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Medicare Coverage of a CPAP

By on August 24, 2015 in Health and Medical, Medicare, Resources

Original Medicare will cover an initial three-month trial of your CPAP device if you have been diagnosed with obstructive sleep apnea. At the end of the trial, Medicare will continue to pay for the device if your doctor certifies that you have benefited from the device and used it properly.

Before the three-month trial, your physician and supplier must submit paperwork to Medicare to justify your need for a CPAP device. Although it is their job to know these requirements, familiarizing yourself with them can help to avoid errors and navigate any challenges that arise.

To qualify for coverage of a three-month CPAP trial, Original Medicare requires certain steps:

  1. Your doctor must diagnose you with obstructive sleep apnea based on an examination and subsequent sleep test. This test can be performed in your home or at an approved facility.
  2. Your doctor must certify that you had a face-to-face exam with him/her or another health professional within the six-month period before the CPAP was ordered.
  3. You must use a Medicare-approved supplier who provides you and/or your caregiver with instructions about proper use and care for the CPAP device. Many areas including Chesapeake, Virginia are called competitive bidding regions, which means Medicare will usually only pay for most durable medical equipment (DME) from a select group of suppliers, known as contract suppliers.
  4. Lastly, for continued coverage of your CPAP device following the three-month trial, your provider must re-evaluate you during those initial three months. He or she must certify that the CPAP device is helping you and that you are using it as recommended.

If these conditions are met, Medicare will cover 80 percent of the rental fees for a CPAP device for 13 months, once the Part B deductible is met. After that you will own the device. Note that these 13 months include the three-month trial. Medicare will also pay 80 percent of the cost of CPAP supplies, such as masks and tubing.

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Medicare Durable Medical Equipment (DME) policy tips

By on May 20, 2014 in Health and Medical, Medicare, Resources

Here are some pointers for qualifying for a lift chair, and for replacing old DMEs. As you probably know already, Medicare can pay 80% and Medicaid can pay the remaining 20% for qualifying members. But, for lift chairs, there is an added cost for the chair itself.

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Guide to Consumer Mailings from CMS, Social Security, & Plans in 2012/2013

By on October 19, 2012 in Health and Medical, Medicare, Resources

See the attached documents for information about the various Medicare/CMS/Social Security mailings and what they mean for your clients.

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Senior Medicare Patrol Programs: Help Prevent Health Care Fraud

By on October 17, 2012 in Health and Medical, Medicare, Resources

The SMP programs, also known as Senior Medicare Patrol  programs, help Medicare and Medicaid beneficiaries avoid, detect, and  prevent health care fraud. In doing so, they not only protect older  persons, they also help preserve the integrity of the Medicare and  Medicaid programs. Because this work often requires face-to-face contact  to be most effective, SMPs nationwide recruit and teach nearly  5,700 volunteers every year to help in this effort. Most SMP volunteers  are both retired and Medicare beneficiaries and thus well-positioned to  assist their peers.

Please see the link below for additional information:

http://www.smpresource.org//AM/Template.cfm?Section=Home

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Extra Help with Medicare Prescription Drug Costs

By on August 15, 2012 in Health and Medical, Medicare, Resources

Medicare  beneficiaries can qualify for Extra Help with their Medicare prescription drug plan costs. The Extra Help is estimated to be worth about $4,000 per year. To  qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 States or the District of Columbia. For more information about this benefit, click here.

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