Deciphering the questions
Improvements made to Continuous Glucose Monitoring systems over the last several years have sparked an increased demand in patients living with Diabetes, as well as the healthcare providers prescribing them. CGM devices, like the Freestyle Libre, give patients a pain-free way to monitor and manage their Diabetes diagnosis so they can live a more active and healthier lifestyle. CGM devices allow patients to monitor blood glucose levels on a continual basis and help to alleviate frequent, painful fingersticks that can deter patients from managing Diabetes properly.
Even though CGM devices sound like the perfect solution for many, qualifying to be a recipient is not always easy. Like many things in life, there is a process and system to get through and dreaded paperwork which can deter some patients and medical providers from choosing this alternative. The process can be overwhelming, but it doesn’t have to be. Let us, here at Quest Health Solutions, help you understand the steps and make the process seamless. We have over 20 years of experience dealing with the process and it is our mission to make it easier for everyone.
CGM Qualifications
In order to qualify for a Continuous Glucose Monitor, a few key criteria must exist which we have broken down into four main steps.
Step One is Identification. Potential candidates are testing blood sugar levels more than 4 times per day and injecting insulin more than 3 times per day. They are also adjusting their insulin regimen frequently based on blood sugar testing results and have seen a doctor in the past 6 months for an evaluation.
Step Two is Proper Documentation. We are pleased to announce that Medicare now covers Continuous Glucose Monitors for patients. However, it is very important that the patients most recent progress notes reflect that qualifications have been met. Often, progress notes are missing testing and injection frequency which is a necessary piece of information for coverage and qualification.
Step Three is Order Form Completion. An order form will need to be completed that includes all of the patient’s insurance information and specific demographic data. It is important that this form is filled out completely and accurately so there are no delays.
Step Four is the Prescription. A properly written prescription is vital. It is important that the script contains the physician’s signature, the diagnosis code, and patient’s date of birth. Missing information can delay the process.
Insurance Verification and Prio Authorization
Insurance coverage can vary from plan to plan and prior authorization is often required. CGM devices are typically covered by the DME or Durable Medical Equipment portion of the policy, but it’s important to verify coding and reimbursement requirements before prescribing. This is a necessary but tedious next step. For various reasons, like incomplete paperwork or missing criteria, a patient may not be approved on the first pass. This builds extra time into the process and often requires lengthy, back-and-forth phone calls and document shuffling. If rejected, the appeal process can take even more time and that is something that today’s healthcare professionals do not have the luxury of wasting. However, if done the right way, many of these nuisances can be resolved and it can be a win for everyone involved.
The Solution
At Quest Health Solutions, we have found a better way. We can help you through the entire process so that you can focus on what is important – your patients! Our CGM Fulfillment Solution is designed to take unnecessary work off your plate with an experienced team that will handle all paperwork, insurance verification, billing and authorization calls. Quest Health Solutions is the only DME service in the market that handles the tedious paperwork and time-consuming, health verifications for you. An account manager will be assigned to oversee and maintain patient activity, including reviewing progress notes and ensuring speedy product to patient delivery. You will have direct connection to your account manager who can assist with real-time verification and same day approvals.
Your next and final step in the process is to simply send everything to us, and we will take care of the rest. Your patient is our patient and is our number one concern. We are committed to providing the best patient care possible, saving healthcare professionals valuable time and being a one-stop shop for all Continuous Glucose Monitor needs. Our goal is to make living with Diabetes more manageable for everyone. Let us simplify the process and do the hard part so you can focus on your patients. Contact Quest Health Solutions at 1-877-888-7050 Ext. 1011 or email ben@questhealthsolutions.com to get started with your CGM Fulfillment Solution today.