Medicare CPAP Compliance Rules

provider wrote:Here is the LCD update released in April by Medicare: http://www.ngsmedicare.com/PRINT.aspx?DOCID=21846

I hope that helps.

Bad link.

DreamOn wrote:See this .pdf document: http://www.sleephealth.com/Collateral/D ... 0019_0.pdf. While this is not a direct link to the government regulations regarding CPAP compliance requirements for Medicare, it does state, in part:

"Medicare requires 4+ hours/night of use ≥ 70% of the nights in 30 consecutive days for continued coverage for PAP therapy.... 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. If the above criteria are not met, continued coverage of a PAP device and related accessories will be denied as not medically necessary."

I called Medicare when I felt I was not being compliant with the 2 hrs I was able to use it per night. They told me I was compliant at the 2 hr mark, but they like to see the 4 hr mark. So I am not sure what is going on there. I don't have to worry anymore now though because I am up to the 4 hrs.

Good Luck!

My supplier calls every month to check on compliance. I have had the machine for over three years. They say it is for Medicare. Is this necessary?

The also want to replace supplies very often, which is allowed by Medicare. They want to imply that Medicare requires it. It seems excessive to me, especially as Medicare will go bankrupt soon enough. Obviously, the little paper filters need replacing, but hoses, tanks, the headgear, and the nose pillows? And they are all ridiculously expensive. What is your wisdom on this?

At the very most Medicare stopped caring about your compliance after 13 months and you owned the machine and they no longer had to pay rent to own fees.

The monthly calls are geared to generate sales of the other products that Medicare will pay for per their replacement schedule. If you don't feel you need what is offered...just decline it. Medicare doesn't care.

The DME cares because it generates revenue for them. Helps the cash flow.

It's nice to have a spare hose or tank or headgear or mask. I recently bought a heated hose but prior to that change I have used the same Performance hose for well over 2 years. Nothing wrong with it. It is now my travel hose. I still have another spare new Performance hose. Nasal pillows....well some people do seem to feel that theirs needs replacing fairly often due to leakage but I have always been able to use a set of pillows for months and months.

To put your mind at ease just call Medicare and tell them what they tell you and you'll get the answer that Pugsy just gave you.

I have using a cap machine for 13 years. I am now eligible for medcare, Does any one know if I have to through
The compliance thing again. My machine is over 5 years old.

You'll probably have to do another sleep test and Medicare rents for 13 months and then it's your and I wouldn't doubt that you'll have to prove your complaint to them.

Interesting thread. I was asking the DME person I deal with and he told me that actually nothing gets sent to Medicare but they, the DME, need to have the documentation in their files in the event they are audited by Medicare. Does that make any sense at all? Oh well, I'll just do everything I need to do and hope they do the same, whatever it is.

Suz

Suzjohnson wrote:Interesting thread. I was asking the DME person I deal with and he told me that actually nothing gets sent to Medicare but they, the DME, need to have the documentation in their files in the event they are audited by Medicare. Does that make any sense at all? Oh well, I'll just do everything I need to do and hope they do the same, whatever it is.

Make sense? Well, yeah it does. Medicare has to balance their manpower expenditure with the return from it. There is no real mileage to be gained by reviewing all users' compliance records because the non-compliance rates are probably pretty low. But, if the DMEs didn't have to keep records, and knew Medicare would never check on them, the system would be rife with fraud, much worse than it is now.

Government contractors are notorious for cheating, cutting corners, and doing anything they can to enhance their bottom line at the expense of Uncle. Basically, every Government supplier is crooked until demonstrated otherwise. And a lot of them have, in fact, demonstrated otherwise.

idamtnboy wrote:

Suzjohnson wrote:Interesting thread. I was asking the DME person I deal with and he told me that actually nothing gets sent to Medicare but they, the DME, need to have the documentation in their files in the event they are audited by Medicare. Does that make any sense at all? Oh well, I'll just do everything I need to do and hope they do the same, whatever it is.

Make sense? Well, yeah it does. Medicare has to balance their manpower expenditure with the return from it. There is no real mileage to be gained by reviewing all users' compliance records because the non-compliance rates are probably pretty low. But, if the DMEs didn't have to keep records, and knew Medicare would never check on them, the system would be rife with fraud, much worse than it is now.

Government contractors are notorious for cheating, cutting corners, and doing anything they can to enhance their bottom line at the expense of Uncle. Basically, every Government supplier is crooked until demonstrated otherwise. And a lot of them have, in fact, demonstrated otherwise.

Very good points you make. Thanks for your input?

Suz who is finding it funny and slow typing with an oximeter on.