diabetestalk.net

Medicare Diabetes

Medicare Diabetes Prevention Program - Centers For Medicare & Medicaid Services

Medicare Diabetes Prevention Program - Centers For Medicare & Medicaid Services

Registration: Visit the MLN Event Registration website. Clarification [PDF, 192KB] The CY 2018 Medicare Physician Fee Schedule final rule includes the expansion of the Medicare Diabetes Prevention Program (MDPP) Model starting in 2018. During this call, CMS experts provide a high-level overview of the finalized policies. A question and answer session follows the presentation. The MDPP expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. Participants should review the final rule prior to the call. Target Audience:Current Centers for Disease Control and Prevention (CDC) recognized Diabetes Prevention Program organizations; organizations interested in becoming MDPP suppliers, including existing Medicare providers/suppliers, community organizations, non-for-profits; associations, and advocacy groups focused on seniors or diabetes; and other interested stakeholders, including health plans, primary care/internal medicine specialties. For More Information: Visit the MDPP Expanded Model webpage. Continue reading >>

Medicare Fee-for-service Spending For Diabetes: Examining Aging And Comorbidities

Medicare Fee-for-service Spending For Diabetes: Examining Aging And Comorbidities

1 KPMG, LLP, Economic and Valuation Services, USA 2 Health Systems Research Associates, USA Citation: Erdem E, Korda H (2014) Medicare Fee-for-Service Spending for Diabetes: Examining Aging and Comorbidities. J Diabetes Metab 5:345. doi: 10.4172/2155-6156.1000345 Copyright: © 2014 Erdem E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Diabetes & Metabolism Abstract This research report examines prevalence and spending on diabetes for fee-for-service (FFS) beneficiaries of the Medicare program, the health insurance program that covers the majority of adults age 65 and above in the U.S. To date, most studies of spending on diabetes care in the U.S. have relied on self-reported survey data and estimates of utilization and spending, but do not represent actual spending identified through administrative claims. This report is based on newly available administrative claims data from the Centers for Medicare & Medicaid Services 2010 Chronic Conditions Public Use File. Diabetes was prevalent among approximately 1/4 of Medicare FFS beneficiaries in 2010. Prevalence increased with age initially for the aged population, but dropped for beneficiaries > 85. Only about 1/4 of diabetic beneficiaries had diabetes without a comorbidity. Beneficiaries with diabetes had 2.8 chronic conditions (including diabetes) with average Medicare Part A and Part B spending of $5,741 and $5,991, and drug costs of $3,119, respectively. Spending increased with age for beneficiaries >65. Findings of these analyses consider diabetes in the context of chronic comorbi Continue reading >>

Medicare’s National Mail Order Program For Diabetic Testing Supplies

Medicare’s National Mail Order Program For Diabetic Testing Supplies

On July 1, 2013, Medicare Part B will implement a national mail-order competitive bidding program specifically for diabetic testing supplies. [1],[2] The program applies to all zip codes in the 50 United States, the District of Columbia, Puerto Rico, U.S. Virgin Islands, Guam and American Samoa.[3] Once implemented, beneficiaries in traditional Medicare[4] will purchase diabetic testing supplies using a mail order option or a non-mail order option.[5] Included Supplies Equipment such as blood glucose test strips, lancet devices, lancet, and glucose control solutions for checking the accuracy of testing equipment and test strips and other Medicare Part B covered diabetic testing supplies are included in the national mail-order program.[6] However, Medicare Part D-covered supplies such as syringes, needles and inhaled insulin devices are not included in the national mail-order program.[7] Mail-Order Options Under the national mail-order competitive bid program, traditional Medicare beneficiaries will purchase their diabetic testing supplies through a national mail-order contract supplier ("Mail Order Option") or in person from any Medicare-enrolled supplier of non-Medicare testing supplies ("Non-Mail Order Option"). [8] Mail-order supplies will be shipped directly from the supplier to the beneficiary through a service such as United States Postal Service, Federal Express, the United Parcel Service or a mail-order contract supplier's delivery service.[9] Beneficiaries can find suppliers at Medicare Part B will reimburse mail-order deliveries provided that they are delivered directly from the supplier to a beneficiary's residence.[10] Beneficiaries who select the Mail-Order Option cannot have diabetic testing supplies shipped to a pharmacy and then have the pharmacy deliver Continue reading >>

