Medicare's New Law

chunkyfrog · Post by **chunkyfrog** » Sat Oct 26, 2013 12:36 pm

The rules are somewhat different for cpap patients starting Medicare and Medicare beneficiaries just starting cpap.
I was diagnosed while working, and our BCBS had NO requirement for follow-up visits or compliance checks.
In the Medicare world, compliance is king.

StuUnderPressure · Post by **StuUnderPressure** » Sat Oct 26, 2013 12:56 pm

chunkyfrog wrote:Sleep2die4: According to your stated age, your sleep study was when you were 68.
I assume you were on Medicare at the time? --or started within 5 years of that age?
I was informed that if my last sleep study was within 5 years of when I started Medicare, that it would be accepted.
Of course, the "gubmint" changes some rules every year; and my information was for this year's enrollment.

Well, if he was on Medicare when he had his Sleep Study done, then I assume it DID qualify under the Medicare requirements.

The requirements I noted are for people who were already on CPAP before entering Medicare.

So, unless your Sleep Study just does NOT meet the very basic requirements that Medicare has set, it WILL meet the current Medicare requirements. If so, then there are NO requirements as to WHEN it was done.

Unless your Sleep Study was done in a cave by Neantherthal Hospital, it WILL qualify.

robysue · Post by **robysue** » Sat Oct 26, 2013 5:14 pm

StuUnderPressure wrote: Medicare does NOT require another Sleep Study if yours is over 5 years old.

Medicare only REQUIRES that your Sleep Study meets their current requirements. Basically, uses the right current terminology.
Any Sleep Study that meets those requirements would be accepted by Medicare not only for supplies, but also for a new machine.
(emphasis added)

I'm glad I'm not yet close to Medicare age because my diagnostic sleep study had hypopneas scored under the Alternative Standard which Medicare does not recognize and my "Medicare AHI" was a piddling 3.3 on that test because none of my hypopneas met the Recommended Standard's requirement of a 4% O2 desat.

ClayL · Post by **ClayL** » Sun Oct 27, 2013 9:59 am

Pugsy wrote:SNIP

It doesn't have to be a sleep doctor. The main reason for the visit is that there is documentation that the patient says they are using the machine and that they are doing well....coming from a doctor. ...any doctor will do.
It's called a face to face interview discussing the therapy. I think that all is needed is for the DME to get a copy of that doctor visit and they do the rest. It's not highly technical...or doesn't really need to be.
The requirement is for a "face to face" interview with doctor somewhere between the 31st and 90th day after receiving the equipment and sometime during those 90 days there needs to be 30 consecutive nights where compliance hours of use is met which is 4 hours a night for 70% of those 30 nights.

Thanks for clearing that up. As I said that is good for us since it means a much shorter drive. I guess I will take a summary report of Lee's first 30 days for him to take a look at. It doesn't appear that compliance will be an issue for her. She is adapting well to CPAP. She is on her third trial mask and it looks like this mask is going to be the one. But even with the first two that didn't work well for her she kept them on all night.

StuUnderPressure · Post by **StuUnderPressure** » Sun Oct 27, 2013 10:49 am

ClayL wrote:I guess I will take a summary report of Lee's first 30 days for him to take a look at. It doesn't appear that compliance will be an issue for her.

You may just luck out.
Or, since he will NOT be a Sleep Doctor, he may not know enough to be insistent.

But, most Sleep Doctors do NOT accept any report YOU generate.
They have to see it for themselves.

So, do bring the SD card with you to your Doctor visit.

The DME may also require the SD card - because those modem connections are notorious for not working (even if you are in a good coverage area).

Also tell the Doctor to send a copy of his report to the DME.

Even BEFORE you go to the Doctor, have the DME provide you in writing EXACTLY what the Doctor needs to attest to. He may not be knowledgeable about what is needed & it is best to get it right the 1st time.

islandboy5150 · Post by **islandboy5150** » Sun Oct 27, 2013 10:54 am

helene wrote:I got the same notice from my clap supply provider. They implied that I needed a sleep study at a sleep center (which I can't do- see previous post). It sounds like it was enough to get a prescription from you pcp without a new study. That would be a godsend if true. I'll definitely call medicare.

Now that's a funny typo. A clap supply provider, LOL! And you need a "sleep" study to get your "clap"

Yes, I know it juvenile bathroom humor. Sorry.

Medicare's New Law

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