Sleep Therapy
We understand the crucial role that quality sleep plays in your overall health and well-being. Our mission is to provide you with the best in sleep therapy products and services, tailored to meet your unique needs. Explore our wide range of cutting-edge equipment and personalized care options designed to improve your sleep quality and enhance your life.
Sleep Therapy Equipment
Everyone deserves a good night’s sleep, which is why Carolina Home Medical offers sleep therapy equipment and services to help you and your loved ones achieve restful nights. Our experts partner with your physician to ensure you receive the equipment that best meets your needs.
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PAP Supply Replenishment Guide
Your PAP equipment is essential for treating your sleep apnea and ensuring you get a good night's sleep. For effective treatment, it's important to keep your PAP equipment and supplies in good working order. This involves knowing when to replace certain supplies to maintain the best possible results. Our PAP Supply Replenishment Guide from Carolina Home Medical will help you understand when you can get new PAP supplies through Medicare and Medicaid.
PAP Compliance Guidelines - First 90 Days
With Medicare and Medicaid, as well as most private insurance plans, the following PAP compliance guidelines must be met during the initial 90-day “trial” period to qualify for continued use or purchase after the first 3 months of use.
In the first 90 days, you must have at least one (1) documented* consecutive 30-day period where you:
- Used the PAP device for at least 4 hours per night for 21 of those 30 nights.
PLUS
You must have a face-to-face clinical re-evaluation by your doctor between the 31st and 91st day. Your doctor must document the following in your chart notes:
- That your symptoms of sleep apnea have improved. AND
- That the objective evidence* of PAP “compliance” has been reviewed and placed in your medical record.
* Actual use data from your equipment
Once you have met all these requirements, insurance will resume payment for the rental and/or purchase of the PAP equipment, and future replacement supplies when needed, as long as you continue to be benefit-eligible.
Medicare & Medicaid North Carolina PAP Coverage Requirements
Regular replacement of PAP supplies is covered by Medicare, Medicaid, and private insurance plans, and is essential for ongoing comfort, compliance, and cleanliness. With regular use, these items deteriorate over time, which is usually not noticeable until they have been replaced. Medicare and Medicaid maximum replacement frequency is:
Nasal mask: 1 per 3 months
Replacement nasal cushion/pillow: 2 per 1 month
Full face mask: 1 per 3 months
Replacement full face cushion: 1 per 1 month
Tubing: 1 per 3 months
Headgear: 1 per 6 months
Chinstrap: 1 per 6 months
Disposable filter: 2 per 1 month
Washable filter: 1 per 6 months
Water chamber: 1 per 6 months
NOTICE TO CHM PATIENTS:
If you wish to purchase additional supplies more frequently than your insurance allows, we suggest that you check competitive pricing on the internet. Suppliers with a Medicare/Medicaid supplier contract have variable requirements by plan that may limit our ability to provide additional items directly to patients. Internet suppliers are not restricted by these requirements.
Frequently asked questions
If you've got questions, we've got answers!
What if I have Medicare and don't meet the compliance requirements?
Unfortunately, if you don't meet the exact requirements, Medicare compliance requires that you either return the equipment to Carolina Home Medical or pay for it and future replacement supplies out of pocket. To retry PAP therapy, your physician will need to prescribe another sleep study at a facility-based lab, and you will have to start a new PAP compliance trial period.
What if I have Medicaid and don't meet the compliance requirements?
Unfortunately, if you don't meet the exact requirements, Medicaid requires you to return the equipment to Carolina Home Medical immediately. To retry PAP therapy, your physician and Medicaid will need to review your compliance issues to decide if a new sleep study is appropriate. If it is, your physician will determine the next steps and collaborate with Carolina Home Medical to assist you.
Does Carolina Home Medical help with compliance?
YES, we are on your team! We will:
- Follow up with you to answer any questions.
- Arrange for a mask fitting if you are having difficulty with your interface, mask or equipment.
- Give you feedback to let you know if you are "compliant" and what you can work on.
- Be available to answer questions or make recommendations or suggestions.
Do you have recommendations for compliance?
We sure do!
- Practice using your mask during the day or before you go to bed.
- Learn to adjust your mask and headgear, not just tighten it.
- Keep your interface clean to minimize leaks and maintain a good fit.
- Replace your supplies regularly to maintain the integrity of your equipment.
- Talk to your doctor.
- Be consistent, patient, and don't give up! We are here to help.