Treating Diabetic Patients in Your Office?

by  Shannon DeConda
June 30th, 2017

CMS will be rolling out an Expanded Diabetes Prevention Plan January 1, 2018 as well as new Durable Medical Equipment (DME) supply codes for Continuous Glucose Monitors (CGM) July 1, 2017. These services will offer your practice the opportunity to better assist your diabetic patient's needs.

Remember that prior to providing DME supplies to a patient, you must be credentialed by Medicare as a DME supplier. For more information, visit the CMS website using this link:

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/DMEPOSEnrollment.html

Continuous Glucose Monitoring (CGM) Devices Effective July 1, 2017

In January of this year, CMS Ruling (CMS-1682-R) advised that Continuous Glucose Monitoring (CGM) will be considered DME. CMS offered the following guidance on what considerations a CGM must offer in order to meet this description.

The CGM must:

Proper reporting of DME supplies typically requires the use of HCPCS codes for reimbursement through the DMERC System. To facilitate accurate reporting of these services, two new HCPCS codes have been created to report CGM:

To-Do List for CGM Implementation

If you are interested in providing CGM services to your Medicare Beneficiaries, you may use the following to add to your to-do list:

1. Verify you have an active DMERC number. The key here is an active number. If you failed to provide specific updated information or re- validation, your number may have been inactivated. Additionally, CMS will typically inactivate numbers that have not been used within 6 months.

2. If you do not have a DMERC number, you will need to obtain one. Your DMERC MAC carrier may NOT be the same as your Part B MAC, so be sure you identify your DMERC Carrier using the following link:

https://www.cms.gov/Medicare/Medicare-Contracting/Medicare- Administrative-Contractors/Downloads/DME-MAC-Jurisdiction- Map-Jan-2016.pdf

3. Investigate your options for CGM devices that meet the description set forth by CMS and work to obtain best pricing. Consider consulting with Craig King with the PowerBuying division of DoctorsManagement (our parent organization) for pricing options. You can contact Craig via email at cking@drsmgmt.com

4. Begin staff training. You will need to have a team member trained on the CGM device, troubleshooting and application. The manufacturer or distributor representative from whom you've purchased your CGM may be able to offer this training. Don't forget to train your billing staff on the appropriate code use along with ICD-10 coding application process.

5. Be ready to implement and bill on July 1, 2017. For more information on CGM, visit:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning- Network-MLN/MLNMattersArticles/downloads/MM10013.pdf

Medicare Diabetes Prevention Program (MDPP) Expanded Model Proposed Effective Date January 1, 2018 (Pending Final Rule)

Medicare is rolling out the Medicare Diabetes Prevention Program (MDPP) Expanded Model beginning January 1, 2018. This program will target Medicare beneficiaries with pre-diabetes in hopes of behavioral modifications to prevent Type 2 Diabetes.

Description of this proposed benefit includes:

Eligible Beneficiaries will include those individuals who meet all of the following criteria:

As the final ruling is still pending, CMS has begun to outline some information regarding supplier eligibility, but additional rulemaking is required. If your organization is interested in this program, keep a watchful eye for more information that will include the requirement of the organization to have full recognition of the CDC Diabetes Prevention Recognition Program (DPRP). Organizations will provide this service through "coaches" who must have a valid NPI. The organization will be required to pass application screening at a high categorical risk level (per 42 CFR 424.518(c)) regardless of current Medicare enrollment. Final rulings will also provide information on payment structure.

To-Do List for MDPP Implementation

If you are interested in providing MDPP services to your Medicare Beneficiaries, you may use the following to add to your to-do list:

  1. Most importantly, watch for the final rule to be released to know all information on billing, supplier eligibility, and benefits/coverage.

  2. Once the final ruling is released with reimbursement details, create an internal feasibility analysis to ensure implementation of this program will be financially viable.

  3. Begin researching the CDC Diabetes Prevention Recognition Program. Here is a link to assist: https://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf

  4. Identify staff who may meet the CDC definitions of a "coach" as outlined in their standards (at the link above) on page 25 which is Appendix C.

  5. Begin identifying potential eligible beneficiaries for review of potential implementation starting January 1, 2018.

For more information on MDPP, you may visit: https://www.cms.gov/newsroom/mediareleasedatabase/fact- sheets/2016-fact-sheets-items/2016-11-02-2.html

Treating Diabetic Patients in Your Office?. (2017, June 30). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/treating-diabetic-patients-in-your-office-31417.html

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