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Medicare FAQs |
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 Questions |
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1. What sleep apnea products does Medicare cover?
2. What is the Medicare deductible for 2007?
3. Are CPAP supplies covered by Medicare?
4. How are CPAP/BiPAP/APAP machines covered?
5. What qualifies me for a CPAP with Medicare?
6. What will I need to provide BMHI?
7. Do you work with patients who have no secondary insurance to cover the 20% Medicare does not cover?
8. Do you bill secondary insurance companies for the 20% Medicare does not cover?
9. What amount will Medicare cover?
10. Are you participating or non-participating provider with Medicare?
11. How often will Medicare replace my supplies and machine?
12. Will Medicare purchase or rent my CPAP machine?
13. Will you make sure I have everything Medicare requires prior to shipping my CPAP machine or supplies?
14. What if I currently receive my supplies from another vendor?
15. How do you cover warranty issues?
16. What are the benefits of using Bill My Health Insurance versus my local provider?
17. What determines what Medicare is billed and what Medicare pays?
18. Can Medicare’s prices be negotiated?
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Answers |
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1. A large array of sleep apnea products are covered by Medicare, including a capped rental of CPAP/BiPAP equipment and other authorized supplies. Fee levels vary by state, but must fall within a Medicare-determined range of fees for each product or service. Medicare covers 80% of that fee, and the patient or secondary insurance carrier is responsible for the remaining 20% (the co-pay). This co-pay is collected only after Medicare has paid their 80%, and therefore nothing is due when the items are shipped. You will not be charged a shipping fee (and neither will Medicare) for your equipment.
2. The Medicare deductible for 2008 is $135, which is the responsibility of the patient, unless you have a secondary insurance coverage that picks up the deductible. This deductible is non-negotiable and must be paid.
3. Yes, Medicare covers most CPAP supplies including masks, headgear, tubing, filters, humidifiers, and replacement pillows and cushions. Medicare has guidelines for beneficiary receipt of CPAP/Sleep Apnea related equipment, giving patients the opportunity to replenish their equipment regularly through us. See below for a list of eligible supplies, their HCPCS codes, and the Medicare allowed replacement frequency.
4. CPAPs, APAPs, and BiPAPs cannot be purchased directly per Medicare guidelines. Instead, CPAP Machines, Auto CPAP Machines (APAP), and BiLevel Machines (BiPAP) are purchased through Medicare via a 13-month rental process, whereby Medicare is billed on a monthly basis and the machine is then converted to a purchase and owned by the patient at the end of this timeframe. Medicare sets the monthly bill and covers 80% of the rental cost (the remaining cost (co-pay) is the responsibility of the patient or secondary insurance provider).
5. Medicare has certain qualifications that must be met before they will cover a CPAP machine. First, you must have had a sleep study performed at an accredited sleep facility. Second, your AHI (Apnea Hypopnea Index) must be greater than 15 episodes per hour. You must also have a minimum of 2 hours of recorded sleep. To complete your requirements, ensure you have a diagnostic study, a titrating study, and a signed prescription from your physician including your parameter settings.
6. We will need a copy of your sleep study, a valid prescription from your physician, a copy of your Medicare card and a secondary insurance card. We will also need your general information to verify benefits.
7. Yes, we can work out payment plans to meet your needs. These are done on a case by case basis and one of our insurance care coordinators can assist you.
8. Yes. In most cases your secondary insurance company is automatically sent a bill for the 20% Medicare does not cover. Our customer service team can assist you with your particular insurance company.
9. Medicare will cover 80% of their published fee schedule. Your secondary insurance will most likely cover the remaining 20%. We must verify your coverage for confirmation.
10. Manor Healthcare is a participating provider with Medicare. This means that we accept the reimbursement Medicare sends us and will not bill you the difference, excepting the 20% co-pay.
11. Please refer to Medicare fee schedule and replacement schedule at the bottom of this page.
12. Medicare rents your machine for a total of 13 months and you can elect at that time to either consider it purchased or continue renting. If you elect to consider it purchased, you will be responsible for any repairs made to the machine. If you elect to continue renting this machine, Medicare will pay us a monthly rental fee 2 times per year to maintain your CPAP machine.
13. Our customer service team will work to make sure we have everything that would be required by Medicare for reimbursement prior to obtaining your authorization to ship your products.
14. We must verify when you last received supplies from another vendor. Once we have done this, we will be able to tell you when you can receive supplies from us.
15. As with any vendor, we honor all warranty issue that may arise. We will make sure that the machine is sent to the proper manufacturer for repair at no cost to you as long as the problem did not arise from patient abuse or neglect.
16. BMHI will allow you to choose from a variety of CPAP machines and supplies that a majority of your local providers do not offer. We will work with you to make sure you are receiving the best customer service and follow-up in the industry. We are dedicated to providing you with the level of service you deserve.
17. Medicare publishes its own fee schedule. As a participating provider, we accept their fee schedule and you will only be responsible for the 20% of Medicare’s fee schedule.
18. No. Medicare allows no negotiation with its pricing.
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