Home Health & Hospice Week

If you supply blood glucose test strips to patients who use more than the standard amount, getting Medicare to pay your claims might get a lot harder. That's because the HHS Office of Inspector General has found that a large percentage of such claims don't meet Medicare billing criteria, according to a new report.

Background: Medicare allows up to 100 test strips and 100 lancets every month for insulintreated diabetics and every three months for noninsulin- treated diabetics, as long as there is a physician order and proof of delivery, the OIG report  notes. To cover more than that standard amount, the Centers for Medicare & Medicaid Services requires documentation supporting the  pecific reason for and frequency of testing. And the physician must have seen the patient within the last six months to evaluate her "diabetic control," the report says.

When the OIG audited 100 high-utilization test strip claims for 2007, 70 didn't meet those higher requirements. Fifty-five claims lacked documentation of the reason for or frequency of testing or the

physician's evaluation visit. Another 27 claims did not show that the refill requirement was met -- suppliers may refill an order only when the beneficiary has nearly exhausted the previous supply and specifically requests the supplies to be dispensed. For 27 claims, physician orders were incomplete or entirely lacking. For seven claims, there was no proof of delivery.

The audit findings indicate Medicare incorrectly paid out nearly $50 million for high-utilization test strip claims in 2007, the OIG includes. Almost $40 million of that went to suppliers.

The OIG wants better and more system edits in place, including edits for claims that have overlapping dates; pre-pay review for "DME suppliers with a high volume of high-utilization claims;" and more referrals of such suppliers to the OIG or CMS for investigation. The report is online at www.oig.hhs.gov/oas/reports/region9/90800043.pdf.