Medicare Coverage Of Diabetes Screenings And Supplies

Medicare Coverage Of Diabetes Screenings And Supplies

Medicare covers tests to screen for diabetes as well as services and supplies to help treat the disease. Medicare covers blood tests to screen for diabetes if you are at risk for diabetes or have pre-diabetes. You are eligible for one Medicare-covered diabetes screening every 12 months if you: have hypertension; have dyslipidemia (any kind of cholesterol problem); have a prior blood test showing low glucose (sugar) tolerance; are obese (body mass index of 30 or more); or meet at least two of the following: you are overweight (body mass index between 25 and 30); you have a family history of diabetes; you have a history of diabetes during pregnancy (gestational diabetes) or have had a baby over nine pounds; or you are 65 years of age or older. The Medicare-covered diabetes screening test includes: a fasting blood glucose tests; and/or a post-glucose challenge test. If you have been diagnosed with pre-diabetes, Medicare will cover two diabetes screening tests a calendar year. Having pre-diabetes means you have blood glucose (sugar) levels that are higher than normal, but are not high enough to be classified as diabetes. Medicare will pay for 100% of its approved amount for the test even before you have met the Part B deductible. You will pay no copay or deductible for these tests if you see doctors who take assignment. Doctors and other health care providers who take assignment cannot charge you more than the Medicare approved amount. Medicare Advantage Plans cover all preventive services the same as Original Medicare. This means Medicare Advantage Plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that ar Continue reading >>

Medicare Diabetes Prevention Program Enrollment

Medicare Diabetes Prevention Program Enrollment

Medicare Diabetes Prevention Program Enrollment Medicare Diabetes Prevention Program Enrollment On November 2, 2017, the Centers for Medicare & Medicaid Services issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) final rule, which finalizes policies to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018. The expanded model is a structured intervention with the goal of preventing progression of type II diabetes in individuals with an indication of pre-diabetes. The CY 2018 PFS includes the MDPP payment structure as well as enrollment requirements and supplier compliance standards. The effective date for furnishing services is April 1, 2018. MDPP suppliers may begin enrolling on January 1, 2018, through a new MDPP-specific enrollment application, which will be available prior to January 1, 2018. Screening individuals that will be furnishing the MDPP services will be identified as coaches on the MDPP-specific form. Suppliers must meet and remain in compliance with several standards as a condition of initial and ongoing enrollment as a Medicare Supplier, including but not limited to: Suppliers may not be terminated from Medicaid Suppliers may not deny access to MDPP services, except in certain circumstances Suppliers must respond to beneficiary complaints reasonably and timely Submit evaluation crosswalk file upon request Continue reading >>

People With Diabetes Stuck Waiting For Medicare Cgm Access

People With Diabetes Stuck Waiting For Medicare Cgm Access

We're sorry, an error occurred. We are unable to collect your feedback at this time. However, your feedback is important to us. Please try again later. Longtime type 1 Dan Patrick in Ohio is one of many people with diabetes currently in limbo, waiting for finalization of Medicare coverage of the Dexcom G5 continuous glucose monitor -- facing the uncertainly of not being able to access needed supplies for the CGM he's been using for years. He's stuck in regulatory purgatory, so to speak -- standing by while Medicare gradually rolls out a CGM coverage policy, painfully slowly and currently lacking clarity for those who need answers ASAP. "No one knows what to do right now, and that's unfortunate," Dan says. "We're all being left fending for ourselves while the bureaucrats work out the details." Dan is of course just one of scores of patients on Medicare or close to turning 65 who are facing the same concerns. While CMS's decision to cover this life-changing technology is of course a positive development that many have been advocating on for years, the practicalities of implementing it are less desirable. Yep, all those jokes about "MediScare" have turned into a reality that many don't know how to navigate. For those not hip to what's going on, here's the skinny (fraught with acronyms): Medicare hasn't traditionally covered continuous glucose monitors (CGMs), but limited case-by-case rulings by Administrative Law Judges have allowed some Medicare-covered PWDs (people with diabetes) to get access through the years. In recent years, the Centers for Medicare and Medicaid Services (CMS) has pretty much said they wouldn't cover CGM unless it was determined to be a medically necessary tool, not an "adjunctive" device that supplemented fingerstick BG (blood glucose) tests. That Continue reading >>

