Home Health & Hospice Week

Add diabetes LCD to your physician education hit list.

What can you do if the physician doesn’t order an HbA1c test, under the new diabetes LCD from Palmetto GBA (see related story, this page)? Despite the fact that your agency has no control over what the physician will or will not do, it’s the agency’s payment that will take the hit.

Unfortunately, you can’t simply document the physician’s refusal, according to the Texas Asso-ciation for Home Care & Hospice’s Feb. 19 member newsletter. And you can’t perform a fingerstick (POS) HbA1c yourself, either, the newsletter Q&A advises.

Palmetto has done some outreach toward educating physicians about this new requirement through social media, TAHC&H says. And the MAC plans to use the physicians on its Contractor Advisory Committee to help disseminate the LCD and its supporting information, as well as during in-person educational sessions hosted by the Provider Outreach and Education (POE) Department.

Palmetto has provided medical literature to support this new initiative and it has suggested that agencies should share the articles with physicians so that they can understand what is expected of them, says attorney and certified coder Lisa Selman-Holman with Selman-Holman & Associates, Code Pro University and CoDR — Coding Done Right in Denton, Texas. Medicare pays for the HbA1c every 90 days and they encourage physicians to monitor blood glucose levels with the test, she says.

The cost: Palmetto has clarified that agencies shouldn’t even submit a claim if a current HbA1c isn’t available, Selman-Holman says. “So it is in the agencies’ best interests to educate the physicians, get an order for a venipuncture if necessary at SOC or recert, and report the results to the physician.”

The episode(s) will be subject to denial if claims are submitted and an HbA1c is not available, Selman-Holman says. This applies to all type II diabetics, not just the ones where diabetes is primary and not just to ones who use insulin, she says.

Keep An Eye On Your MAC

Caution: If you think you’re in the clear because your agency isn’t in Palmetto’s jurisdiction, think again. “The other MACS could apply this requirement at any time,” Selman-Holman warns. “Palmetto unofficially has stated they intend to revise the policy to include only type II diabetics who require insulin injections, but I think we should wait and see until that point and try to comply.”

Note: For a PDF copy of the LCD, email the editor at rebeccaj@eliresearch.com with the subject line “Palmetto Diabetes LCD.”