Proposed diabetes LCD 'dings' providers

Thursday, October 7, 2010

BALTIMORE - Diabetes providers could find themselves shouldering a heavier burden if recent proposed coverage changes get approved.

A draft local coverage determination (LCD) released Sept. 23 by the four DME MACs seeks to increase documentation requirements for providers and ordering physicians for refills of strips and lancets. The LCDs would also require DME providers to get the documentation upfront; previously, they only needed to get it upon request in the event of an audit.

"They are trying to prevent over utilization of these items and the way to do that is to require more documentation and more information from the doctors," said Chris Smith, director of policy and regulatory affairs for the National Community Pharmacists Association (NCPA). "In the end, it's the supplier that gets dinged."

A public meeting on the proposed LCDs is scheduled for Oct. 26 in Baltimore. CMS will accept comments through Nov. 8.

Other proposed changes in the LCDs: They split patients into non-insulin treated and insulin treated groups, and reduce the number of testing supplies allowed. They also require additional criteria, including more frequent contact with the physician's office, for certain patients. That's asking a lot of providers, say stakeholders.

"How are providers supposed to force the patient to go to the doctor?" said Karen Kaczmarek, president of Boca Raton, Fla.-based KBK Consulting. "What if the doctor doesn't want to see the patient every three months or the patient can't afford it?"

At the end of the day, the proposed LCDs would make it harder for diabetes providers to get paid, and they could make it harder for beneficiaries to get their supplies, say stakeholders.

"If (providers) become such a hassle to deal with, that's going to cause an issue," said John Norton, associate director of public relations for the NCPA. "(The requirements) could also cut the adherence (to treatment) we are looking for."