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→Obtaining a replacement machine
== Obtaining a replacement machine ==
'''[https://www.huffingtonpost.com/stanford-center-for-sleep-sciences-and-medicine/medicare-regulations-and-sleep-apnea_b_8917878.html Medicare Regulations Are Driving a Wedge Between Obstructive Sleep Apnea Patients and Their Providers]'''
[https://www.resmed.com/us/dam/documents/articles/QualifyingmypatientforanewCPAPMachine.pdf Helping patients replace their current CPAP machines (2014)]
Less than five years The replacement of an item before its five-year life-time expires can only be done if the item is lost, is irreparably damaged, or the patient’s medical condition changes and the item no longer satisfies the medical needs of the patient.
* Loss or irreparable damage: – Irreparable damage is considered damage caused by a specific accident or natural disaster. – A physician’s order is needed to reaffirm the medical necessity of the item.
* If a PAP machine is replaced during the RUL because of loss, theft or irreparable damage due to a specific incident, there is no requirement for a new clinical evaluation, sleep test or trial period.
* The supplier must replace the equipment free of charge if it does not last the full five-year period (ie, is no longer serviceable or needs substantial repairs). If it is determined that the item is unable to last for the entire five-year RUL based upon accumulated repair costs (those repair costs exceeding 60% of the cost to replace), the supplier must replace the equipment with properly working equipment at no charge. Replacement equipment does not need to be new.
'''[https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-part-b/replacing-durable-medical-equipment-dme Replacing durable medical equipment (DME)]'''
If you have a chronic condition and will need DME for a long period of time, it important to learn about Medicare’s rules for replacing your equipment. Replacement means substituting one item for an identical or nearly identical item. For example, Medicare will pay for you to switch from one manual wheelchair to another, but will not pay for you to upgrade to an electric wheelchair or a motorized scooter.
Medicare will pay to replace equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or a natural disaster. Medicare should cover a new piece of equipment with proof of the damage or theft.
If your equipment is worn out, Medicare will only replace it if you have had the item in your possession for its whole lifetime. An item’s lifetime depends on the type of equipment. An item’s lifetime is never less than five years from the date that you began using the equipment in the context of DME replacement. Note that this five-year time frame differs from the three-year minimum lifetime requirement that most medical equipment and items must meet in order to fall under Medicare’s definition of DME. The item must also be so worn down from day-to-day use that it can no longer be fixed. Keep in mind that Medicare will repair worn out equipment up to the cost of replacement before the end of its lifetime.
Medicare will only cover replacement equipment if your doctor writes you a new order or prescription with an explanation of the medical need.
If you are affected by the competitive bidding demonstration, you must use a contract supplier to replace your equipment. If you are not affected by the competitive bidding demonstration, you can use any Medicare-approved supplier to replace your equipment. However, you will pay the least if you use suppliers who accept assignment.
'''[https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-part-b/durable-medical-equipment-dme-repairs-maintenance-and-replacement-except-for-oxygen Durable medical equipment (DME) repairs, maintenance, and replacement]'''
If you need DME, your equipment may need regular maintenance and repairs from your supplier. Repairs by a supplier involve fixing equipment that is worn or damaged. Maintenance means checking, cleaning and servicing your equipment. If possible, you are expected to do regular maintenance yourself using the owner’s manual. However, a supplier should do maintenance if it is more complicated and requires a professional. Medicare coverage of repairs and maintenance that is more specialized depends on whether the supplier owns the equipment or you do.
If you need oxygen equipment, Medicare pays for repairs and maintenance differently.
As long as you are paying a monthly rental fee for your equipment, your supplier must perform all needed repairs and maintenance that require the work of a professional. The supplier cannot charge you for this work.
On the other hand, Medicare will pay a separate amount to the supplier for repairs and maintenance if you buy your equipment or if you now own your equipment after first renting it. The repairs and maintenance must require a professional and must not be covered by warranty. Medicare will pay 80% of the Medicare approved amount and you will be responsible for the 20% balance.
You can save money by going to a supplier who takes assignment. If you live in a competitive bidding area and you own equipment that is on the list of items you must get from a contract supplier, it is best to get repairs done by contract suppliers. Although Medicare will cover maintenance (and replacement parts needed for the repair) from any Medicare-recognized supplier, contract suppliers must accept assignment for the repair.
== DME Checklist ==
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