If you purchased your machine while on Medicare...

...how was your compliance period handled by your DME?

I had a call about 38 days after receiving my machine, telling me that I was at 80% compliance, doing well, and that I could take the tattletale modem off and return it. Great! No longer under surveillance?? I thought.

But about 61 days after getting the machine, an automated call asking how many hours I was using my machine, did I have a modem, and if not, to send in my data card. What??? Right now, I'm ignoring the request for the card, because Medicare rules just state you have to have compliance for ANY 30 day period during the first 90 days.

What have your experiences been? Am I to be under surveillance for another month?

I don't believe that you are under surveillance if you don't send in your card. You are right about Medicare rules. It was several years ago, but I got a call after 30 days asking me to "read off" the usage numbers on my machine. That was the last time I communicated with that DME. They never called me except to ask if I needed supplies. I stopped those calls. I found a DME that I can call and pick up my supplies as I need them.

Thanks, tooter! I know I'm not really under survelliance if I don't send in the card - I should have expressed myself more clearly. They are attempting it, and at present, I'm not cooperating. If I get an actual call from a real person giving a reasonable explanation, I may comply. My concern is that they may attempt to force me, as I've seen other comments from people much farther down the line who had been in compliance from day one who had stilll been hassled.

I think Medicare requires an in person visit to the doctor in the first 90 days. He has to certify 30 days of compliance and some other stuff.

The problem with not giving them the info is, Medicare is doing a "rent to own" on your machine. If they can't prove / document you are "continuing to use" your machine, Medicare may not pay and the provider might ask you to return your machine. Some providers just call and ask you "are you still using your equipment?", but the safest bet for them to continue to get paid, is to document the increasing hours on your machine.

archangle wrote:I think Medicare requires an in person visit to the doctor in the first 90 days. He has to certify 30 days of compliance and some other stuff.

I think this is how it was handled with my mom's new machine. She was told when she received it that she would have a compliance period, but the only contact she has had since was her followup at the doctor's office.

Followup - I think the last phone call I got was a mistake. I had already demonstrated compliance over a 30 day period, and I saw my doctor about 31 days after the beginning of treatment, and she sent Medicare their required statement of my compliance. I had been told to return the modem already. I only ever received the one call after the 30 day period report, and they never contacted me again with a call about compliance.

I actually ended up with two 'compliance' checks. The first one was within the 90 day period. And then, after I had been using my machine for about six months, the DME's biller wanted me to send them my SD card to prove to Humana Medicare Advantage that I was in compliance. I questioned it. Humana can be a real busybody at times IMO. After calls back and forth, I never did send my SD card. I just don't trust 'big insurance' anymore after getting screwed by Aetna. Question everything, all the time. All of this 'lovey, dovey' we care about you BS doesn't cut it with me anymore.

archangle wrote:I think Medicare requires an in person visit to the doctor in the first 90 days. He has to certify 30 days of compliance and some other stuff.

The compliance is technically certified by the DME.

The visit to the Sleep Doctor is to verify that you are using the machine and that it is helping you.

The completion of the compliance certification by the DME is dependent on them getting the report from the Sleep Doctor.

Under the Medicare rules, you must do both.

If you were previously on CPAP / APAP & you were just getting a replacment machine on Medicare, you actually do not have to do the DME compliance nor the Doctor visit.

But, most DMEs & Doctors think you do & it is more of a hassle to convince them otherwise. So, it is simplier to just do what they ask.

I got a new machine in May through Medicare, no modem attached, and no calls from anyone.

GTOJim wrote:I got a new machine in May through Medicare, no modem attached, and no calls from anyone.

Ditto, so far. I got my new one in June.

Papit wrote:

GTOJim wrote:I got a new machine in May through Medicare, no modem attached, and no calls from anyone.

Ditto, so far. I got my new one in June.

Then, both of your DMEs must actually know what the Medicare rules are.

Do both of you care to share the name of your DME?