Medicare Compliance & Reimbursement

Now labs can bill at least once per year for all patients

The Medicare Modernization Act (MMA) rang in the New Year with far-reaching reimbursement changes that open the door for annual diabetes screens for patients - and bi-annual ones for those who qualify.

"Before this, Medicare patients were refused screening except for certain procedures," excluding diabetes, explains Margaret Ann Hyder, lab manager for Clinical Laboratory Services in Lincolnton, NC.

Good news: The screening benefit, effective Jan. 1, allows for one test per year for patients not previously diagnosed with diabetes. That means a diabetes screen can become part of patients' annual physicals, Hyder asserts.

Frequency increases with risk The rules are especially helpful for those at risk for developing diabetes, points out Maggie Mac, a health care consultant with Pershing, Yoakley & Associates in Clearwater, FL. Medicare says it will consider patients to be "at risk" if they present at least one of the following symptoms:

 Hypertension

 Dyslipidemia

 Obesity (body mass index [BMI] of 30 kg/m2 or more)

 Previously identified elevated fasting glucose

 Previously identified impaired glucose tolerance

Or two or more of the following:

 BMI between 25 and 30 kg/m2

 Family history of diabetes

 History of gestational diabetes or delivery of 9-pound or larger baby

 65 years of age or older

Patients who display any of these symptoms qualify for a bi-annual diabetes screen no fewer than six months from their first test.