Article

 

Diabetes, Medicare Part B and You

 

Living with diabetes whether you are on insulin or not, is a challenge. However, getting the care and testing supplies you need shouldn’t be. I am constantly amazed by the number of people I meet that are not aware that Medicare will reimburse for diabetic testing supplies as well as many other diabetes related medical services. With that in mind, let’s review you need to do in order to have Medicare Part B reimburse for supplies and services.

First and foremost, any services and supplies you may need require a diagnosis of diabetes from your doctor. Any provider, such as the mail order diabetic supply company that you may use, will require that diagnosis and a Certificate of Medical Necessity (CMN) form completed by your doctor. This is required in order to be reimbursed by Medicare/Medicaid or your insurance company. More about the CMN in a minute.

In order for Medicare to reimburse any provider, you must have a written prescription/diagnosis (CMN) from your doctor. Medicare will reimburse the provider 80% of the “allowed amount”. Translated, each state has determined the maximum amount that Medicare may be billed for an item. This is called the allowed amount. Medicare will only reimburse 80% of the allowed amount. You, the Medicare beneficiary, are responsible to pay the remaining 20% to the provider, unless you have a secondary insurance carrier.

If Medicare has your secondary insurance company on file, they will transfer or “cross-over” your claim automatically to your secondary insurance carrier. Otherwise the provider will typically bill your secondary insurer for you.

Additionally, any provider that you use will require the Assignment of Benefits Form (AOB). This form gives the provider written permission to bill Medicare on your behalf. The form must be signed and dated by you prior to the services being rendered, otherwise, Medicare can and will deny the claim, and the provider will come looking to you for payment.

Now that the paperwork is all in order, here is an overview of the Medicare Part B coverage for diabetics.

Diabetic Testing Supplies

Medicare will reimburse for blood glucose testing meters, strips and lancets as long as you follow the rules. Here is what is required.

A prescription/CMN must that states the following:

- That you have a diagnosis of either Type 1 or Type 2 diabetes.
- That you need a blood glucose meter, Medicare will only pay for one every 5 years.
- The number of blood tests per day, or per month.
- The number of blood glucose strips and lancets needed per month.
- Whether or not you are on insulin.

If you are testing your blood more than 3 times per day, Medicare requires that the supplier have a record of your blood testing log on file. This is to “prove” to Medicare that you are really using all those test strips and apparently not selling them on the black market. The log must be updated every 6 months.

For Medicare reimbursement, your doctor must complete a Certificate of Medical Necessity Form (CMN) every 12 months in order to reiterate to Medicare that you still require testing supplies. This form is required to be completed by the physician and kept on file with your diabetic supply company.

In the event that the supplier is audited by Medicare, the absence of the completed and accurate CMN form is enough reason to charge the supplier with fraudulently billing Medicare.

Diabetes Education

In addition to the testing supplies, Medicare will also reimburse for diabetes education classes. Again, this requires a written prescription from your doctor and services must be provided by a Diabetes Educator, approved by Medicare.

Medicare will initially reimburse for 10 hours of education and then 2 hours of additional classes each year.

Nutritional Therapy Services

The services provided by a Registered Dietitian require a diagnosis of either diabetes and or kidney disease. The Registered Dietitian (RD) must be approved by Medicare for reimbursement, and Medicare will initially pay for 3 hours of therapy and then 2 hours each year after that.

Diabetic Therapeutic Shoes

Reimbursement again requires a Certificate of Medical Necessity (CMN) that states the following:

Diagnosis of either Type 1 or Type 2 Diabetes
The presence of poor circulation, neuropathy, foot ulcers, history of callus that can lead to foot ulcers, partial or complete amputations or foot deformity.

Coverage is based on the 80 % of the Medicare “allowed amount” for depth inlay shoes or custom molded shoes.

Eye Exams and Glaucoma Screening

If you live with diabetes, you probably know that you are at a higher risk of glaucoma, and retinopathy. Medicare recognizes this and will pay for eye exams once every 12 months

Self Inflicted Billing Problems

Here are a few ways to eliminate Medicare billing problems and issues with your suppliers.

- Promptly return the Assignment of Benefits Form, signed and dated so they can bill Medicare on your behalf.
- If you test your blood more than three times a day, send them a copy of your signed and dated log sheet.
- Don’t order supplies from more than one supply company at the same time. Medicare will only pay the first company that submits a bill, the second company will be denied and will only come after you for reimbursement.
- If you switch insurance carriers, especially to an HMO, let your supplier know. Chances are good that your supplies may not be covered by Medicare if you have switched to an HMO. You are responsible for notification.
- If you move, let everyone know. Returned packages just waste everyone’s time and money.

While Medicare does offer fairly comprehensive coverage for the diabetic, they don’t always make it easy to get reimbursed. Hopefully, my experience in dealing with both Medicare and Medicare beneficiaries will make the adventure a little bit easier.

 

Jeff Meese is the owner of DiscountMeds4You.com and previously founded Preferred Rx of Ohio, a national mail order diabetic supply company. He has participated as a research volunteer in diabetes research programs for over 18 years and has been a regular contributor on Golden Opportunities, a weekly syndicated television show.

Contact: Jeff Meese
DiscountMeds4You
866-933-2434
http://www.discountmeds4you.com