Home Health & Hospice Week

Put HbA1c tracking at the top of your to-do list.

Palmetto GBA’s new LCD addressing coverage for patients with type II diabetes contains some big changes to coverage rules. Follow this advice from A.D. Maxim Consulting to prevent denials for daily insulin injection patients — and the resulting reimbursement drain.

1. Identify all patients who have diabetes mellitus. If the patient problem list and care plan include 250.x0 or 250.x2 (Diabetes mellitus type II or unspecified type), you must have the HbA1c results in the medical record.

2. Ensure that your documentation describes a patient who is either physically or mentally un-able to self-inject insulin and that she has no other person able and willing to inject the insulin for her.

3. Establish a process to ensure that HbA1c testing is performed within the time limits and that all results are included in the medical record. Include the following steps in your process:

•  Ask the physician for the most current HbA1c results upon referral.
•  If the test has not been performed within three months prior to the home health admission, make certain the test is performed at the time of home health admission.
•  If the patient is admitted to the hospital during the episode, follow up to obtain the discharge summary, including HbA1c results.
•  Routinely query to determine if blood tests are done during physician or NPP visits so that you can follow up for results.

4. Educate your referral sources regarding the new requirement. Remember that many physicians are following best practice and performing HbA1c, but may not be performing them as frequently as Palmetto requires in the LCD.

5. If the physician has ordered additional methods of monitoring glucose control, such as capillary blood sticks by the patient or caregiver, ensure that all clinicians (including therapists) include the frequency of self-testing, review the log at every visit, and report results to the physician as ordered