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Compliance Data Requirement -- Unhappy Customer
publishing an email i got as well as my response on this subject:
Question
I am a Texas attorney, 66 years of age and was recently diagnosed with sleep apnea and prescribed a CPAP medical equipment device and was issued a Fisher&Paykel Sleepstyle 600 which I used for about a month and found to be tolerable and effective. However, my equipment provider contacted me and indicated that to meet Medicare reimbursement requirements I need a CPAP with documentation and shipped me a replacement, a RemstarM Seriew Auto C Flex CPAP with heated humidifier. Unfortunately my experience was disappointing with respect to the noise level of the Remstar. While it was to some extent quiet, the pulsating intermittent positive air pressure was an unfavorable noise factor and also seemed to be trying to simulate my breathing pattern. In short, I did not have a satisfactory result.
My Question: Is there a new documentation requirement that requires the CPAP to have documentation or memory card features ? If so, is there any provision to obtain a waiver of this requirement through doctor’s orders or otherwise ?
I am tempted to buy my own Fisher&Paykel Sleepstyle 600 w/o documentation.
An aside, Is it because I am an attorney, over 65, or just paranoid that I have issues with the gov’t insisting that they monitor my sleep habits. While I understand that the objective is probably to stem the abuse of the cottage industry that has arisen with M.D.s referring to sleep study businesses referring to (or acting as suppliers themselves) the CPAP machines and accessories and patients who do not need or do not use the CPAP that Medicare pays for ?
In fact the result is the opposite, the CPAP with documentation is about twice as expensive, requires follow-up taking the memory card to the Dr. or other provider, etc.
I am considering buying my own Sleepstyle 600 and avoiding the red tape.
Do you have comments or suggestions?
[name redacted for sake of anonymity]
Houston TX
Answer
Hi,
Yes, I am aware of this development. Basically, CMS/Medicare (with private insurers following suit) has enacted a requirement that for equipment providers to get reimbursed for the CPAP machines/supplies they are dispensing to you, they need to show that you are using it for more than 4 hours more than 75% of the time. So naturally, they're wanting to switch you out with a machine that they'll get paid for (i.e., one that shows compliance data). You can absolutely buy a machine out of pocket, but you might jeopardize your ability to get replacement parts and supplies paid for by insurance (hose, mask, filters, etc.).
I am publishing this question (with your name/personal information redacted) to the sleep apnea forum www.sleepguide.com. I invite you to join us there to continue this conversation amongst a number of sleep apnea patients and professionals who can help you further.
Warm regards,
Mike
Question
I am a Texas attorney, 66 years of age and was recently diagnosed with sleep apnea and prescribed a CPAP medical equipment device and was issued a Fisher&Paykel Sleepstyle 600 which I used for about a month and found to be tolerable and effective. However, my equipment provider contacted me and indicated that to meet Medicare reimbursement requirements I need a CPAP with documentation and shipped me a replacement, a RemstarM Seriew Auto C Flex CPAP with heated humidifier. Unfortunately my experience was disappointing with respect to the noise level of the Remstar. While it was to some extent quiet, the pulsating intermittent positive air pressure was an unfavorable noise factor and also seemed to be trying to simulate my breathing pattern. In short, I did not have a satisfactory result.
My Question: Is there a new documentation requirement that requires the CPAP to have documentation or memory card features ? If so, is there any provision to obtain a waiver of this requirement through doctor’s orders or otherwise ?
I am tempted to buy my own Fisher&Paykel Sleepstyle 600 w/o documentation.
An aside, Is it because I am an attorney, over 65, or just paranoid that I have issues with the gov’t insisting that they monitor my sleep habits. While I understand that the objective is probably to stem the abuse of the cottage industry that has arisen with M.D.s referring to sleep study businesses referring to (or acting as suppliers themselves) the CPAP machines and accessories and patients who do not need or do not use the CPAP that Medicare pays for ?
In fact the result is the opposite, the CPAP with documentation is about twice as expensive, requires follow-up taking the memory card to the Dr. or other provider, etc.
I am considering buying my own Sleepstyle 600 and avoiding the red tape.
Do you have comments or suggestions?
[name redacted for sake of anonymity]
Houston TX
Answer
Hi,
Yes, I am aware of this development. Basically, CMS/Medicare (with private insurers following suit) has enacted a requirement that for equipment providers to get reimbursed for the CPAP machines/supplies they are dispensing to you, they need to show that you are using it for more than 4 hours more than 75% of the time. So naturally, they're wanting to switch you out with a machine that they'll get paid for (i.e., one that shows compliance data). You can absolutely buy a machine out of pocket, but you might jeopardize your ability to get replacement parts and supplies paid for by insurance (hose, mask, filters, etc.).
