Pat Hicks
Member
I will start Medicare about a year from now. I currently have my INR checked at a clinic. When I go on Medicare, will they cover the home testing and supplies?
Thanks for your input.
Thanks for your input.
Medicare and Home Checking
- Thread starter Pat Hicks
- Start date
Help Support Valve Replacement Forums:
Best to check out medicare's website. I put in Mississippi for the searches I did.
http://www.medicare.gov/Coverage/Home.asp
http://www.medicare.gov/Coverage/Se...+Medical+Equipment&submitState=View+Results+>
http://www.medicare.gov/Coverage/Home.asp
http://www.medicare.gov/Coverage/Se...+Medical+Equipment&submitState=View+Results+>
Ross
Well-known member
Marsha, I tried to do a search for her, but the way the government pages come up, she'd have to look at them herself. You can't save them, you can't email them, basically you can't do anything but read them. Of course, at that time, I was trying to help her find a Medicare advantage plan, so ..........
Ross
Well-known member
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=209
Here is what your looking for.
190.11 - Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management – Effective March 19, 2008
(Rev. 90, Issued: 07-25-08, Effective: 03-19-08, Implementation: 08-25-08)
A. General
Use of the International Normalized Ratio (INR) or prothrombin time (PT) - standard measurement for reporting the blood’s clotting time) - allows physicians to determine the level of anticoagulation in a patient independent of the laboratory reagents used. The INR is the ratio of the patient’s PT (extrinsic or tissue-factor dependent coagulation pathway) compared to the mean PT for a group of normal individuals. Maintaining patients within his/her prescribed therapeutic range minimizes adverse events associated with inadequate or excessive anticoagulation such as serious bleeding or thromboembolic events. Patient self-testing and self-management through the use of a home INR monitor may be used to improve the time in therapeutic rate (TTR) for select groups of patients. Increased TTR leads to improved clinical outcomes and reductions in thromboembolic and hemorrhagic events.
Warfarin (also prescribed under other trade names, e.g., Coumadin®) is a self-administered, oral anticoagulant medication that affects the vitamin K-dependent clotting factors II, VII, IX and X. It is widely used for various medical conditions, and has a narrow therapeutic index, meaning it is a drug with less than a 2-fold difference between median lethal dose and median effective dose. For this reason, since October 4, 2006, it falls under the category of a Food and Drug Administration (FDA) “black-box” drug whose dosage must be closely monitored to avoid serious complications. A PT/INR monitoring system is a portable testing device that includes a finger-stick and an FDA-cleared meter that measures the time it takes for a person’s blood plasma to clot
B. Nationally Covered Indications
For services furnished on or after March 19, 2008, Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin. The monitor and the home testing must be prescribed by a treating physician as provided at 42 CFR 410.32(a), and all of the following requirements must be met:
1.
The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,
2. The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,
3. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,
4.
Self-testing with the device should not occur more frequently than once a week.
C. Nationally Non-Covered Indications
N/A
D. Other
1. All other indications for home PT/INR monitoring not indicated as nationally covered above remain at local Medicare contractor discretion.
2. This national coverage determination (NCD) is distinct from, and makes no changes to, the PT clinical laboratory NCD at section 190.17 of Publication 100-03 of the NCD Manual.
(This NCD last reviewed March 2008.)
Here is what your looking for.
190.11 - Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management – Effective March 19, 2008
(Rev. 90, Issued: 07-25-08, Effective: 03-19-08, Implementation: 08-25-08)
A. General
Use of the International Normalized Ratio (INR) or prothrombin time (PT) - standard measurement for reporting the blood’s clotting time) - allows physicians to determine the level of anticoagulation in a patient independent of the laboratory reagents used. The INR is the ratio of the patient’s PT (extrinsic or tissue-factor dependent coagulation pathway) compared to the mean PT for a group of normal individuals. Maintaining patients within his/her prescribed therapeutic range minimizes adverse events associated with inadequate or excessive anticoagulation such as serious bleeding or thromboembolic events. Patient self-testing and self-management through the use of a home INR monitor may be used to improve the time in therapeutic rate (TTR) for select groups of patients. Increased TTR leads to improved clinical outcomes and reductions in thromboembolic and hemorrhagic events.
