DMERCs Scour Diabetic Supply Claims

WASHINGTON–CMS’ durable medical equipment regional carriers are
beginning to examine diabetic supply claims more carefully, so
providers must take steps to make sure those claims are reimbursed,
a CMS official announced during the agency’s Open Door Forum June
23. Recently, a number of providers, particularly in DMERC Region
A, have expressed concern about these reimbursements, he said.

“Diabetic supplies are a significant area of concern for our
[comprehensive error rate testing] program,” the representative
continued. The CERT program measures how well providers prepare
claims for submission and whether the DMERC made appropriate
payment decisions. “I expect [the DMERCs] are going to take a
closer look at those claims,” he said.

With diabetes, the beneficiary’s condition may worsen, and
providers may have to order additional supplies if, for example,
the patient needs to check glucose levels an increased number of
times a day. If supplies have been ordered within the last 90 days,
“the DMERC is going to look at [the new claim] and think it’s a
duplicate claim,” the CMS spokesperson explained.

To avoid claim hassles for diabetic supplies, the official told
providers to make sure the claim’s text field notes that the
patient’s condition has changed. “That is normally sufficient,” he
said, though he cautioned that the DMERC may still send a request
for additional documentation. If these requests are followed, he
said, “I don’t expect any properly justified claims will be
denied.”