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+--- Thread: DME charges for remote monitoring (/Thread-DME-charges-for-remote-monitoring)
DME charges for remote monitoring - KC8RXQ - 07-01-2022
I'm a bit confused about what my DME is doing. I have recently started seeing invoices for a code "A9279 Monitoring feature/devicenoc". Both Medicare and my Plan G provider (Aetna) have denied coverage for this monthly charge. The DME's main office says it for the built-in modem and the uploads. It won't break the bank at $10/month but it seems to me that it should already be part of the monthly charges for the CPAP itself. Is there recourse to push back and see if this is some sort of add-on or is this a typical industry practice?
RE: DME charges for remote monitoring - StratCat48 - 07-01-2022
This may be relevant.......
https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/2021/incorrect-use-of-hcpcs-code-a9279-correct-coding-revised
RE: DME charges for remote monitoring - KC8RXQ - 07-01-2022
(07-01-2022, 04:48 PM)StratCat48 Wrote: This may be relevant.......
https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/2021/incorrect-use-of-hcpcs-code-a9279-correct-coding-revised
Thank you for the information. I may have to get the DME to justify the charge based on that info.
RE: DME charges for remote monitoring - Sleeprider - 07-01-2022
Simply decline to be monitored unless there is some good reason such as a need to demonstrate DOT or FAA compliance for therapy. Since you are probably retired, and Medicare does not cover, the DME is prohibited from billing it. This is exactly the problem we were concerned about when we issued the Action Alert forum and thread http://www.apneaboard.com/forums/Thread-ACTION-ALERT-Your-CPAP-data-is-be Philips is using data, that they encrypted to keep it away from patients and doctors to create a "value added" service for suppliers and health care providers to be able to charge for monitoring and therapy feedback.
From post #3: "To expand on the Philips Corp long-term strategy that works to monetize the data they collect from your medical devices, here is a longer version with a glossary to help interpret the motive and effect of their vision. Their plan is to work with their health systems "customers" (DMEs, equipment suppliers, clinics, physicians and insurance) to increase revenue by making consumers or patients more dependent on care managers to access solutions to their therapy issues. Philips will use therapy data to flag patient issues and refer them to care managers that subscribe (pay) for these referrals and recommended solutions. To achieve this, it is a clear objective of Philips Respironics to ensure patients will not have access to either data or settings, eliminating the self-help avenue that is the basis of the Apnea Board forum."
RE: DME charges for remote monitoring - srlevine1 - 07-01-2022
Other than compliance for insurance and proof of use for other agencies, the monitoring function serves as an incentive to keep you engaged. Your doctor, if he is concerned, can monitor you using ResMed's professional software for which he pays the tab.
For pilots, you might want to look at https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/special_iss/all_classes/sleep_apnea/ which was last modified on January 22, 2021. Ask your local FAA medical examiner if you can use an Oscar report with a signed statement of use.
For your DME, demand a written report and a statement of who receives the data or you will file a HIPPA complaint -- they normally go away.
RE: DME charges for remote monitoring - clownbell - 07-01-2022
If you open the CPAP machine and unplug the modem, they cannot "monitor." I wonder if the charge would go away.