How does CPAP usage get reported to Medicare?

My machine was paid for before I went on Medicare and so far they have paid for my supplies. But, how do they know that I am compliant? Neither my doctor nor my DME knows.

cherylann wrote:My machine was paid for before I went on Medicare and so far they have paid for my supplies. But, how do they know that I am compliant? Neither my doctor nor my DME knows.

I know the doc has to submit a statement that you are benefiting from its use to get paid. The DME has to have documentation that your are using to get paid for the machine.
Maybe they don't care about supplies - you could always call Medicare to ask them directly to get the most accurate answer.

xxyzx wrote:

cherylann wrote:My machine was paid for before I went on Medicare and so far they have paid for my supplies. But, how do they know that I am compliant? Neither my doctor nor my DME knows.

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i dont think they care unless they are paying for the machine

WOW.....I can't believe I am agreeing with you

In theory, your doctor is supposed to verify you are using your machine and it is treating your sleep apnea. The doctor I use for my sleep apnea has me come in every six months and checks my usage. Others here on the forum say they see their doctor once a year, and some others say they never see their doctor. My doctor set up the six month visits due to a statement in the affordable care act that required presciptions to be renewed every six months. For me, going to see the doctor every six months is no big deal. It is only a 20 minute drive and the appointment takes about 10 minutes. I get my blood pressure checked and the doctor listens to my lungs and heart. For me, I figure it is just another routine check up. This works out to where I see either my primary care physician or the sleep doctor every three months. I have Medicare and Tricare for Life, so I have no out of pocket expenses for office visits or supplies.

Okie bipap wrote:In theory, your doctor is supposed to verify you are using your machine and it is treating your sleep apnea. The doctor I use for my sleep apnea has me come in every six months and checks my usage. Others here on the forum say they see their doctor once a year, and some others say they never see their doctor. My doctor set up the six month visits due to a statement in the affordable care act that required presciptions to be renewed every six months. For me, going to see the doctor every six months is no big deal. It is only a 20 minute drive and the appointment takes about 10 minutes. I get my blood pressure checked and the doctor listens to my lungs and heart. For me, I figure it is just another routine check up. This works out to where I see either my primary care physician or the sleep doctor every three months. I have Medicare and Tricare for Life, so I have no out of pocket expenses for office visits or supplies.

I'm one that never sees a doctor about sleep apnea. My DME or Medicare Supplement provider has never asked for any documentation.

Medicare requires a face to face appointment with your doctor to verify usage.
Get it done---ASAP.
The DME may very well be sitting on a pile of bills they will present to YOU when it is too late to establish usage for Medicare
Do not trust them.

xxyzx wrote:

LSAT wrote:

Okie bipap wrote:In theory, your doctor is supposed to verify you are using your machine and it is treating your sleep apnea. The doctor I use for my sleep apnea has me come in every six months and checks my usage. Others here on the forum say they see their doctor once a year, and some others say they never see their doctor. My doctor set up the six month visits due to a statement in the affordable care act that required presciptions to be renewed every six months. For me, going to see the doctor every six months is no big deal. It is only a 20 minute drive and the appointment takes about 10 minutes. I get my blood pressure checked and the doctor listens to my lungs and heart. For me, I figure it is just another routine check up. This works out to where I see either my primary care physician or the sleep doctor every three months. I have Medicare and Tricare for Life, so I have no out of pocket expenses for office visits or supplies.

I'm one that never sees a doctor about sleep apnea. My DME or Medicare Supplement provider has never asked for any documentation.

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did you pay for it yourself ?

on either machine.

I have been on Medicare/Medicare Advantage for 12 years. This is my second Medicare paid machine. No one ever asked me for compliance data.

I did not have a CPAP with a modem prior to mid-2016. My private insurance (which follows medicare rules), never questioned me about compliance. They sent supplies regularly.

It is reported by the DME. The DME sends a form and request for updated prescription about once a year to your sleep doctor or your primary (depending on who you have designated). The doctor certifies that the machine is benefiting you and sends the updated script. Now that I have a cpap, every time I visit my primary, I'm asked if I'm still using the cpap and how is it going? I switched supplies to primary since there is nothing more the sleep doc is going to do and it saves me a doc trip (and copay).

Now, that what is supposed to happen, but I'm sure there will be variability. I know there was at least one person here who said that they continue to get their Medicare paid for supplies and see neither a sleep doc or primary on an annual basis. So, I don't know what's happening with that DME but they would lose big on the Medicare contract if they don't have the documentation to back it up (fines too!) if they are audited.

Now, in my case, if I needed a new machine paid for by Medicare, I could get it through my primary so long as I don't need a sleep study. However, by the time 5 years is up, my primary will have retired, so who knows.

If you don't have a modem who knows. I don't have a modem and my last DME would write down data from the screen when he came to visit.

Nobody came to visit and my old CPAP did not have a modem (until mid-2016). Furthermore, the old machine did not measure anything but blower hours.

The NSA uses the mike that records your snoring, it hears when your breathing slows down in your sleep, and everything else that happens in your house. Then once a day it sends that data over the A/C power grid to the NSA where it is checked for plots. Jim

Medicare, bugged the NSA, to get the info, it is forwarded to the XPAP Police headquarters.

Goofproof wrote:The NSA uses the mike that records your snoring, it hears when your breathing slows down in your sleep, and everything else that happens in your house. Then once a day it sends that data over the A/C power grid to the NSA where it is checked for plots. Jim

Medicare, bugged the NSA, to get the info, it is forwarded to the XPAP Police headquarters.

All of the above.
They know EVERYTHING.
Back in the 70's, when we still had a land line, we would often hear extraneous clicks on our phone.
We would often get a few giggles from mocking the unseen snoop.
" How bored are you today?" Who in the agency did you piss off?"
"How many of your colleagues lost their minds this week?"

xxyzx wrote:

chunkyfrog wrote:All of the above.
They know EVERYTHING.
Back in the 70's, when we still had a land line, we would often hear extraneous clicks on our phone.
We would often get a few giggles from mocking the unseen snoop.
" How bored are you today?" Who in the agency did you piss off?"
"How many of your colleagues lost their minds this week?"

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its all automated
unless the computer hears a key word no person ever listens

have fun by randomly throwing in words like
abomb
terrorist
attack
bin laden
assasinate
al queda
isis

and let them listen to your other drivel trying to figure out what you really meant with that key word the computer hit on

And wait for the Black Helicoptors and SUV's to arive in the middle of the night, while you have your guns torn down on the kitchen table and are polishing your bullets.

Rule #1: Don't clean them all at once, no you see why I don't clean my XPAP equiptment, I'm always ready!!! Jim "I'm Goofproof, I'm always ready"