I thought you might be interested in a question I recently got from a (K)notes Plus subscriber. I am paraphrasing, but it went like this:
We recently sent a broken CPAP machine to the manufacturer for a warranty repair. I just received a letter saying the repair was denied and the warranty voided because evidence showed the patient used an ozone cleaner. Will Medicare pay for the repair or replacement?
The good news is Medicare probably will.
Standard Documentation Requirements
I first looked to Medicare’s Standard Documentation Requirements Policy Article for support. In fact:
- Medicare will cover repairs to beneficiary owned equipment when necessary to make the item serviceable, but
- Medicare does not separately reimburse for repairs of covered items under a manufacturer’s or supplier’s warranty.
Since the manufacturer voided the warranty in this case, Medicare should cover the repair if the patient owns the equipment.
Does it Matter if the Patient is the Reason for the Voided Warranty?
To get a firm answer, I reached out to the CGS Medical Directors in Jurisdictions B and C to get their opinions, and I was encouraged by their collective response.
“If there is no intent [emphasis added] on the part of the beneficiary to damage the PAP device, and it results in irreparable damage, Medicare will pay for the repair or replacement of the device.”
I understand that to mean that Medicare will pay for the repairs in a case like this one so long as the patient did not intentionally damage the device. I would submit that a patient using an ozone cleaner was actually trying to care for the equipment … not damage it.
Therefore, it is my opinion suppliers can reasonably expect Medicare to pay to repair or replace beneficiary-owned equipment after ruling out any warranty coverage and intentional patient sabotage.
I hope this helps.