Diabetes Billing

Diabetic Billing, Documentation and Supplies
Presented by: Medicare Part B & DME MAC Provider Outreach and Education (POE) ( ) September Encore 2012
Workshop Protocol
Entering workshop
Attendee lines are muted upon entry Enter attendee names, provider, city in Chat (not Q&A) Print slides in Adobe PDF
https://www.noridianmedicare.com/partb/train/workshops/index .html Throughout workshop

Questions pertinent to workshop slide addressed Address Q & A to all panelists; not to host directly All other questions, call Part B Provider Contact Center Address all written questions in Q&A section, not Chat section
Workshop conclusion
Take short polling survey Asking questions aloud? Use raise/lower hand feature raise/lower hand MUTE phones do not place on HOLD
September 2012 NAS, LLC Proprietary 2
CEU Process
Att d entire workshop - t Attend ti kh type names in Ch t i Chat Take short polling survey at conclusion Part B Practitioners
To retrieve CEU certificate and print
http://www.noridianmedicare.com
Education Center/Workshops (next to registration) E Enter password ( d (provided at workshop conclusion) id d kh l i )
DME Suppliers
Certificate will be sent via email
DISCLAIMER This information release is the property of Noridian Administrative Services, LLC (NAS). It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by NAS and CMS. The most current edition of the information contained in this release can be found on the NAS website at http://www.noridianmedicare.com and the CMS website at http://www.cms.gov The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2012 American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
September 2012
NAS, LLC Proprietary
Agenda
Diabetic Screening Di b ti S i Diabetic Self Management Training (DSMT) Medical Nutritional T M di l N i i l Treatment (MNT) Documentation Glucose Monitors & Testing Supplies Therapeutic Shoes for Persons with Diabetes External Insulin Infusion Pump Resources and Reminders
NAS, LLC Proprietary 5
September 2012
Objective
T assist providers and suppliers with a b tt To i t id d li ith better understanding of the NAS Medicare Part B and Durable Medical Equipment (DME) roles in providing Diabetic billing, coverage, documentation and supplies.
September 2012
DIABETIC SCREENING
Diabetic Overview
Diabetes is 7th leading cause of death in USA Diabetes can lead to severe complications:
Glaucoma (significant risk factor) Heart disease Kidney failure Stroke
Medicare provides several diabetes-related preventive services for eligible beneficiaries Implanted pump for insulin infusion not covered
To treat diabetes
September 2012
Diabetes Screening Risk Factors

Risk Factors for Diabetes:
Hypertension High Cholesterol Obesity Elevated impaired fasting glucose/glucose intolerance
Previous Identification
With any two following risk factors:

Overweight
Body Mass Index (BMI) > 25
Family history of diabetes Age 65 or older Gestational diabetes history or deli ery of baby over 9 lbs delivery o er
Glucose Screening Lab Codes

CPT
82947 82950 82951
Descriptors p
Glucose; quantitative, blood (except reagent strip) Glucose; post glucose dose (includes glucose) Glucose; tolerance test (GTT), three specimens ( (includes g glucose) ) Non Pre-diabetes, V77.1 diagnosis Covered one per 12 month period Covered Pre-diabetes, V77.1, modifier TS (follow-up) Covered Covered twice/12 month period
Diagnosis V77.1
September 2012
Glaucoma Screening
Covered for these high risk groups:
Individuals with Diabetes Mellitus Glaucoma family history individuals African Americans African-Americans over 50 Hispanic-Americans age 65 or older
Deductible/coinsurance waived Glaucoma screening includes:

Dilated eye examination (intraocular pressure measurement) Direct ophthalmoscopy examination, or Slit-lamp biomicroscopic examination Sl t la p b o c oscop c e a at o
Recommended once every 12 months, test performed/supervised by ophthalmologist legally allowed to p provide in their state
Glaucoma Screening Codes

HCPCS
G0117 G0118
Descriptors
Glaucoma screening for high risk patients furnished by optometrist/ophthalmologist Glaucoma screening for high risk patients furnished d direct supervision of f i h d under di ii f optometrist/ophthalmologist
i for l i l d Diagnosis S i l screening f neurological, eye, and ear Di i Special diseases, glaucoma V80.1
September 2012
12
Hyperbaric Oxygen (HBO) Therapy

