Washington Irregular billing cycles are to blame for almost $79 million in improper Medicare reimbursement for blood glucose test strips, according to a report from the Department of Health and Human Services' Office of Inspector General.

In the report, Blood Glucose Test Strips: Inappropriate Medicare Payments, the OIG said the irregular billing cycles make it difficult for durable medical equipment regional carriers to identify overlapping claims, claims without correct supporting documentation and claims containing excessive amounts of test strips.

Medicare allowances for test strips more than doubled from 1994 to 1997, jumping from $102 million to $220 million. Of the $79 million in erroneous claim payments in 1997-the year used by the OIG for its report-$33 million had insufficient documentation to support claim eligibility. For example, the report said that 25 percent of the sampled claims failed to establish beneficiary eligibility for the test strips and were missing physicians' orders, had no indication of insulin usage, were unsigned or did not cover the dates of service billed.

The OIG said that 8 percent of claims were supported by physician orders that did not cover the service dates billed, which would make beneficiaries ineligible for coverage. "Generally, suppliers must have completed orders in their possession before providing supplies to beneficiaries," stated the report. "However, we found instances where orders were dated months-even years-after the beginning dates of service." The report added that the time from initial supply of test strips to date of completed order ranged from five weeks to almost 25 months, with the average being four months.

The other $46 million in erroneous claims had incomplete orders or no supplier delivery records. Of these, the OIG found that 21 percent of claims were missing basic details such as the item being ordered (test strips), quantity needed, frequency of utilization or length of need.

To remedy such problems, the OIG made the following recommendations:

* Alert suppliers of the importance of properly completed documentation to support their claims for test strips, including physicians' orders, supplier delivery documentation and documentation to support the medical necessity of quantities of test strips greater than 100 per month.

* Require suppliers to indicate actual and accurate "start" and "end" dates on claim forms. The OIG said this will help DMERCs identify potential problems, such as overlapping claims or if further documentation is needed.

* Promote supplier concurrence and cooperation with the OIG's Compliance Program Guidance for the Durable Medical Equipment, Prosthetics, Orthotics and Supply Industry document.

* Advise beneficiaries, as part of its outreach service, to report fraudulent or abusive practices involving their home blood glucose monitors, test strips or related supplies to their DMERCs.

The full OIG report can be down-loaded via the Internet at http://www.hhs.gov/oig/oei/whatsnew.html.