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Regulatory: Use non-technical words 

Regulatory: Use non-technical words 

ST StarkQ. Can suppliers sell new CPAPs to Medicare beneficiaries who own a recalled machine but don’t want to wait for warranty repairs? 

A. Yes. When the equipment is over five years, it has exceeded its reasonable useful life. Suppliers can bill new equipment to Medicare with a new prescription. 

If the patient’s equipment is less than five years old, Medicare will not pay for a new machine because the equipment remains within the useful lifetime. 

Patients may want to buy a new machine out-of-pocket, and suppliers may provide one with a valid Advanced Beneficiary Notice of Non-Coverage (ABN). The document must explain to the customer – in terms they understand – why Medicare may not cover the new machine. When patients have equipment subject to the Philips recall, I also recommend including a summary of the patient’s recall rights and the manufacturer’s warranty plans. 

Use non-technical wording to help the customer understand the choice they are making. For example:

You are buying a PAP device after Medicare paid for another machine in the last five years. Medicare will not reimburse you for similar equipment within five years of getting your previous device, even though your current device is subject to a manufacturer’s recall. You understand the manufacturer has accepted responsibility to repair or replace that unit. By buying a new device, you are choosing not to wait for the manufacturer to fix your current device. The decision to buy a new machine does not affect your rights with the manufacturer to fix your other machine. 

The ABN is designed to help beneficiaries understand the benefits and consequences of the financial choice they are making. Suppliers should use words that make sense to a friend – presumably one who doesn’t work in medical billing. 

Andrea Stark is the founder and head of reimbursement at MiraVista, LLC. Reach her at [email protected]

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