DMERCs Scour Medicare 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, a patient who previously needed to check his glucose levels once a day now needs to check them twice 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.