Who tells Medicare I am using my new CPAP in first 90 days?
Long time CPAP user. I had my previous (not medicare purchased) machine consumables replaced under medicare via a DME. I replaced my Resmed AS10 with another around May 22. DME said something about me needing a medical appt 60-90 days after purchase to show use for medicare.
I had an Aug 5 appt with the sleep PA. I am well over 70 pct over 4 hours. The sleep PA said the DME would take care of medical compliance with medicare. Today Aug 15 DME said Medicare could read MyAir so no one had to do anything.
What do I do to show compliance? Who tells medicare?
08-16-2024, 03:17 PM
(This post was last modified: 08-16-2024, 03:18 PM by Narcil.)
RE: Who tells Medicare I am using my new CPAP in first 90 days?
compliance data is sent over the mobile 4G networks. your sleep PA most likely tied your machine's serial number to your account so they can see your data. you have network bars at the top of your screen?
if they told you not to do anything, don't do anything
RE: Who tells Medicare I am using my new CPAP in first 90 days?
(08-16-2024, 03:06 PM)silverchief2 Wrote: I had an Aug 5 appt with the sleep PA. I am well over 70 pct over 4 hours. The sleep PA said the DME would take care of medical compliance with medicare.
Yes, the DME and the Doctor or PA, should submit to insurance that you have met compliance.
But, if there's one thing I've learned over the years, don't take for granted it will be done. The medical community and DME's are slow to act. You should follow up yourself and make sure.
08-17-2024, 10:49 AM
(This post was last modified: 08-17-2024, 10:55 AM by cps22.)
RE: Who tells Medicare I am using my new CPAP in first 90 days?
When I saw my doctor for my appointment in the first 90 days, he gave me a copy of compliance letter that he sent to the DME. I would suggest trying to get that information from your DME (or insist on it from your PA), showing that you met the compliance requirements. I would not count on your DME's statement that Medicare can read your MyAir data. Get proof in writing that you have met the requirements. Even if Medicare can (and actually does) read the data, at what point are they doing so? What if you're compliant during the first 90 days, but then something happens where you aren't/can't use it enough to be compliant at a later date within the initial Medicare rental period?
It was my understanding from the doctor that I only needed to show that I can use it in compliance for a 30-day period, and that it is helpful - not that I need to use it in compliance for the entire rental period. I have no proof that's correct other than what the doctor told me, but if it is, then you definitely want something that shows you were able to do so.
Edited to add: Apparently what my doctor said was incorrect. According to Medicare's website:
Quote:Medicare pays the supplier to rent a CPAP machine for 13 months if you’ve been using it without interruption. After Medicare makes rental payments for 13 continuous months, you’ll own the machine.
I'd still want something in writing that shows I was compliant in the first 90 days, though.