Medtrade session preview: Strong communication is key to CGM success

DALLAS - With roughly 1.4 million Americans diagnosed with diabetes every year, the need for patient access to continuous glucose monitoring (CGM) suppliers will only increase, says Collin Donoghue, vice president and general manager of ABCO Medical Supply in Knoxville, Tenn. 

HME News spoke to Donoghue and Ronda Buhrmester, senior director of payer relations and reimbursement for VGM Group, who will be co-presenting a session on how to navigate the intricacies of providing CGMs and why it’s not for the faint of heart. 

HME News: What’s the best strategy for capturing CGM referrals? 

Collin Donoghue: Educate the referral sources on coverage guidelines. In our experience, referral sources get frustrated when items get denied coverage. Strong communication with the referral sources alleviates that frustration and makes for smoother processes.   

HME: When providing CGMs, what should providers be aware of in terms of documentation and billing? 

Ronda Buhrmester: Understanding that the coverage criteria is not about the diagnosis of diabetes. There’s more to meeting the coverage criteria, such as using insulin treatment at least three more times per day, and that treatment regimen needs frequent adjustments based on the testing results. In addition, there are timelines with in-person evaluations with the treating practitioner on a regular basis. All this information needs to be documented within the medical record. 

HME: If attendees leave this session with one take-away, what should it be? 

Buhrmester: It’s not for every supplier in this industry. Suppliers need to be aware that CGMs are a top item going through various levels of audits. Know each payer's policy for coverage criteria, and do not call the payer and have a verbal conversation. Get it in writing from their policy manual.