Wiki New time limits for A1C and Lipids..........

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nneecole44

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Can someone help me find a link on the Medicare web site to find out what the time limit is for lipids, A1C ect? I have searched the web site and it is so confusing. We are getting denials for our A1C and lipids saying its to soon. How do I go about finding this info? Help.
 
nneecole said:
Thank you so much. I just had to read a little harder. LOL. Thank you sooooooooo much!
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Happy to help. Just a "heads up". A1C is on the OIG's radar for next year....

Laboratories: Part B Payments for Glycated Hemoglobin A1C Tests

We will review Medicare contractors' procedures for screening the frequency of clinical laboratory claims for glycated hemoglobin A1C tests and determine the appropriateness of Medicare payments for these tests. Preliminary OIG work at two Medicare contractors showed variations in the contractors' procedures for screening the frequency of these tests. It is not considered reasonable and necessary to perform a glycated hemoglobin test more often than every 3 months on a controlled diabetic patient unless documentation supports the medical necessity of testing in excess of national coverage determinations guidelines. (CMS's Medicare National Coverage Determinations
Manual, Pub. 100-03, Ch. 1, pt. 3, § 190.21.) (OAS; W-00-12-35455; various reviews; expected issue date: FY 2012; new start)

Page 51

http://www.oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf
 
A1c

We were getting denials from Palmetto and we are in NC. The A1C's were more than 3 months apart. So we called and Palmetto stated they didn't go by any 3 month rule but instead a "rolling year". The way the "rolling year" was described is if you are performing an A1C today 12/28/11 you need to check the patient's record back to 12/28/10 and make sure you don't perform more than 4 in that year. You can only perform 4 in a year on a controlled patient. Doesn't matter if performed less than 3 months of each other as long as you have not performed more than 4 in a year. Per Palmetto J11 Part B Medicare.
 
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