Standard wound care-diabetic wound patients:
Vascular status assessment Correction of vascular problems Maintenance of clean, moist bed of granulation tissue Necessary treatment to resolve i f i l infection Failure to respond - 30 y days
September 2012
T Treatment not covered d if measurable signs of healing not demonstrated in 30 day period Optimization of: Glucose control Nutritional status Debridement by any means t remove to devitalized tissue Evaluated at least every 30 days d i HBO d during
13
HBO Therapy Coverage

Type I / Type II diabetes with lower extremity wound due to diabetes patient must have one of these diagnoses Physician attendance and supervision, per session 99183 Diagnoses 250.60 250.63 g
Diabetes Mellitus with neurological manifestations 250.70 250.73 Diabetes Mellitus with peripheral circulatory disorders 250.80 250.83 Diabetes Mellitus with other specified manifestations
(adjunctive therapy only, after no measurable signs of healing at least 30 days of treatment)
DIABETES SELFSELFMANAGEMENT TRAINING (DSMT)
DSMT Coverage
B fi i i (usually i li d Beneficiaries ( ll insulin dependent) with hi h d t) ith high risk from complications of the foot, kidney complications or retinopathy Program educates self-monitoring:
Blood Glucose Diet and Exercise Education Insulin Treatment Plan
Not covered
Services hospital inpatient, hospice, home health or Skilled Nursing Facility (SNF) included in ongoing care
Eligible DSMT Practitioners

Until Medicare Benefit Policy Manual (100-02 Chapter 15, (100-02, 15 Section 300) is revised, Medicare recognizes DSMT services may be furnished by individual CDE, RD, RN or pharmacists
Not just in rural settings j g Does NOT affect who qualifies as "certified providers" to bill DSMT
Certified program usually provided by team of individuals

Determine individual/group DSMT with signed statement of need g p g
Registered Dietitian (RD)/certified diabetic educator (CDE)

May bill on behalf of DSMT program and accept claim assignment Must have a Medicare Provider Transaction Access Number (PTAN) ( )
Accredited by diabetes self-management education program

American Diabetes Association (ADA)/Indian Health Service (IHS)/American Associate of Diabetes Educators (AADE) Taught by providers with special diabetes education training
September 2012 NAS, LLC Proprietary 17 17
DSMT Coding
Physician must refer / certify with plan of care
Includes # of sessions, frequency and duration
Nutrition portion of program must be billed using:

G0108 (individual session, 30 minutes) G0109 (group session, 2 or more, 30 minutes)
Hour session = 2 (Item 24G/electronic equivalent) E/M billing not mandatory before billing DSMT Payment to non-physician practitioners billing on behalf of DSMT program made at 100% MPFS rate Coi s Coinsurance/deductible still apply c /d d ctibl l
DSMT Coding Tips

DSMT and MNT b fit can b provided t same d benefits be id d to beneficiary in same year, but not same day
DSMT and MNT require separate referrals
When patient has been diagnosed with diabetes:

Initial: Up to 10 hours for a continuous 12-month period 12 month Subsequent: If eligible, another two hours of followup/year covered with another doctors written order
DSMT provider must maintain documentation

Original order/training plan with instructions Bill with no particular diagnosis
MEDICAL NUTRITION TREATMENT (MNT)
MNT Coverage
C Covered services f di d i for disease management: t
Initial nutrition and lifestyle assessment Nutrition counseling Managing lifestyle factors affecting diet Follow-up sessions to monitor progress Medicare Part B News, #243 February 15 2008
Overview of Covered Diabetes Supplies/Services Med learn Number (MLN): SE0738 Revised
September 2012
21
Who Can Treat MNT?

Physician prescribes services to be performed by a registered dietitian (RD) or nutritional professionals ( g (e.g. Certified Diabetic Educator CDE) )
900 hours supervised dietetics and licensed/certified
Provided by team of individuals with the certified program

Cannot be sole provider of MNT Must accept claim assignment Incident to does not apply Need Medicare Provider Transaction Access Number (PTAN) & National Provider Id ifi (NPI) S N i l P id Identifier Spec. 71
September 2012
MNT Requirements
Medicare provides MNT coverage when coverage conditions are met:
Diagnosed with diabetes and/or renal disease g Referral from treating physician indicating diabetes/renal disease diagnosis N Non-physician practitioners cannot refer f h i i titi t f for MNT DSMT and MNT benefits can be provided to same beneficiary in same year, but not same day DSMT and MNT require separate referrals
MNT Billing/Coverage
M receive MNT as I di id l or G May i Individual Group b i basis Deductible/coinsurance waived Therapy Initial Year:
3 hours one-on-one counseling (no carryover) Subsequent years (with physician referral) - 2 hours/year
97802, 97803, 97804, G0270, G0271 MNT may be performed as telehealth services
September 2012
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Telehealth Services Expansion