How Medicare Covers Diabetes

How Medicare Covers Diabetes

Dear Savvy Senior: What does Medicare cover when it comes to diabetes? I’m 65 and have pre-diabetes, and would like to find out what all is covered. — Fat Albert Dear Albert: Medicare actually offers a wide range of coverage to help beneficiaries who have diabetes, as well as those who are at risk of getting it — but they don’t cover everything. Here’s a breakdown of what Medicare covers when it comes to diabetes services and supplies along with some other tips that can help you save. Doctor’s services: If you’re a Medicare beneficiary, Medicare Part B will pay 80 percent of the cost of all doctor’s office visits that are related to diabetes. You are responsible for paying the remaining 20 percent after you’ve met your annual 2013 $147 Part B deductible. Screenings: If you don’t currently have diabetes, but you do have pre-diabetes or some other health conditions that put you at risk of getting it — such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes — Medicare will pay 100 percent of the cost of up to two diabetes screenings every year. Education: If you have diabetes, Medicare covers 80 percent of the cost of self-management training (after you meet your Part B deductible) to teach you how to successfully manage your diabetes. Supplies and medications: Eighty percent of the cost of glucose monitors, test strips and lancets (100 per month if you use insulin, or 33 per month if you don’t), glucose control solutions and insulin (if you use an insulin pump) are covered by Medicare Part B, after you’ve met your deductible. If, however, you inject insulin with a syringe, Medicare’s Part D prescription drug benefit may help pay your insulin costs and the supplies needed to inject Continue reading >>

Medicare’s National Mail-order Program For Diabetes Testing Supplies

Medicare’s National Mail-order Program For Diabetes Testing Supplies

Medicare has a National Mail-Order Program for diabetes testing supplies (like test strips and lancets). No matter where you live, you'll need to use a Medicare national mail-order contract supplier for Medicare to pay for diabetes testing supplies that are delivered to your home. If you don't want diabetes testing supplies delivered to your home, you can go to any local pharmacy or storefront supplier that's enrolled with Medicare and buy them there. The National Mail-Order Program doesn't require you to change your testing monitor. If you're happy with your current monitor, look for a mail-order contract supplier or local store that can provide the supplies you need for your monitor. If you switch suppliers, you might need to arrange to have your current prescription transferred or get a new prescription for testing supplies from your doctor. Plan ahead before you run out of supplies. How much will I pay if I buy supplies at a store? You'll pay the same amount for diabetes testing supplies whether you buy them at the store or have them delivered to your home. National mail-order contract suppliers can't charge you more than any unmet Part B deductible and 20% coinsurance. Local stores also can't charge more than any unmet Part B deductible and 20% coinsurance if they accept Medicare assignment. Local stores that don't accept assignment may charge you more. If you get your supplies from a local store, check with the store to find out what your payment will be. Find a supplier. The National Mail-Order Program applies to Original Medicare only. If you’re enrolled in a Medicare Advantage Plan (Part C) (like an HMO or PPO), your plan will let you know if your supplier is changing. If you’re not sure, contact your plan. What if I need a specific brand of equipment or su Continue reading >>

Making The Switch To Medicare With Diabetes

Making The Switch To Medicare With Diabetes

By Pearl Subramanian and Jeemin Kwon From enrolling in the four types of plans to what they cover, everything you need to know when making the switch to Medicare with diabetes Despite covering 58 million Americans in 2017, Medicare can be difficult to navigate. The US-government-run program provides health coverage to people over the age of 65 and to those under 65 who have certain disabilities or other conditions. If you are ready to make the switch over to Medicare or know someone who is, this article is a guide on what you need to know for as smooth a transition as possible, understanding that there are plenty of complexities here! Click to jump to a section: About Medicare Though Medicare is often thought of as one big plan, it actually has four different types of coverage: Part A covers hospital stays, care in nursing facilities, hospice care, and home health care. Part B covers doctors’ services, non-hospital (outpatient) care, some medical devices and preventative services. People pay a monthly premium for this coverage. Part C allows people the option to enroll in private insurance plans (HMOs and PPOs) and to receive their benefits under Parts A and B. Those plans are called Medicare Advantage and some offer additional benefits such as dental and vision. Part D covers prescription drugs and is voluntary. For more information on decoding and understanding health insurance language, check out diaTribe’s guide here. Medicare and Diabetes Medicare covers certain benefits and supplies specific to people with diabetes, including diabetes drugs, blood glucose monitoring equipment, insulin delivery devices, and therapeutic shoes/inserts. Refer to Medicare and Diabetes Coverage for additional information regarding these provisions, and see the table below to learn w Continue reading >>

