Tighter Controls on Diabetic Supply Claims

19 Jul

Providers and suppliers will be under greater scrutiny when submitting claims for large numbers of test strips and lancets, thanks to an Office of Inspector General (OIG) June 2012 report. The OIG report estimates contractors overpaid as much as $271 million for these types of claims in 2007. In response to the report, contractors say they have made appropriate changes, or plans to do so.

Home blood-glucose test strip and lancet supplies are covered by Medicare Part B for physicians who prescribe them for their diabetic patients.
While the National Coverage Determination (NCD) does not specify utilization guidelines and documentation requirements, Local Coverage Determinations (LCDs) for the four related contractors reviewed by the report (NHIC, Corp., National Government Services, CIGNA Government Services, and Noridian Administrative Services) – state that Medicare covers up to 100 test strips and 100 lancets each month for insulin-treated diabetics, and 100 test strips and 100 lancets every three months for non-insulin-treated diabetics.
Medicare considers 50 test strips as one unit and 100 lancets as one unit. This means a standard claim for a patient’s monthly (or three-month) allotment of these supplies would be two units of A4253 blood glucose test or reagent strips for home blood glucose monitor, per 50 strips and 1 unit of A4259 Lancets, per box of 100.
To be reimbursed for a claim that exceeds these guidelines, there must be documentation that supports the reason for additional supplies and documentation in the physician’s or supplier’s records that supports the frequency of testing. The doctor must also have seen the patient and evaluated their diabetic control within six months prior to ordering the excess supplies.
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