Don't Get Stuck

If you provide diabetic supplies to your patients, then you can expect to receive an audit from CMS or the DMERC based on medical documentation and other components of the patient's file.

Let's review how a patient qualifies for diabetic supplies, the documentation that should be present in the patient's file and what you will need to provide if and when you receive one of these audits.

Medicare reimburses supplies and a home glucose monitor for insulin-dependent and non-insulin dependent diabetic patients if they meet the following medical coverage criteria as set forth by DMERC policy: a) the patient has a diagnosis of diabetes (ICD-9 code range 250.00-250.93) that is being treated by a physician; b) the glucose monitor and supplies have been ordered by the treating physician; c) the patient or caregiver has been properly trained or is scheduled to be trained on the use of the glucometer and supplies; d) the patient or caregiver is capable of interpreting the test results in order to assure the patient's appropriate glycemic control; and e) the device is designed for use in the patient's home.

If the patient meets all of the above criteria, you must obtain a physician order every 12 months per Medicare guidelines. If the patient requires more supplies than Medicare normally allows, you will need to obtain a new physician order every six months stating why the patient needs to test more often than Medicare's normal allowances.

For a non-insulin dependent patient, Medicare will reimburse 100 strips and 100 lancets every three months. You must add a “KS” modifier to the claim. (Make sure you span date all dates of service for all diabetic supplies.)

For an insulin-dependent patient, Medicare will reimburse 100 strips and 100 lancets every month. You must add a “KX” modifier to the claim.

For lancet devices, Medicare will pay for a replacement every six months. But let me warn you about lancet devices: Even if Medicare will allow one every six months, it will not pay for a replacement if the device is still under manufacturer's warranty. A monitor should need to be replaced only once every five years per the replacement chart provided by the DMERC.