Clinical Diabetes Conferences 2018: Medication And Treatment

Clinical Diabetes Conferences 2018: Medication And Treatment

Meetings international welcomes and invites all the participants from over the world to attend the International Conference on Clinical Diabetes , Diabetic Medication & Treatment " going to be held onAugust 17-18, 2018atSingapore. DiabetesMedicareConference highlights the theme Conquering diabetes and endocrinology challenges. Diabetes Medicare Conference is a congress designed to provide an exclusive forum for doctors,dieticians, researchers, scholars, students furthermore scientists to introduce and talk about the latest advancements, challenges encountered, trends, concerns, applications and the solutions taken up for mitigatingdiabetes. The two days of conference will include keynote presentations,session speakers, and poster presenters on the latest and innovative techniques as well as research articles in the areas of Diabetic Nutrition research , diabetic diet, Biomarkers for bio accessibility andbioavailability, Nutritional therapy, diabetic care and clinical diabetes . Your healthcare team will encourage you to follow yourmeal planand exercise program, use your medications and monitor your blood glucose regularly to keep your blood glucose in as normal a range as possible as much of the time as possible. Why is this so important? Because low managed diabetes can lead to a host of long-term difficulties among these areheart attacks, strokes,blindness, kidney failure, and blood vessel disease that may require an amputation,nerve damage, and impotence in men. The worldwide diabetic nourishment market sector expected to grow at CAGR of 5.9% amid the forecast frame. The market sector has been divided into dietary refreshments, ice creams and jams, dairy items, and sweets and baked products, among others. The total market share in 2013 took after by thedairy section Continue reading >>

Medicare And Diabetes: What Is Covered?

Medicare And Diabetes: What Is Covered?

Medicare is the federal health insurance program for people age 65 and older as well as people under age 65 with disabilities and those living with End-Stage Renal Disease. Original Medicare, the most common way to receive Medicare is comprised of part A and part B. Part A is hospital insurance and will cover most medically necessary hospital, home health, skilled nursing facility, and, hospice care. Part B is medical insurance paid for by a monthly premium and covers most medically necessary doctors’ services, durable medical equipment, preventive care, hospital outpatient services, lab tests, x-rays, mental health care, and some home health and ambulance services. You can choose to also get Medicare Part D which is prescription drug insurance and is provided only through a private insurance company that has a government contract. There is also the alternative option to get a private Medicare plan called a Medicare Advantage Plan or Medicare Part C, which generally includes Part D coverage. The Medicare Plan A deductible for 2017 is $1,316 and depending on how long your stay is, you may have to pay an additional amount. The Plan B monthly premium for most Americans in 2017 is $109, though people pay more depending on income level. You can find out your monthly premium by calling Social Security at 1-800-772-1213. You may also have to pay a deductible for Part B. In 2017 the Part B deductible is $183 and after you pay the deductible Medicare pays 80 percent of the Medicare-approved cost of your medically necessary supplies and services. You would pay the 20 percent coinsurance payment. Once the deductible has been met, you cannot be charged to pay more than your 20 percent coinsurance amount and this is the case whether you pick up your diabetes supplies at a local st Continue reading >>

Medicare To Cover Therapeutic Cgm, Sets Criteria

Medicare To Cover Therapeutic Cgm, Sets Criteria

Medicare to Cover Therapeutic CGM, Sets Criteria For Medicare patients on continuous glucose monitoring (CGM), the news is good. The Centers for Medicare and Medicaid Services (CMS) will cover therapeutic continuous glucose monitoring (CGM), and have set the criteria that must be met. In the past, it has not been covered. CMS announced the criteria decision March 23, following their January ruling about granting coverage for CGM. 1 The coverage decision ''is a game changer for our Medicare patients," says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDE. She is program coordinator for the Teen and Adolescent Diabetes Transition Program at the University of Chicago's Kovler Diabetes Center and a member of the editorial board for EndocrineWeb. The decision is ''long overdue," says J. Michael Gonzalez-Campoy, MD, PhD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology in Eagan, MN, and a member of the editorial board for EndocrineWeb. "The medical literature clearly documents that enhanced monitoring improves outcomes in the treatment of diabetes." The coverage is effective for service dates Jan. 12, 2017 and later, according to CMS. The four criteria set down by CMS, all of which must be met for coverage, include that the patient must: Have a diagnosis of diabetes, either type 1 or type 2 Use a home blood glucose monitor (BGM) and conduct four or more daily BGM tests Be treated with insulin with multiple daily injections or a constant subcutaneous infusion (CSI) pump Require frequent adjustments of the insulin treatment regimen, based on therapeutic CGM test results.1 To meet the criteria, the system must be classified as a therapeutic CGM. That means users can make treatment decisions using the device. To date, the Dexcom G5 Mobile, by S Continue reading >>

