Industry News: Home Health Plans of Care: Monitoring Glucose Control in Type II Diabetes Mellitus patients
February 16th, 2015

Home Health Membership News - February 6, 2015

Palmetto GBA LCD Reminder

Home Health Plans of Care: Monitoring Glucose Control in Type II Diabetes Mellitus patients

Effective December 30, 2014

 

This is a reminder that Palmetto’s Diabetes II Local Coverage Determination (LCD) Policy is in effect.  To view the entire policy, along with comments received from CMS last year, go to:

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35413&ver=5&ContrId=227&ContrVer=1

 

In addition, the 16 State Medicare Coalition discussed this policy last week with Palmetto who provided the following additional questions/answers this morning:

 

Q1:  Is this LCD applicable to all diabetic care plans or for those patients where the agency is monitoring the insulin? (During the meeting, the question was somewhat modified and records as Is the LCD requirement for all diabetic patients or just Type II diabetics receiving insulin injections on a daily basis?

A1: The Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus (L35413) applies to all patients with Type II Diabetes Mellitus (DM). If the agency is billing a Type II DM code on the claim, and included it in the OASIS, then the provider should follow the policy requirements.

 

Q2:  If an episode ended, for example, the first week of January and an A1c had not been ordered, could the agency still bill?

A2:  Yes. The LCD applies to episodes that begin on or after December 30, 2014.

 

Q3:  If a patient was opened in early December, for example, with an episode ending in February – is the A1c required prior to billing that episode?

A3: The effective date of the policy is for services performed on or after 12/30/2014. The policy was not in effect when the patient was opened in early December. Therefore, an A1c is not required prior to billing the episode.

 

Q4:  For both Start of Care (SOC) and recertification episodes beginning after January 1, 2015, the A1c is required?

A4:  Yes. The LCD applies to both SOC and recertification episodes that begin on or after December 30, 2014.

 

Q5:  Was there discussion during the comment period on the promotion of Metformin in the LCD?

A5:  As a standard operating procedure, Palmetto GBA uses several resources to develop and support LCDs. One particular resource is peer-reviewed literature. The "sources of information" cited in the LCD discuss the evidence-based algorithm that supports the use of Metformin. The LCD contains an electronic link to the article and algorithm.

 

Sources of Information and Basis for Decision

       i.         Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes, which can be viewed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606813/.

 

A recent peer-reviewed article also reinforces the risks of over treatment. It was published in the JAMA Internal Medicine on January 12, 2015. The study is titled, Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control. The article can be accessed at http://archinte.jamanetwork.com/article.aspx?articleid=2089233.

 

Q6:  If a visit is made for another reason, but the patient is diabetic and part of the care requires monitoring the patient’s glucose levels, would this LCD apply?

A6:  The LCD applies to all patients with Type II DM when the POC includes monitoring of the patient’s glucose level and/or daily insulin injections.

 

Q7:  If the patient’s physician refuses to order the H1A1c test, what should the HHA do if the POC requires monitoring of the patient’s diabetic condition?

A7:  The physician who establishes the plan of care must sign and date the certification. Among the requirements that the physician is "certifying" is that a plan of care has been established and will be periodically reviewed by a physician. The HHA should ask the physician for the test results as they may already have them in their records.

Posted by Sharron Smitherman in Home Health   |  0 Comment(s)  |  Leave a Comment

Careers: Remote ICD-9 Coders/OASIS Specialists
February 2nd, 2015

ICD-9 Coders/OASIS Specialists

HCS is currently seeking nurses with Home Health experience and who have Certifications in OASIS and ICD-9 to join our coding department. HCS contracts nurses throughout the country who are full-time, part-time or need extra work to supplement their full-time positions. Want to work from home? Come join our growing team of home health professional outsource coders!

Posted by Sharron Smitherman in Coders   |  0 Comment(s)  |  Leave a Comment

Careers: Software Trainer
February 2nd, 2015

Software Trainer

Duties:

  • Train customers on the adoption and implementation of our software product line
  • Provide remote and onsite training sessions to customers nationwide
  • Assist in design and development of training tools to assist the successful implementation of our products and services
  • Work closely with the sales and support teams to ensure customer needs are met.
  • Build relationships with customers to identify their needs and recommend appropriate product improvements
  • Maintain extensive knowledge of all company products and services.
  • Act as point person in the resolution of all customer issues.
  • Research current training delivery opportunities to improve company methods.
  • Travel in support of sales or training meetings, customer site visits, and/or trade shows as required or requested.
  • Demonstrate product and technical knowledge in providing detailed and effective online and in-person product demonstrations
  • Successfully hand-off new clients to support team for ongoing training and support
  • Provide feedback to sales and support teams in developing effective training tools

 Qualifications:

  • Home health industry experience required
  • Proven history of successful training/sales experience and proven ability to exceed goals
  • Strong interpersonal skills. Ability to easily communicate with people.
  • Demonstrated ability to anticipate customer needs.
  • Ability to travel regularly
  • Strong oral and written communication skills with a good sense of humor
  • Proven leadership skills and experience
  • Experience conducting product demonstrations via web conferencing is preferred
  • Desire and ability to work effectively in an entrepreneurial and dynamic environment

Posted by Sharron Smitherman in IT   |  0 Comment(s)  |  Leave a Comment