I am publishing this question (with your name/personal information redacted) to the sleep apnea forum www.sleepguide.com. I invite you to join us there to continue this conversation amongst a number of sleep apnea patients and professionals who can help you further.
Warm regards,
Mike
Views: 372
Replies to This Discussion
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Permalink Reply by Judy on
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At 65 your primary insurance is Medicare I take it. But even if it is your secondary insurance, as long as Medicare is involved Medicare does now require that the local DME supplier be able to provide documented proof of your compliance usage of a minimum of 4 hours per night and 5 nights a week (or perhaps more accurately as Mike stated 4 hrs and 75%). Prior to this all I got after 3 months of usage was a form letter from my local DME supplier in which I had to verify I was using my xPAP a minimum of 4 hours per night and 5 nights a week, sign it and return it to the DME supplier..
You really can't blame Medicare for wanting some type of FIRM DOCUMENTATION that a device that they are paying 80% for is being used and not sitting in the closet.
If the Respironics M Series Auto w/C-Flex is too noisy. The F&P SleepStyle didn't have an expiration pressure relief option. I'm taking a guess that either 1] your M Series Auto is set in auto mode and thus the fluctuation noise or 2] the C-Flex is turned on and that is providing the fluctuation noise. Ask that it be set in straight CPAP mode. It seems the noise fluctuation and noise level varies w/in the same models by individual device and just exchanging for another M Series Auto would do the trick for you.
I believe the SleepStyle 600 "may" be capable of providing compliance data (depends on which model) - BUT - it also may be that your local DME supplier does NOT have the ComplianceMaximizer software from F&P whilst they "may" have the Respironics EncorePro software and thus do not want to spend the money to buy the ComplianceMaximizer software or don't want to spend the money to purchase both software and opted for the Respironics software as the more popular brand. (Each manufacturer has their own proprietary software).
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Permalink Reply by Mike on
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more from this gentleman in TX:
Thanks Mike, and happy for you to post my question with my personal info redacted.
My wife had told me for years that I snored loudly and stopped breathing also at 66 I have high blood pressure. So the Dr. recommended the sleep study which I followed up with for a sleep study and then they diagnosed me with sleep apnea. While the facility was nice, and the sleep study personnel professional, seemed like they were running a lot of folks thru there. When I actually got my CPAP I really did not get much instruction on use so had to go back again and still got about 10 minutes instruction. Then I got use to the Fisher-Pykel, I got the call about the replacement Responics Remstar M Series C-Flex which has the memory card, etc.
Received no training or instructions on that one and like I said it is noisier. Reported it to the CPAP supplier and wanted something quieter. But have not heard back from them. I think they have made their sale and have moved on. As I may have said before, it looks like this is another cottage industry to sell sleep studies and equipment at inflated prices. I saw a segment on 60 Minutes or 20/20 type show about children's dental clinics performing dental procedures, metal caps, and all sorts of procedures on kids who lose their baby teeth anyway; under Medicare there is no dental care; as a solo attorney dental insurance coverage was not affordable.
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Permalink Reply by Glen England on
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I use a Sleep Style 600 and I know there is an hr meter on there that shows how many hours the unit has operated, and the next figure as you cycle thru the menus shows average number of mask hours per night. This can be verified by checking the website: http://www.fphcare.com/osa/cpaps.asp. There is also a checksum number that comes up at the end and you cycle thru the options on the menu after you turn on the machine. Right now, my machine reads 214. I don't know what that number means, but the same website mentioned above says that F&P does know what that number means and it has to do with compliance. The DME may not have the necessary software to read the Sleep Style, but, you should at least have some success from F&P on the compliance code. Apparently, the machine can tell the difference between the run hours and average mask hours. My machine shows that my average mask hours are 8.5 / night which should be right, becuase I wear my mask every night all night. I even wear it during my Sunday afternoon naps. I love the Sleep Style 600, and I would fight to keep mine if I had to. Good luck.
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Medicare does have required compliance guidelines. However they do not dictate which manufacturer of equipment to use. There are many and to my knowlege they all offer compliance data even though some may be more simplified. The compliance also consist of a face to face visit with the prescribing physician who must document the the patient is benefiting from the use of CPAP. I think you should ask for your original equipment back or a different machine that is more quiet. Hope all turns out well!!!!!!!!!!!!!!!!!!!!!
Brad
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