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Diabetes Pharmacist Explains Program Posted: Wednesday, August 10, 2006
Each of us in the health care industry knows the long term consequences for our patients who have diabetes. Complications which lead to cardiovascular disease and other serious problems have been extensively documented. Recently it has been shown that patients who understand their disease and make changes in their lifestyle are more likely to prevent or delay the development of type 2 diabetes and its complications. Background Diabetic care services are the specialty and passion for pharmacist DeAnn Mullins of the WeCare Diabetes Education and Empowerment Program. In November 2000, her pharmacy began selling meters, testing supplies and therapeutic shoes. Now thanks to recent changes in Medicare (the Balanced Budget Act of 1977), a pharmacy can now be paid for providing diabetes self-management training. The Finances Medicare currently pays approximately $60 for one hour of individual assessment and $33 for nine hours of group education. This is a one time benefit, with an additional two hours per year of group education covered for annual review. A class of 10 people will require 10 hours of individual assessment and 9 hours of group training with a reimbursement of approximately $357 per person. That's 19 hours for $3,570 or $188 per hour. Not bad reimbursement in a time when our third party payers keep trying to drive down our reimbursements to even lower levels. Requirement 1: Pharmacies must have a Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier number. Requirement 2: Pharmacies must have an American Diabetes Association (ADA) recognized program in order to receive reimbursement. This process requires date collection of 20 patients over a period of 6 months. This process must be completed before you can bill Medicare for your services. You must reapply for this every 3 years. Requirement 3: After the first two requirements are completed you can now apply for a Medicare billing number. A copy of the implementation instructions for carriers can then be downloaded. This document is useful in understanding the coverage requirements.
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