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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.
== Changing DME Providers ==
Changing DME providers is necessary for a number of reasons. If a DME ceases business operations, a patient moves out of a DME’s service area, the patient may be dissatisfied with a DME or a combination of these factors, then a patient will have to select a new DME. A patient may have options to select DME providers. Limiting factors in DME selection are Medicare competitive markets and insurance network coverage.
When you wish to change DME providers, it is important to remember that the DME considers you a patient in their care. The DME, like a doctor, keeps records of your healthcare. In order to change DME providers there is a transaction that must occur between your current DME and the DME that you seek to provide your healthcare needs.
To facilitate the transfer of your CPAP related needs, you will need some medical records. The first medical record is your prescription. Although your current DME will have your prescription on file, it is recommended to obtain a copy from your prescribing doctor and deliver that prescription to the new DME.
Secondly, if available, a copy of your sleep study will be requested by the new DME. Again, a copy of your sleep study should be on file with your current DME, since this too is a medical record, your prescribing doctor must make available a copy to you.
Third, a release of medical information document must be on file with the both the current DME and the new DME. This release of information document facilitates the legal transfer of information from your current DME to your new DME. You will sign a copy at the current DME and new DME. Usually you sign this document when you complete new patient intake for any medical services you receive and the document is specific to the medical provider.
Lastly, your current insurance documentation is required for transfer. The new DME will request this from you as a potential new patient.
Having a valid prescription, a copy of your sleep study, a signed release of medical information document, and your current insurance will allow your new DME to begin the request process. Since you are considered a patient with your current DME, they have to release you from their care, much like being released from a hospital.
Once your current DME releases you from their care and insurance has given their approval, your new DME will setup an appointment to do a new patient intake. This intake process is performed anytime you receive medical care by a service provider that has never seen you as a patient before. A medical history questionnaire, personal information questionnaire, current medical needs questionnaire, vital statistics questionnaire and any other information needed to care for you as a medical patient will be obtained.
When changing DME providers, if you currently own your machine, the new DME will ask for you to bring your machine in to their office when they schedule an appointment for you to begin receiving supplies. Assuming that insurance is covering your supplies, the DME will record the serial number from your machine and modem (if equipped), and collect your sleep data from your machine. This is for compliance monitoring. The DME will record the supply types and sizes you require (mask type and size, hose type, filters…) and according to your insurance policy, the DME will create your supply schedule.
It is common practice that an insurance company will rent the machine you are provided by your DME. During the rental period your DME is responsible for collection of compliance records and reporting your usage statistics. If you fail to report compliance or do not meet minimum usage for compliance, your insurance may stop payment to your DME and the DME will stop issuing supplies. If the machine is still in the rental period, the DME will require you to return your machine.
The typical rental period will be 10 consecutive months. After the rental period and you have met minimum compliance requirements, the machine will become your property. The contract is similar to a “rent to own” contract with you being the consumer. If you change DME providers during your rental period, the insurance company reserves the right to deny the issue of a new machine. Therefore, it is recommended that you maintain your DME provider during the entirety of your rental period. After the rental period has been fulfilled and you own your machine, selecting a new DME is, in essence, only selecting who will fulfill your supply needs.
== DME Checklist ==
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