Warfarin (also prescribed under other trade names, e.g., Coumadin®) is a self-administered, oral anticoagulant medication that affects the vitamin K-dependent clotting factors II, VII, IX and X. It is widely used for various medical conditions, and has a narrow therapeutic index, meaning it is a drug with less than a 2-fold difference between median lethal dose and median effective dose. For this reason, since October 4, 2006, it falls under the category of a Food and Drug Administration (FDA) “black-box” drug whose dosage must be closely monitored to avoid serious complications. A PT/INR monitoring system is a portable testing device that includes a finger-stick and an FDA-cleared meter that measures the time it takes for a person’s blood plasma to clot
B. Nationally Covered Indications
For services furnished on or after March 19, 2008, Medicare will cover the use of home PT/INR monitoring for chronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on warfarin. The monitor and the home testing must be prescribed by a treating physician as provided at 42 CFR 410.32(a), and all of the following requirements must be met:
1.
The patient must have been anticoagulated for at least 3 months prior to use of the home INR device; and,
2. The patient must undergo a face-to-face educational program on anticoagulation management and must have demonstrated the correct use of the device prior to its use in the home; and,
3. The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring; and,
4.
Self-testing with the device should not occur more frequently than once a week.
C. Nationally Non-Covered Indications
N/A
D. Other
1. All other indications for home PT/INR monitoring not indicated as nationally covered above remain at local Medicare contractor discretion.
2. This national coverage determination (NCD) is distinct from, and makes no changes to, the PT clinical laboratory NCD at section 190.17 of Publication 100-03 of the NCD Manual.
(This NCD last reviewed March 2008.)
Medicare approved me for weekly home INR testing within 5 days from when the forms were submitted. I have Blue Cross insurance that picks up what Medicare doesn't pay. All supplies are paid for.
I had called Medicare before but the people I talked to didn't know what INR testing was all about.
I had called Medicare before but the people I talked to didn't know what INR testing was all about.
Ross
Well-known member
I had called Medicare before but the people I talked to didn't know what INR testing was all about.
It's for this reason alone that I always dig up the law before talking to them. Government employees will tell you anything whether it's true or not simply because they don't know themselves.
One would think that Medicare phone employees would know a little but they are almost useless.
Not all government employees are like that. For I applied for disability using the 800 Social Security number and was approved 6 months later. In fact, wife is also drawing SS and we both have never been in a SS office... everything was taken care of over the phone or internet. I have often wondered, WHY we have a local SS office?
Dayton -- who did you go through to get your machine?? And does one actually own the machine or is it considered a rental from the medical device company? I don't like a bunch of rules, but I'm thinking of giving it a shot since the price is right..
ShezaGirlie,
I used QAS.
As far I as I know... as with all equipment supplied by Medicare I own the meter. This I know from when my mother in law passed from being on Home Care from Medicare for 6 years. She had all kinds of equipment that belong to her that Medicare had provided.
I downloaded the forms from QAS, filled out my form and faxed it to QAS. Partially filled out my doctors forum, (personal information, to test weekly, control limits on test) hand carried it to his office. His office faxed the completed form to QAS that day. Five days later QAS notified me that I was approved. Took another 2 weeks before the trainer showed with my monitor... but that was due to a foul up on delivery.
I used QAS.
As far I as I know... as with all equipment supplied by Medicare I own the meter. This I know from when my mother in law passed from being on Home Care from Medicare for 6 years. She had all kinds of equipment that belong to her that Medicare had provided.
I downloaded the forms from QAS, filled out my form and faxed it to QAS. Partially filled out my doctors forum, (personal information, to test weekly, control limits on test) hand carried it to his office. His office faxed the completed form to QAS that day. Five days later QAS notified me that I was approved. Took another 2 weeks before the trainer showed with my monitor... but that was due to a foul up on delivery.
Ross
Well-known member
Shhhh, don't say that to loud or you'll likely find out and when it happens, it ain't no fun.
Shhhh, don't say that to loud or you'll likely find out and when it happens, it ain't no fun.
Ross, do you them mixed up with the IRS?
Ross
Well-known member
Ross, do you them mixed up with the IRS?
IRS, CIA, FBI, SS, what's the difference, there all the same.
