Medicare 30 day rule

I have had my bipap about 20 days and just got a notice from my DME, Nationwide Medical, that if I don't have a face to face with my prescribing MD in the first 30 days of receiving my new equipment that Medicare will not pay for it. Is this true? It was a struggle to get the bipap as the DME provider lost the order and kept telling me it was being processed. I did have an appt I cancelled as I had not received the bipap. The first appt they could give me is about 6 weeks from when I started using it and I made that appt as soon as I received the bipap. I can return the bipap to Nationwide if I do it this week but need to know how strict Medicare is with this "rule"? I have used it every night for >4 hrs so I am in use compliance.

That IS true IF this is your 1st machine ever (Medicare or prior private insurer).

That is NOT true if you had a prior machine(s) & were previously documented as being successful on it / them. HOWEVER, both the Sleep Doctors and the DMEs DO think that it also applies to this situation & you will NEVER be able to convince them otherwise. So, the effect is that it applies in ALL situations.

When you got your machine, you either signed something that had this statement or you were given a written statement that if you do not meet this requirement, Medicare will no longer pay for it and the DME will either take back the machine OR hold YOU liable for the remaining amount not yet paid.

So, YES, get it done.

You say you are in compliance, & I don't doubt you.
Problem is that Medicare needs your Sleep Doctor to verify that.

Thanks for the info. I did have a prior Apap that I was in compliance with until I started using the Bipap and did see the doc for the Apap 30 day checkup. I thought about calling Medicare but didn't want to put myself on their radar. They usually just refer me to the regulations.

Maybe you can email a report to your doc, and ask them to notify Medicare?

You could call the Dr's office and see if you could bring the machine or card down and let them pull a report real quick for the compliance issue. They should be willing to do that for you.

All good ideas. I can't email my report as I cannot access Sleepyhead or any other kind of software on my Mac with my kind of machine. I hope to put Windows on my Mac this week. I will call my provider tomorrow at Stanford. I like the idea of taking my card in and meeting with an RT so it will get documented. Thanks.

Actually, that's not exactly true! Your physician must have a face to face meeting with you between days 31 and 90 to determine compliance.

This is from ResMed: http://www.resmed.com/us/documents/1013 ... ilevel.pdf

Continued Coverage Beyond the First Three Months
of Therapy
Continued coverage documented between 31st and 91st day after initiation of therapy
1. Face-to-face clinical re-evaluation by treating physician and documentation of improved symptoms of OSA; and
2. Physician review of objective evidence of adherence (defined as use of PAP ≥4 hours per night on 70% of nights during a consecutive 30-day period) via direct download or visual inspection of usage data.

Great info. Thanks