr to sign it without the download cause the compliance only machine's are cheaper. so yes they are trying to make a buck but they wont get away with it for long cause when the get audited medicare will take all there money back so they will get whats coming to them. I think this all hits home cause I don't like be grouped in under the tarp of normal DME's but I can't defend them either lol most of them are shady.
I'm on medicare but to the best of my knowledge I did not have either 1 or 2 done!! Survived it and doing great anyway, Thanks to this board!!
Jerry
The above requirements started November 1st of 2008.
Evil DME guy with bad Grammer
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Mike@TibroMedical
- Posts: 40
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by Mike@TibroMedical » Fri Apr 24, 2009 2:45 pm
nobody wrote:Mike@TibroMedical wrote: instead of a card slot it's a modem that is wired into your home phone and automatically uploads every morning to the web based queue they set up, for DME providers.
Are you sure that is newer and not older? Because I can't see that lasting, unless it can work with mobile phones. I don't have a hardwired phone in my house, and haven't for years. I use a cellular phone only and I'm pretty sure more and more people will be going this route as well.
Yes I'm sure, and you are correct, which is why RESMED will be heading the pack with there wireless modem's that only need a cell phone signal. 90% of the patients we set up are over 65 and they tend to keep there land lines it seems, not all but most still have land lines.
Evil DME guy with bad Grammer
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jnk
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by jnk » Fri Apr 24, 2009 2:53 pm
http://www.sleephealth.com/Collateral/D ... 0019_0.pdf
AS I read it, any one of the following statements made to the doc will let the entire medical team off the hook:
1. "I ain't as sleepy as I used to be."
2. "I don't gasp as much as I used to."
3. "My head doesn't hurt as much in the mornings."
-------------------
Patient: "So, Doc, wanna see my printouts of my AHI?"
Doc: "Your what? Oh. No, thanks. Say, did you have a headache this morning?"
Patient: "No, why?"
Doc: "Oh, nothing. [Furiously writes notation in file.] Thanks for stopping by. Be sure to see the front desk about billing."
Cha-Ching!!!
Last edited by
jnk on Fri Apr 24, 2009 2:59 pm, edited 3 times in total.
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nobody
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by nobody » Fri Apr 24, 2009 2:56 pm
Mike@TibroMedical wrote:Yes I'm sure, and you are correct, which is why RESMED will be heading the pack with there wireless modem's that only need a cell phone signal.
I wouldn't spend my minutes on that. Machine have no card, I no buy.
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BleepingBeauty
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by BleepingBeauty » Fri Apr 24, 2009 2:59 pm
I'm glad you posted this thread, Mike. You're getting a lot of good feedback here from the people who really matter in the sleep therapy equation - the users.
As you can see, the majority of us are not happy with the care we're getting from our doctors and DMEs. Perhaps you can pass along the dissatisfaction that so many of us experience to others in your industry, whether via an article in a newsletter or monthly magazine, word-of-mouth, or at a national convention (if there is such a thing). We talk to each other here, giving and getting good advice to help each other, because nobody else out there is listening.
I hope you're learning a lot from the responses you're getting.
Veni, vidi, Velcro. I came, I saw, I stuck around.Dx 11/07: AHI 107, central apnea, Cheyne Stokes respiration, moderate-severe O2 desats. (Simple OSA would be too easy.
)
PR S1 ASV 950, DreamWear mask, F&P 150 humidifier, O2 @ 2L.
