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For too long home health agencies, with Palmetto GBA as their Medicare MAC, have been fighting physicians over trying to get orders and information needed to meet the Local Coverage Determination (LCD) requirements for documenting Hemoglobin A1c (HbA1c). After very dedicated state associations and agency representatives sharing the issues at hand and having multiple conversations with PGBA, the battle is over!! Following is the language in the updated LCD – effective 06/03/16:
Evidence-based medicine supports ascertaining glucose control and the risk of secondary conditions known to occur in individuals with diabetes mellitus by monitoring glucose and hemoglobin A1c (HbA1c) levels in individuals with diabetes mellitus. This information and its communication between the physician and home health agency caring for a given beneficiary helps ensure that a home health plan of care is not only patient-centered, but also addresses prognosis – as required by the Medicare Benefit Policy Manual. Performing the HbA1c test quarterly in patients whose therapy has changed or who are not meeting glycemic goals is supported by the American Diabetes Association Standards of Medical Care in Diabetes – 2016 (ADA Standards).1 Based on Palmetto GBA’s claims data and the increased risk of emergency department (ED) encounters and acute inpatient admissions related to hypoglycemia in this population, physicians and home health agencies should consider the inclusion of HbA1c testing in the Home Health Plan of Care.
This is definitely a win for home health agencies. This is proof that when there are things that agencies struggle with agencies should be communicating that to the MAC and to CMS and not just being loud, but providing evidence of the hardships and best practice issues to support the case.