Docs agree: Prescription process is burdensome

LEAWOOD, Kan. - A request from family physicians to simplify the Medicare requirements for diabetes supplies could ultimately help suppliers beleaguered by audits.

In a May 8 letter to CMS Administrator Marilyn Tavenner, the Leawood, Kan.-based American Academy of Family Physicians (AAFP) describes the current criteria—documenting that the patient has diabetes, specifying the frequency of testing and length of need, and verifying that the glucometer is designed for home use—as “burdensome and non-value added.”

You won't get any argument from the diabetes supplier community.

“The documentation process is dated in past technology, it's cumbersome, and the physicians don't have time,” said Tom Milam an industry consultant and former diabetes provider.

So cumbersome, that many physicians don't want to be bothered with it, say providers.

“It's hard to get everything to where it needs to be and make sure they've completed all the tasks that they need to complete,” said Robert Salmon, president and founder of the Charleston, Miss.-based The Diabetic Shoppe. “But if the documentation doesn't match the requirements, we flunk the test.”

Providers flunk the test a lot. Prepay reviews have found denial rates of nearly 100% for diabetes test strips, although the denials are often overturned on appeal.

The letter from the AAFP urges CMS to allow physicians to use generic terms when writing prescriptions and to write open-ended prescriptions.

Provider Chris Rice would like to see axed the requirement that the records contain a copy of the patient's testing logbook.

“Some of these patients have a very difficult time keeping track, or they don't want to do it,” said Rice, CEO of Diamond Respiratory Care in Riverside, Calif. “Or, it's in the meter and they download it at the doctor's office.”

Simplifying the documentation requirements will only help if auditors adhere to them, says provider Marcus Suess.

“Usually when we provide everything that's necessary, in perfect detail, more often than not, we get denied, anyway,” said Suess, executive chairman of All-States Medical Supply in Fletcher, N.C.