I learned this from my wife the pharmacist. Here are the hoops a patient and doctor have to jump through before medicare will pay for more than 100 test strips/month. (Approximately 3.3 strips/day.)
___ 1) Copy or original prescription from physician (The order for the glucose monitor and/or testing supplies must Include, the Item to be dispensed, the specific frequency of testing, the treating physicians signature, the date of treating physicians signature, a start date of the order-only required If different than the signature date) NOTE: According to Medicare an order that states “as needed” will result in those items being denied as not medically necessary.
___ 2) Certification of completion of training in the use of a Home Blood Glucose Monitor
___ 3) Glucose Level Testing Logs within 6 months prior to your date of service.
___ 4) Copy of Delivery Slip/Signature Log
___ 5) A patient signed refill request stating the date they made the request. the item that was ordered and that the supply from the previous fill Is nearly exhausted.
___ 6) Physician office notes within 6 months prior to your date of service.
I am on Medicare because of being on disability – that has actually been Medicare’s policy for some time now. I test my BS 18 times a day and have never had a problem getting test strips. I transfer my readings to my computer so anytime they want 5,000 pages of readings, they can have them!
What did change in April this year will make it hard for some people on pumps – you have to see the prescribing physician every 90 days. My PCP signed for my pump, so that is not a problem for me. I just saw an endo the beginning of Sep for my thyroid and when I was leaving, they said she is booked solid thru the end of Jan. My next appointment is 5 months so that would be a problem if she were the one signing the paperwork. A lot of endos do have long waits. I did read someplace someone did not know about the new law and when her supply company asked the question, she had not seen her doctor within 90 days and could not get her supplies shipped until she saw her doctor.
Medicare will pay for shoe inserts if you are diabetic. In May I went to my orthotics place with a script for new ones. Usually it takes about 2 weeks for them to call that they are done. Several weeks went by so I called them to find out what was taking so long. They said in April, the law was changed and they now needed proof that I was diabetic. They called the prescribing doctor but said she didn’t think he understood what they needed because he didn’t send it. She then sent something to the PCP she had on file for me. Unfortunately, he was no longer my PCP and she didn’t know that. Once she sent it to my PCP, she was able to get what she needed. I don’t have a problem with them needing proof that I am diabetic if Medicare will only pay if you are diabetic – I think that is part of how they are cutting back on fraud.
My wife the pharmacists explains that it is in part a fraud prevention measure - it keeps fraudulent pharmacist from charging to distribute non-existent test strips. go figure.
There is a whole lotta fraud going on with Medicare service/supply providers. I understand that you can get what you need from Medicare, but your doctor has to be pretty specific. I also notice that where I’m getting some PT for my neck they have notices to medicare patients that they need to have their prescription for PT renewed every 90 days. I try to check in with my endo every 90 days or so. i live in a metropolitan center so it’s no biggie, but if I were a retired person living on my farm out in the middle of the plains, getting in to see the doctor every 3 months might be a much harder proposition.
There was a sign in the exam room at my PCP when I was there in Sept. Paraphrased: Patients with diabetes must show logs to receive Rx renewals. It didn’t state Medicare patients (that I noticed), but I’m wondering now if this is related.
