Posted by Andrew Senske on 6/29/2012 to
On June 8, 2012 Medicare communicated a policy clarification regarding the re-supply of CPAP equipment for Medicare beneficiaries. Changes in this revision include revised refill documentation instructions regarding consumable and non-consumable supplies. While the policy clarification left many questions unanswered for both CPAP users and suppliers, in general the updated policy is a good one. The updated policy states, in part, the following:
"For non-consumable supplies i.e., those more durable items that are not used up but may need periodic replacement (e.g., Positive Airway Pressure and Respiratory Assist Device supplies) – The supplier should assess whether the supplies remain functional, providing replacement (a refill) only when the supply item(s) is no longer able to function. Document the functional condition of the item(s) being refilled in sufficient detail to demonstrate the cause of the dysfunction that necessitates replacement (refill)."
Clearly, this puts a burden on suppliers who are billing Medicare regularly based on a reimbursement schedule without checking to see if a beneficiary actually needs new equipment. Many of these suppliers undoubtedly don't like this policy change because it fundamentally changes their business model from one of "pushing" products to patients, to one of the patient "pulling" a product from a supplier based on need. My guess is that most reasonable people would view replacing supplies based on need rather than on a fixed reimbursement schedule created by the government to be an exercise in common sense. If you're like me, you don't want ANY government program - whether it's Medicare or the now-infamous GSA - to be throwing your hard-earned money down the metaphorical drain.
With that said, Medicare has strict eligibility requirements for beneficiaries who use CPAP equipment, as well as strict documentation guidelines for suppliers, both of which can be seen as bureaucratic and unnecessarily burdensome to both beneficiaries and suppliers. Medicare has its faults to be sure. So, I'm not saying Medicare has fixed everything with a single policy revision. I'm simply saying it's a good policy revision and it's a step in the right direction if we want to have even the slightest chance of controlling costs in healthcare.
Anyone on the other side of this issue will argue that a policy like this is bad for beneficiaries and that it can compromise patient care. However, the intent of this policy is for the government to save money where it's able to do so, not to make it difficult for a patient to get what he needs. If a supplier and beneficiary work together to determine a CPAP mask is no longer functional and useful for a patient, then the mask can be replaced. If the mask is working adequately then there is no need for replacement. Let's not forget, any Medicare beneficiary is free to buy supplies in any quantity by paying out-of-pocket. Just because an individual has Medicare insurance doesn't mean that individual should use only that insurance to buy supplies. Internet discounters like us can help take the sting out of paying out-of-pocket. We sell complete masks for as little as $43. In most cases, the only reason patient care would be compromised by this policy revision, is if the patient chooses to compromise their own care. A typical Medicare beneficiary can easily end up paying more than $43 for a mask purchased through the Medicare program, so there's very limited merit to the patient care argument.
Medicare Part B covers durable medical equipment, including CPAP equipment. For 2012, Medicare Part B beneficiaries can expect to pay between $99.90 and $319.70 per month in insurance premiums - depending on income level - with a $140 deductible. After the deductible is met Medicare will pay 80% of allowable expenses with the beneficiary picking up the remaining 20%. Of course, this is all in addition to the amount of money each beneficiary pays into the program in the form of Medicare tax on wages earned.
Like with any insurance policy, Medicare beneficiaries have a monthly premium - designed by law to approximate one quarter of expected costs of services incurred for the individual - as well as a deductible and copay. Since many local suppliers who bill Medicare directly charge so much for the equipment, it stands to reason that buying out-of-pocket can often be the most economical choice for beneficiaries who need to buy supplies.
If you're a Medicare beneficiary, you should be embracing and enthusiastically heralding this policy revision, because it's going to save all Americans money. Medicare isn't free for anyone, as you can see above. We're all paying for it, so we should all want to save as much money as we can.
The bottom line: controlling costs is the only responsible way to run a government. Medicare has now proven they're willing to act responsibly, at least a little. This trend needs to continue.
Next step: our government must find a way to eliminate the $60 billion per year in Medicare fraud. Yes, that's billion with a B.
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