I di id l and group t i i - DSMT services Individual d training i G0108 and G0109
E Ensures effective i j ti t i i ff ti injection training
Individual and group therapy MNT services 97803 (individual) and 97804 ( (i di id l) d (group) ) Group health and behavior assessment and intervention (HBAI) services 96153 and 96154
September 2012
25
CMS Guide to Medicare Preventive Services
Guide includes: Medicare s Medicare's preventive benefits including coverage, frequency, coverage frequency risk factors, billing and reimbursement
September 2012
26
DOCUMENTATION REQUIREMENTS
Intake Process for DME Suppliers

Assists in accurate claim submission Assures appropriate documentation collected Ask questions based on item dispensed As ite
Have you had this equipment in the past? Did you receive supplies last month from someone else? HMO?
Suggested intake form

https://www.noridianmedicare.com/dme/forms p Specialize your intake process
Documentation checklist
h https://www.noridianmedicare.com/dme/coverage/ // idi di /d / /
Authorized to Order DMEPOS

Treating Physician, MD, or g y DO Nurse Practitioner or Clinical Nurse Specialist
Treating patient for condition for which item is needed Practicing independently of g p y physician Bill Medicare for other covered services using own NPI Permitted to do in state where services are rendered
Physician Assistant y
Meet definition of physician assistant found in Section 1861(aa)(5)(A) of Social Security Act Treating beneficiary for condition for which item is needed Practice under supervision of MD or DO Have own NPI Permitted to perform services in accordance with state law
September 2012
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Dispensing Order
Most DMEPOS may be dispensed based on verbal/preliminary order Elements
Description of item Beneficiarys name Physicians name Date of order Physician signature (if a written order) or supplier signature (if verbal order)
Items provided based on a dispensing order must be followed up with completely detailed written order
Detailed Written Orders

R i d prior t claim submission Required i to l i b i i
Append EY modifier if not received
Basic elements
Beneficiarys name Detailed description of item All options or additional features Physicians signature y g Date order is signed Initial date if provided based on dispensing order
September 2012
31
Additional Elements
F items provided on a periodic b i th written For it id d i di basis, the itt order must include:
Item to be dispensed Dosage or concentration Route of administration Frequency of use Duration of infusion Quantity to be dispensed Number of refills
September 2012
32
Acceptable Detailed Written Order

M be completed by someone other than physician May b l t db th th h i i
Treating physician must review, sign, and date
Acceptable orders
Fax Photocopy Electronic Original pen and ink g p
September 2012
33
When is a New Order Required?

New N supplier li New physician Changes to order, i equipment, accessory, supply Ch d i.e. i l Equipment reaches reasonable useful lifetime Lost, stolen, or irreparable damage due to specific incident S State licensure or regulations li l i
September 2012
34
DME Information Form

F Form completed, signed l t d i d and dated by supplier Initial claim must include electronic DIF Revised DIF required if drug changes or another drug added g
September 2012
35
Relevant Medical Records

E Examples of relevant medical records i l d l f l t di l d include:
Physician notes Non-physician clinical notes Non-physician clinical evaluations
September 2012
36
Supplementary Documentation
Oth types of information not sufficient b Other t fi f ti t ffi i t by themselves to document coverage criteria
Even if signed or initialed by treating physician Not considered part of patients medical record
Will be given consideration if corroborated by medical record

Applies to documents created before delivery of item(s) y ()
September 2012
37
Examples of Supplementary Documentation

