When a Medicare patient wants to start using a continuous glucose monitoring device, it is important to first know the difference between the different parts of Medicare when it comes to coverage of diabetes supplies and services for your patients.
Medicare coverage guidelines are complex and many physicians are too busy caring for patients and don’t have time to keep up with these intricate regulations. As a result, the patient is left dealing with the frustration of a denied prescription and delayed access to a device they’re looking forward to using.
We’ll take a look at how that happens, and how working with a direct supplier like Quest Health Solutions can eliminate the headaches that come with getting CGM devices into the hands of your patients.
Keeping up with the intricacies of Medicare
As you know, Medicare Part A is responsible for coverage when a patient is admitted to a hospital. Medicare Part B covers two types of services: Those that are medically necessary to diagnose or treat your patients’ medical conditions and preventive services to prevent illness like the flu or detect it at an early stage. And lastly, Medicare Part D is responsible for patients’ prescription drug coverage.
Things get more complicated when it comes to patients with diabetes. For example, Medicare Part D covers certain medical supplies to administer insulin, including syringes, needles, alcohol swabs, gauze and inhaled insulin devices. Whereas Medicare Part B covers blood sugar or glucose testing monitors and infusion pumps and related supplies and accessories for this equipment, including test strips, lancets and glucose sensors.
Standard operating procedure: Send it to the pharmacy
In a medical setting, procedures and processes make the world go around. They help you set expectations and create the networks that make everything work smoothly.
After a checkup with a patient with diabetes, you would do what you normally do: Send the prescription of their diabetic supplies to the pharmacy. When your patient needs strips, lancets or insulin, the pharmacy would accept the prescription, get it to the patient, and then bill Medicare Part D. And that was all there was to it.
The Problem: CGM devices are covered under Medicare Part B
When it comes to filling prescriptions for CGM devices, you might start by following the usual procedures mentioned above. But CGM devices are not covered under pharmacy benefits (Medicare Part D). They are covered under Medicare Part B. So when a patient brings their prescription for a CGM to a pharmacy, they will find out it is not covered and will not be able to get the device.
What does Medicare need for CGMs and how do you get it for them?
When a Medicare patient wants to switch to a CGM, Medicare requires them to meet strict coverage requirements and go through a different verification process for approval. This verification process can be complicated. Building procedures to make the approval process more seamless and efficient can be time-consuming and daunting. (Not to mention, it’s a tall order because the benefits investigation and authorization phone calls can be confusing and tedious, taking time away from patient care.)
Solution: Work with a CGM supplier
This is one of those times when it’s more efficient to partner with a CGM supplier that’s well versed in DME coverage and has the procedures in place so your patients get their CGM device quickly.
When you partner with Quest Health Solutions to fulfill your patient’s CGM needs, here’s what you can expect:
- • You send us the prescription, the most recent progress notes on the patient and the order form.
- • Your patient gets their new CGM on their doorstep via Priority Mail within 72 hours.
In between those two steps, we handle everything else: the paperwork, your patient’s benefits investigation along with those time-consuming authorization calls.
Medicare helps many people, but it’s not always straightforward for medical providers to navigate. Between various coverage plans and different authorization rules it makes it difficult to provide quality care and navigate this cumbersome process simultaneously. Developing the skill and expertise to navigate Medicare can require years of experience your staff may not have and result in delayed care for your patients.
Quest Health Solution eliminates those headaches. That’s the value of working with us.
Let Quest Health Solutions make it easier to get CGM devices into the hands of your patients.
Our patient-first philosophy makes a world of difference for you and the people under your care.
CGM devices are a game-changer for your patients. But DME authorization can cause delays for Medicare Part B patients.