Home Health & Hospice Week

Watch overutilization cases carefully.

If you bill Medicare for diabetic test strips and lancets, take note: Attention to two billing concerns could go a long way toward warding off federal overpayment charges.

A recent report from the HHS Office of Inspector General claims that iCare Medical Supply of Jupiter, FL, owes Medicare more than $8 million because the firm did not have adequate controls to ensure that test strips and lancets were medically necessary and documented in accordance with Medicare requirements.

To save yourself from such charges, take stock of your own documentation practices, with special attention to these two matters:

1. Make sure your physician order form fits the bill. Medicare allows suppliers to come up with their own physician order form, explains Jane Bunch of Jane's Healthcare Consulting in Marietta, GA. But many suppliers unwittingly devise forms that don't cover the necessary ground, she says.

The physician's order must provide all of the information to prove medical necessity, says Bunch. This includes the length of need, frequency of testing, all supplies including quantities, the monitor listed, patient's ability to use the home monitor, patient's insulin dependency status, whether or not the patient is an overutilization patient and the medical requirements of testing more than three times a day or just once a day, physician information and patient information.

Double-check: Contact your Durable Medical Equipment Medicare Administrative Contractor (DME MAC) to ensure that your physician's order form meets all necessary requirements.

2. Go the extra mile when documenting for overutilization. Be especially careful when a patient requires more than the usual number of test strips or lancets, says Bunch.

Medicare will routinely reimburse 100 strips and 100 lancets every three months for a patient who is non-insulin dependent and 100 strips and 100 lancets every month for a patient who is insulin dependent. Any supplies above those limits are subject to overutilization documentation requirements.

When the patient requires more supplies than Medicare normally allows, you must obtain a new physician order or physician progress notes, says Bunch. Documentation must also include a copy of the patient's testing log every six months stating why the patient medically needs to test more often than Medicare's normal allowances.

Tip: Inform such patients up front that you will require a copy of their test logs each month in order for Medicare to reimburse you for the overutilization, coaches Bunch.