F Forms ( ith narrative or check-off) devised b (either ti h k ff) d i d by supplier and completed by physician Summaries of patient s medical condition prepared patients by supplier or physician Forms (either narrative or check-off) developed by suppliers and completed by patient or caregiver
September 2012
38
Refills
No automatic dispensing on predetermined basis Must contact beneficiary to determine:
Consumable supplies: quantities that remain from p pp q previous delivery Non-consumable supplies: supplier should assess if items remain functional
Document functional condition of item being refilled
Contact no sooner than 14 days prior to delivery/ship d d l / h date Deliver no sooner than 10 days prior to end of usage of current product
Refill Documentation
R fill request must b d Refill t t be documented b f t d before shipment hi t Retrospective attestation statement not sufficient D Documentation must i l d i include:
Beneficiarys name or authorized representative Description of each item being requested Date of refill request Consumables: quantity of each item remaining Non-comsumables: functional condition of item being refilled
September 2012
40
Proof of Delivery
Supplier St d d 12 S li Standard Required to verify beneficiary received item Must be M b available upon request il bl Maintain documentation for seven years Signature
Can be signed by beneficiary or designee C Cannot be signed by suppliers, employees of suppliers or tb i db li l f li anyone with financial interest in delivery of item
September 2012
41
Delivery Methods
Directly to beneficiary Have signed delivery slip
Items recommended to be included on slip:
P i name Patients Quantity delivered Detailed description of item delivered B d name Brand Serial number
Delivery/shipping service Proof of delivery recommendations:

Delivery services tracking slip referencing: li f i
Each individual package Delivery address Corresponding package p gp g identification number If possible, date delivered
Date of signature must be date beneficiary or designee received item Date of service = date of delivery
September 2012
Suppliers own shipping invoice

Including delivery services package identification number
Date of service = shipping date

42
Delivery Methods (2)

Return postage-paid p g p Invoice must list
Patients name Quantity Detailed description of item(s) Brand name Serial number Beneficiary or designee signature and date g
Directly to nursing facility y g y Obtain copies of documentation from nursing facility to prove usage and delivery
Nursing notes for usages Signature for proof of delivery
Date of service = date of delivery or ship date
September 2012
43
Authorization to Bill Medicare

B fi i Beneficiary must authorize supplier t bill M di t th i li to Medicare Sign and date Item 12 on CMS-1500 claim form; or Si Signature On File (SOF) O Fil
One-time authorization Statement from beneficiary authorizing Medicare benefits to be paid to themselves or supplier
September 2012
44
SOF & Future Claims

L t claims for same services can be fil d without Later l i f i b filed ith t obtaining additional signature Claims may be assigned or non assigned non-assigned
Exception non-assigned DME rentals
September 2012
45
What is an ABN?
W itt notice of noncoverage Written ti f
Informs beneficiary that Medicare may not pay for item
Allows beneficiary to make informed decision Protects supplier from liability if properly executed IOM Publication 100-04 P bli ti 100 04
Chapter 30 Financial Liability Protections
http://www cms gov/manuals/downloads/clm104c30 pdf http://www.cms.gov/manuals/downloads/clm104c30.pdf
ABN form and instructions

https://www.noridianmedicare.com/dme/forms/ https://www.no idian edica e.co /d e/fo s/
GLUCOSE MONITOR AND TESTING SUPPLIES

Local Coverage Determination (LCD) - L196 Policy Article (PA) - A33673
Basic Coverage Criteria Monitor E0607 P ti t must meet all the following criteria: Patient t t ll th f ll i it i
1. Diabetic (diagnosis code 249.00 250.93) 2. Monitor and supplies ordered by a physician 3. Beneficiary or caregiver completed training on use of equipment f i 4. Capable of using results 5. For use in the home
September 2012
48
Special Feature Monitors E2100, E2100 E2101

I Impaired visual acuity i d i l it
Integrated voice synthesizer (E2100)
Covered when basic criteria is met, and Physician certifies severe impairment
Best corrected visual acuity of 20/200 or worse
I Impaired manual d i d l dexterity i

Integrated lancing (E2101 only)
Covered when basic criteria is met, and met Physician certifies impairment of manual dexterity
Physicians narrative statement on file
September 2012
49
Accessories and Supplies

L Lancets (A4259) t
1 unit = 100 Lancets
Blood glucose test strips (A4253)

1 unit = 50 strips
Glucose control solutions (A4256) Spring powered device (A4258)

1 per six month
September 2012
50
Non-covered Supplies
N Non-covered d
Alcohol or peroxide (A4244, A4245) Betadine or phisoHex (A4246, A4247) (A4246 Urine reagent strips or tablets (A4250) Home glucose disposable monitor (A9275) g p ( ) Continuous glucose monitor
Considered precautionary
Reflectance colorimeter devices

