Medicare Replacement Schedule

StuUnderPressure wrote: . . . Wonder if I could get Medicare & BC/BS to credit that savings on the Nasal Mask cushions towards the cost of headgear & chinstrap needing replacement more often than they allow.

You mean, as in, attempting to apply reason and logic when dealing with gov't programs and big-business payers? Chunkyfrog is right. (Isn't she always, dangit?) Logic is unlikely to strike a chord with those people. It just makes them mad.

Try gently washing the headgear and chinstrap in the sink once in a while using whatever you use on your face/hair. That is enough to get the human oils out of it without causing excessive wear. In my opinion.

I try making my gear last as long as I can just on the principle of the thing. I feel I am getting back at the manufacturers for their sneaky built-in-obsolescence approach to the equipment. But hey, that's just me.

Arizona-Willie wrote:It appears Medicare itself authorizes fraud.

Headgear replacement? That NEVER wears out.

My husbands head sweats so bad he goes through headgear in less than 3 months. He goes through bed pillows fast too.

jencat824 wrote:Somewhere, in another post I think I remember reading that starting 2013 those supplies covered under Medicare would be 'allowed' under that replacement schedule, WHEN REQUESTED. In other words, DME's cannot just send them. For me this is good, since my DME likes to just send tooooo much stuff.

I think that's actually been the case, more or less, for some time now. My DME calls every time when it's time to send something out. They're supposed to have the patient's OK before sending anything out, but then who's to say they don't just scribble a note in the record that says, "patient request (or approval or OK) by phone" without calling the patient. I usually tell them I don't need anything at the moment, call me again next time.

I fired one DME because EVERY time I asked for a cushion they INSISTED on sending a COMPLETE NEW mask with frame and headgear and hose.

Every thing Medicare would allow them to send -- they sent whether I wanted it or not.

THAT'S FRAUD.

And they are no longer my DME --- not that they cared.

My old sleep doctor's company went OUT OF BUSINESS!!!
How in the heck to you go bankrupt with a sweetheart deal like that?

So now I have gone to a new place and will be getting a new DME because this sleep clinic doesn't do DME.

I wonder if I buy from CPAP.COM can I send the bills to Medicare and get paid instead of using these rip off DME'S?

There is a company named cpap-supply.com that is a competitor of our host... Their recommendation for CPAP supply replacement is at the bottom of this page. I think it is very realistic.

http://www.cpap-supply.com/Articles.asp?ID=191

Arizona-Willie wrote:I wonder if I buy from CPAP.COM can I send the bills to Medicare and get paid instead of using these rip off DME'S?

No, Medicare will NOT accept a claim directly from you.

They really ought to.
If they stuck to their allowable amounts, they could still save a pile of money.
Instead of DME's there should be patient classes, with curricula based on the machine type and treatment level.
Instruction should be a separately billable class, with allowable amounts based on real value,
rather than "included" in the grossly inflated equipment prices.
Minimum standards would apply, as it does for school accreditation--they would NOT get paid for,
"Here's your stuff; now go home and use it."

chunkyfrog wrote:They really ought to.
If they stuck to their allowable amounts, they could still save a pile of money.

Not necessarily. If they accepted claims directly from patients, which I agree would be great, they would have to have staff employed to process those claims and convert them to digital form. Plus, staff to straighten out all the messed up and incorrectly filled in claims. The current system is all digital and automatic. You'd be looking at what, maybe 10 to 30 minutes staff time per claim average, factoring in the problem claims, vs. about 1 second machine time to process a claim.

Now, if someone would want to establish a business to process individuals' claims for some fee, charged to the patient, and could get Medicare to accept those claims, then we might have something. You know, kind of like the factoring business trucking companies use.

Right;I forgot how many people have trouble with forms.
A co-worker was scanning accident reports; and some of them were hilarious!

Go to Department of Heath and Human Services Office of Inspector General and look for " Rplacement Schedules for Medicare Continuous Positive Airway Pressure Supplies".

I just found out something interesting about a new change to Medicare. I order my supplies from American Home Patient and they always wanted to send me 3 months at a time but I always said no just one month. It's been awhile since I ordered anything so I called and ordered a cushion and some filters and said send me 3 months worth and I was told they can't do that anymore, just one month at a time. I said when did Medicare change this and they said the first of the year. You can rest assured if they could of sent me 3 months worth they would of done it.

It is listed under the Dept of Health and Human servicesOffice of inspector general

It is on page 7 of the 23 page report!

idamtnboy wrote:

chunkyfrog wrote:They really ought to.
If they stuck to their allowable amounts, they could still save a pile of money.

Not necessarily. If they accepted claims directly from patients, which I agree would be great, they would have to have staff employed to process those claims and convert them to digital form. Plus, staff to straighten out all the messed up and incorrectly filled in claims. The current system is all digital and automatic. You'd be looking at what, maybe 10 to 30 minutes staff time per claim average, factoring in the problem claims, vs. about 1 second machine time to process a claim.

Now, if someone would want to establish a business to process individuals' claims for some fee, charged to the patient, and could get Medicare to accept those claims, then we might have something. You know, kind of like the factoring business trucking companies use.

i think you give medicare far too much credit
certainly it is processed on billable codes which are coded by the sender
certainly a program (an app if you will) that could be used on the internet could be developed
to take advantage of their digital processing for use by others
dont forget cpapdotcom already codes their receipts for insurance use and it is accepted

Supplies is what the original subject was