Medicare Compliance & Reimbursement

Review of related policy could boost funding for care

Wish Medicare Part B was more generous in covering claims for monitoring diabetic residents' blood glucose levels? Hope may be on the horizon.

An administrative law judge has decided in favor of a long-term care provider who challenged denials for blood glucose monitoring claims, reports Dawn Segler, a consultant with Moore Stephens Lovelace in Clearwater, FL.

The judge stated that requiring the physicians to check blood glucose results as frequently as Medicare requires to qualify for Part B reimbursement would in effect "discourage monitoring of blood glucose levels and would contradict national coverage policy and medical practice standards," the firm reports.

In recent months, providers calling into SNF/Long-Term Care Open Door Forums, held by the Centers for Medicare & Medicaid Services, have questioned the Medicare payment policy, maintaining that in many cases the lab tests should be covered under Part B.

CMS has declined to cover routine blood glucose monitoring since 2001, when it issued a national coverage policy to that effect, explains Deborah Elsey of LarsonAllen Healthcare in Minneapolis, MN. Medicare Part B will now pay in some non-routine cases that meet strict criteria.

For example, the services must be provided under a physician's order, the SNF must report the results of the test to the ordering physician within hours and the results must be used to manage the resident's condition.

Most fiscal intermediaries have taken CMS criteria to mean that testing done based on standing orders are not separately reimbursable, notes Segler.

Stay tuned for more on the subject; CMS officials have said that they would continue to be open to discussion at future Open Door Forums.