Frequent professional re-calibration makes them unsuitable for home use
September 2012
51
Not Reasonable and Necessary L Laser skin piercing d i (E0620) ki i i device Replacement lens shield cartridges (A4257)
September 2012
52
Utilization Guidelines
Patient not treated with insulin ith ins lin
100 test strips and 100 lancets or one lens shield every three months
Patient being treated with insulin

100 test strips and 100 lancets or one lens shield every month
Oral medication is not insulin-treated insulin treated
September 2012
53
Over-Utilization Guidelines
Patient who exceeds guidelines must meet all the following criteria:
a) Coverage criteria 1 5 are met ) g b) Supplier of test strips, lens shield and lancets maintains in records the order from treating physician c) Beneficiary has nearly exhausted supply of test strips and lancets, or useful life of one lens shield d) Treating physician ordered frequency of testing that exceeds utilization guidelines d ili i id li
Documented in patients medical record with specific reason for additional materials
September 2012
54
Over-Utilization Guidelines
(cont)
e) Treating physician has seen patient and has evaluated their diabetes control
e) Within six months of ordering strips and lancets, or lens shield that exceed guidelines
f) If refills of quantities of supplies that exceed guidelines ae are dispensed

Must be documented in physicians or suppliers records
Patient actually testing the frequency that corroborates the quantity dispensed Narrative statement or beneficiarys log New documentation at least every six months
For patients that regularly use quantities exceeding guidelines
September 2012
55
Refills
No automatic dispensing on predetermined basis Must contact beneficiary to determine:
Consumable supplies: quantities that remain from p pp q previous delivery Non-consumable supplies: supplier should assess if items remain functional
Document functional condition of item being refilled
Contact no sooner than 14 days prior to delivery/ship d d l / h date Deliver no sooner than 10 days prior to end of usage of current product
KX, KS Modifiers
O of th f ll i modifiers must b used d i One f the following difi t be d during claim submission:
KX KS
September 2012
57
THERAPEUTIC SHOES FOR PERSONS WITH DIABETES

Local Coverage Criteria L157 Policy Article P li A ti l A37076
Coverage Criteria
1. 1 Patient has diabetes mellitus
Diagnosis 249.00 250.93
2. Patient has one or more following conditions:

a. Previous amputation of other foot, or part of either foot, or b. History of previous f b Hi f i foot ulceration of either f l i f i h foot, or c. History of pre-ulcerative calluses of either foot, or d. Peripheral neuropathy with evidence of callus formation of either foot, or e. Foot deformity of either foot, or f. Poor circulation i either f t and f P i l ti in ith foot; d
Coverage Criteria (2)

3. Signed certifying statement f 3 Si d tif i t t t from physician h i i
Certified criteria 1 and 2 are met Treating patient under a comprehensive plan of care for diabetes
In-person visit within 6 months prior to delivery of shoes/inserts; and Sign statement on or after date of S g st te e t te d te in-person visit and within 3 months prior to delivery of shoes/inserts
Shoes are needed

Coverage Criteria (3)

4. Prior to l ti it 4 P i t selecting items, supplier must conduct and li t d t d document in-person evaluation 5. 5 At time of delivery supplier must conduct and document in-person visit with patient
September 2012
61
Allowance Per Calendar Year

One pair of custom molded shoes (A5501) and two additional pairs of inserts (A5512 or A5513) OR One pair of depth shoes (A5500) and three pairs of inserts (A5512 or A5513)
Not including non customized removable inserts provided non-customized with shoes
September 2012
62
KX, GY Modifiers
O of th f ll i modifiers must b used d i One f the following difi t be d during claim submission:
KX modifier must be used if coverage criteria met GY coverage criteria not met and properly executed Advance Beneficiary Notice of Noncoverage is on file
Claim will reject for missing information without a KX, GY modifier
September 2012
63
EXTERNAL INFUSION PUMP

Local Coverage Determination L11570 Policy Article A19834 y
Insulin Infusion Pump E0784 Insulin J1817 I

IV. Subcutaneous insulin f di b t mellitus IV S b t i li for diabetes llit
a. ICD-9 249.00 250.93 Criterion A or B AND criterion C or D C-peptide testing requirement
1. 2. < 110% of the lower limit of normal of the laboratorys measurement method; OR Patients with renal insufficiency and creatinine clearance < 50 ml/minutes, a fasting C-peptide < 200% of lower limit of normal of the laboratorys measurement method; AND Fasting blood sugar obtained same time as C-peptide is < 225 mg/dl
3.
b.
Beta cell autoantibody test is positive