Proposed Fee Schedule Details Diabetes Prevention Program Payments

Proposed Fee Schedule Details Diabetes Prevention Program Payments

The 2018 Medicare Physician Fee Schedule proposed rule recently issued by the Centers for Medicare and Medicaid Services (CMS) includes proposals to boost coverage of diabetes prevention and telehealth services. The CMS proposal includes “a number of positive changes that could improve patient care and save taxpayer dollars,” according to the AMA. Chief among these are a plan for expanding the Medicare Diabetes Prevention Program (MDPP), and new possibilities for telehealth services. “The annual physician fee schedule update is a chance for CMS to modify Medicare policy to ensure the best possible treatment options for patients,” said AMA President David O. Barbe, MD (@DBarbe_MD). “The AMA is encouraged by many of the proposed changes and applauds the administration for working with the AMA to address physician concerns.” Sept. 11 is the deadline to submit comments on the document’s proposed Medicare payment rules and policies—which includes an overall positive payment-rate update of 0.31 percent. Diabetes Prevention Program setup Included in the proposed rule are steps that would further implement a Medicare DPP, which the CMS describes as a structured intervention aimed at preventing a progression from prediabetes to type 2 diabetes in at-risk individuals. Previous research has shown that evidence-based lifestyle changes resulting in modest weight loss can sharply cut the rate at which people with prediabetes go on to develop type 2 diabetes. In a news release, the AMA said it “commends” CMS for going forward to expand coverage of the DPP model the Association has helped promote among physicians and policymakers. More than a quarter of U.S. seniors have type 2 diabetes and that prevalence is expected to double by 2050 unless preventive efforts such Continue reading >>

Medicare To Pay $450 To Help Seniors Lose Weight, Avoid Diabetes

Medicare To Pay $450 To Help Seniors Lose Weight, Avoid Diabetes

Oscar and Teri Lara of Rancho Bernardo were diagnosed with prediabetes a few months ago, a condition 86 million Americans share. That means the retired couple live with a greater chance they’ll develop diabetes, which can lead to heart, nerve, kidney and eye disease, and an early death. Some 86 million Americans live with prediabetes, which can progress to diabetes, a costly and debilitating disease. A new program can help people lose weight, a proven way to reduce the risk of getting the disease. The Laras are lucky. Nine in 10 Americans don’t know they have prediabetes, but the Laras were caught early. They have an opportunity to alter their diets, reduce their sugar intake and lose weight, and likely postpone or prevent that trajectory. On advice from their doctors, they enrolled in a special lifestyle class, part of the Scripps Diabetes Prevention Program, much like the curriculum that will be offered to Medicare beneficiaries across the country, free of charge, starting Jan. 1. “This class changed my thinking about what I eat, how much I eat, how to stay focused, and how to maintain a healthy regimen of proper nutrients to put into my body,” Oscar Lara said. Instead of chomping down on bread and burritos, it’s broccoli, brussel sprouts and salads. $450 for a few pounds of flesh Providers who run Medicare’s year-long programs will receive up to $425 per participant if attendees take all the classes and lose 5 percent of their body weight during the year; $450 if they lose 9 percent. If attendees miss classes, drop out, or fail to lose that much — or gain it back — the programs will be paid incrementally less. In 2012, the direct medical costs for 29 million people diagnosed with diabetes in the U.S. was an estimated $176 billion, including hospital, Continue reading >>

Everything You Need To Know About Prediabetes And Diabetes Supply

Everything You Need To Know About Prediabetes And Diabetes Supply

Diabetes is a serious lifelong condition that may cause other major health problems if you do not keep your blood glucose under control. Whether you are a prediabetes candidate or already have diabetes, it is crucial to understand fully what supplies you need in order to monitor and control your blood glucose level, and alleviate various conditions that may exhibit along with the condition. Prediabetes Supply – Things Prediabetics Need Getting diagnosed with prediabetes is a serious wake-up call to your current health, but it doesn’t have to mean you will most definitely get diabetes. With close monitor to your blood glucose level and paying attention to lifestyle changes, you can slow down the progression to diabetes or even prevent diabetes. Physical activity is an essential part of the treatment plan for prediabetes because it lowers blood glucose levels and decreases body fat. Depending on your health insurance company policy, you may be qualified for an incentive for joining a gym or fitness program. If your insurance company does not offer an incentive, you can try asking about your working company policy and see if they have an incentive for their workers getting fit. At the same time, they may offer an incentive for going to a nutritionist and plan out a diet plan for your needs. However, if both your insurance company and your working company both do not offer incentives, you can still claim these expenses as medical expenses on your tax as long as you have documentation of these treatments being recommended by your doctor. Sleep is crucial for prediabetes candidates. Without proper amount of sleep, your body cannot use insulin effectively and may increase your chance of developing type 2 diabetes. If you suffer from sleep apnea, do seek help from your doct Continue reading >>

More in diabetes