Medicare Compliance Question

[plakky]

I understand that Medicare compliance requires usage of a CPAP machine for a minimum of 4 hours a day for 70% of the time during the first 90 days.  I am past one year into using my CPAP machine and own the machine now.   

My question is, does Medicare continue that compliance requirement AFTER the 90 days, as far as having any impact on their continuing to pay for the masks, hoses, etc.?  I should add that my compliance is very good (thanks in large part to honing in on the right mask and other helpful tips I learned from this forum), but there are times (short trips away from home, etc.) that I would feel okay skipping some days if it wouldn't affect Medicare coverage of those items.


Do I need to worry about this??  

[SideSleeper]

No need to worry. As I understand it, the compliance requirement is just to prove you are actually using the machine that they are paying for. You now own it. Just keep on with your good compliance for your own health! Good job!

[Homerec130]

If you change types of machines, ie CPAP to a BiPAP, the compliance clock restarts. Going thru that with my wife.

[plakky]

Thanks for your helpful answers!

[ajwees41]

If you change types of machines, ie CPAP to a BiPAP, the compliance clock restarts. Going thru that with my wife.

what about the 5 year replacement does that retrigger the clock?

[Melman]

I recently replaced my machine after 6 years and had to demonstrate compliance again. It e\was no problem since I was already accustomed to the treatment and 100% compliant.

[Nightynite]

What if you were on cpap for 5 yrs and since your were up for machine replacement, switched to bipap and just provided DME with a script stating which bipap machine.  Would Medicare cover this?

Would you own it?  Or start on your 13 month rental again?

[OpalRose]

Normally, when you change machine types, example: Apap to BiPap, Medicare may require you to prove "necessity" by getting a sleep study done.

Many DME's won't process a change from Apap to BiPap without a new study done, even with a Doctor's script. Many Doctors know this. But there's always an exception.
If your doctor files paperwork to your insurance stating "necessity" for the change, and insurance approves it, then you are further ahead with the DME.

With the start of another machine after five years, compliance starts over.

Under Medicare and most other insurers, you would own the first machine after the 13 month rental.

[Nightynite]

  OpalRose !    Very helpful!

[Homerec130]

Opal, thanx for jumping in with the update.

In my case, when I got my new machine I also rolled over my insurance to Medicare as primary and my old primary as the secondary so I needed a new sleep study. My sleep doc and I talked about and made plans. I was on my old machine for almost 6 years before I had the new sleep study.