Long-Term Care

Understanding billing for blood glucose

LTC Educator's Corner, February 1, 2010

Under the Centers for Medicare & Medicaid Services (CMS) regulations, any diagnostic test, including a clinical diagnostic laboratory test, to be considered reasonable and necessary, must be ordered by the physician, and the ordering physician must use the result in the management of the beneficiary’s specific medical problem.
Tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary and should not be billed under Medicare Part B.
A physician’s standing order is not sufficient to order a series of blood glucose tests payable under the Clinical Laboratory Fee Schedule.
These requirements might make billing Medicare Part B for blood glucose fingersticks not worth the effort that goes into it. For example, with the added burden of physician certification for each fingerstick, a 120-bed facility will probably end up with 15−20 fingersticks that it can bill to Part B per month—for $6,000—and receive $9,000 in return for its efforts. Facilities should evaluate whether it’s worth the time and effort to meet CMS’ requirements.

Increased financial pressure
Skilled nursing facilities are under increasing financial pressure and Medicare accounts for a large portion of their revenue.  HCPro's Medicare Boot Camp - Long-Term Care Version will give you the knowledge and confidence to:

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  • Improve interdepartmental communication to avoid compliance pitfalls
  • Prevent missing revenue and denials
  • Improve communication that will increase the productivity of your billing and MDS staff
  • Gain nursing and nursing home administrator CEUs

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