September 2012
Insulin Infusion Pump E0784 Insulin J1817 ((cont))

IV. IV Continued criterion C or D
c. Completed comprehensive diabetes education program, multiple daily injections of insulin with frequent selfadjustments at least 6 month prior to insulin pump pump, documented self-testing at least 4 X per day 2 months prior to insulin pump and one or more of the following
1. 2. 3. 4. 5. Glycosylated hemoglobin level (HbA1C) greater than 7 percent History of recurring hypoglycemia Wide fluctuations in blood glucose before mealtime Dawn phenomenon with fasting blood sugars frequently p g g y exceeding 200 mg/dL History of severe glycemic excursions
d.
On external insulin pump prior to Medicare enrollment and testing at least 4 X per day the month prior t d t ti tl t d th th i to Medicare enrollment
September 2012
Continued Coverage for Insulin Pump

P ti t must b seen and evaluated b treating Patient t be d l t d by t ti physician at least every 3 months Physician who orders and follows up must manage multiple patients on continuous subcutaneous insulin infusion therapy s o t e apy Physician works closely with a knowledgeable team
Nurses Diabetic educators Dieticians
KX, GA, GZ Modifiers

O of the following modifiers must b used d i One f th f ll i difi t be d during claim submission:
KX modifier must be used if coverage criteria met, apply: g , pp y
Insulin infusion pump (E0784) Insulin (J1817)
GA coverage criteria not met and properly executed Advance Beneficiary Notice of Noncoverage is on file GZ coverage criteria not met and valid ABN not obtained
All claim line(s) items submitted with a GZ modifier shall be denied automatically and will not be subject to complex medical review
Claim will reject for missing information without a KX, j g , GA or GZ modifier

RESOURCES AND REMINDERS
CERT Review Program

C Comprehensive Error Rate T ti (CERT) post h i E R t Testing t audit random sampling program for Medicare claims
Measures and improves quality/accuracy Send CERT requested documentation timely Q Quarterly NAS CERT web presentations available y p Watch signature requirements/documentation
CMS Claims Review Programs booklet g

November 2011 Includes MR, NCCI, MUEs, CERT, and RAC
September 2012
70
Signature Requirements
Rendering/ordering practitioner clearly ii l l identified in records First name/last name/credentials/date / d i l /d If illegible, must also type/print name Dictated notes must be verified or read by physician/practitioner I Internet Only M O l Manual l (IOM) Publication 100-08, Chapter 3, Section 3.4.1.1
ACCEPTABLE Handwritten H d itt Electronic El t i
NOT ACCEPTABLE Signature stamps p Verbiage stating signed,, but not g read
September 2012
71
National Coverage Decision (NCD) Policies

http://www.cms.gov/mcd/index_list.asp?list_type=ncd
NCD Title Blood Glucose Testing Diabetics Outpatient Self-Management Training & Medical Nutrition Treatment (MNT) Diagnosis/Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (LOPS) Glyclated Hemoglobins/Proteins y g / Home Health Visits to a Blind Diabetic HBO Therapy y Surgery for Diabetes Home Blood Glucose Monitors Infusion Pumps
September 2012 NAS, LLC Proprietary
NCD #
190.20 190 20 40.1 70.2.1 190.21 190 21 290.1 20.29 100.14 40.2 280.14
72
Miscellaneous Coverage
P di t Podiatry One exam every 6 months
With di b t diabetes-related nerve d l t d damage to either f t t ith foot
Hemoglobin A1c Tests M Measures bl d glucose l l over past 3 months blood l levels t th
Ordered by physician for diabetic patients
September 2012
73
Benefits Integrity
Ph i i Physicians: Be aware of mail order suppliers f i B f il d li faxing orders to your office for signature
When not ordered or authorized
Check with patient

E g non diabetic patient receives direct diabetic supplies E.g., non-diabetic
Patient / physician may call to report fraud

1-800-MEDICARE (1-800-633-4227) 1 800 MEDICARE (1 800 633 4227)
Write to Benefits Protection:

Medicare Part B, PO Box 6710, Fargo ND 58108-6710 , , g
September 2012
Provider Compliance Webpage

CMS MLN compliance products
How to avoid common billing errors and other improper activities
Fact sheets/educational tools, such as:

Quarterly Provider Compliance Letter F d/Ab Fraud/Abuse P Prevention, Detection and R i D i d Reporting i Overpayment Collection Process
http://www cms gov/Outreach-andhttp://www.cms.gov/Outreach-andEducation/Medicare-Learning-NetworkMLN/MLNProducts/downloads/MedQtrlyCompNL_ Archive.pdf

OIG Roadmap Booklet

OIG Booklet (31 p g ) ( pages) Fraud/Abuse Laws y y Physicians/Payer Relationship Tips for Medical Directors Other valuable information http://oig.hhs.gov/compliance /physician/ph i i education/roadmap_web_vers ion.pdf p f
Medicare Learning Network (MLN)

MLN Product and Resource Guide http://www.cms.hhs.gov/MLNproducts
Guides Articles Educational Tools Booklets / Brochures Fact Sheets Training Presentations Web-Based Training Special Initiatives Web Resources
77 NAS, LLC Proprietary
Jurisdiction D DME MAC September 2012
77
CMS Resource
I t Internet Only M t O l Manual (IOM) P bli ti 100-02 l (IOM), Publication 100 02 Chapter 15, Section 300 (Diabetes Outpatient SelfManagement Training Services)
110 (Durable Medical Equipment) 140 (Therapeutic Shoes for Individuals with Diabetes) ( p ) 300.1 (Coverage Requirements) 300.2 (Who Can Provide DSMT?) 300.3 (Training Frequency) 300.4 (Outpatient Diabetes Self-Management Training) h // http://www.cms.gov/manuals/102_policy/bp102c15.pdf / l/ li /b df
Join NAS E-mail Lists!

Whats New/Latest Updates What s
Emails sent Tuesday/Friday Simple, quick sign up p ,q g p
Benefits:
Latest news/information from NAS and CMS d Up-to-date Medicare regulations Workshop and educational event notices Medical policy updates Payment/reimbursement updates NAS hours of availability and related notifications
WHAT QUESTIONS DO YOU HAVE?
Thank you for attending todays workshop!

Diabetes Billing

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Diabetes Billing

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Diabetic Billing, Documentation and Supplies

https://www.noridianmedicare.com/partb/train/workshops/index .html Throughout workshop

Education Center/Workshops (next to registration) E Enter password ( d (provided at workshop conclusion) id d kh l i )

NAS, LLC Proprietary

NAS, LLC Proprietary

Diabetes Screening Risk Factors

With any two following risk factors:

Glucose Screening Lab Codes

Deductible/coinsurance waived Glaucoma screening includes:

Glaucoma Screening Codes

NAS, LLC Proprietary

Hyperbaric Oxygen (HBO) Therapy

NAS, LLC Proprietary

HBO Therapy Coverage

DIABETES SELFSELFMANAGEMENT TRAINING (DSMT)

Eligible DSMT Practitioners

Certified program usually provided by team of individuals

Registered Dietitian (RD)/certified diabetic educator (CDE)

Accredited by diabetes self-management education program

Nutrition portion of program must be billed using:

DSMT Coding Tips

When patient has been diagnosed with diabetes:

DSMT provider must maintain documentation

MEDICAL NUTRITION TREATMENT (MNT)

NAS, LLC Proprietary

Who Can Treat MNT?

Provided by team of individuals with the certified program

NAS, LLC Proprietary

Telehealth Services Expansion

NAS, LLC Proprietary

CMS Guide to Medicare Preventive Services

NAS, LLC Proprietary

Intake Process for DME Suppliers

Suggested intake form

Authorized to Order DMEPOS

NAS, LLC Proprietary

Detailed Written Orders

NAS, LLC Proprietary

NAS, LLC Proprietary

Acceptable Detailed Written Order

NAS, LLC Proprietary

When is a New Order Required?

NAS, LLC Proprietary

DME Information Form

NAS, LLC Proprietary

Relevant Medical Records

NAS, LLC Proprietary

Will be given consideration if corroborated by medical record

NAS, LLC Proprietary

Examples of Supplementary Documentation

NAS, LLC Proprietary

NAS, LLC Proprietary

NAS, LLC Proprietary

Delivery/shipping service Proof of delivery recommendations:

Suppliers own shipping invoice

Date of service = shipping date

NAS, LLC Proprietary

Delivery Methods (2)

Date of service = date of delivery or ship date

NAS, LLC Proprietary

Authorization to Bill Medicare

NAS, LLC Proprietary

SOF & Future Claims