Medicare requirements

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Janet L.

Hello Everyone,

Though this is my first post, I have learned much from all of you over a long period of time. I have been going to the lab for over 11 years (I had my AVR in 1997) and am happy to say that I won't be doing that on a regular basis anymore. I received my CoaguChek XS about six weeks ago and I love the freedom it provides.

My question is about Medicare and how often to test. Does Medicare state that I must check my INR once a week or that I may check it once a week? What would happen if I only checked it once in two weeks? Or even once a month? Do they check? I'm pretty stable and don't see a need to test as often as once a week.

Thanks for your reply and for the help I have received from you in the past, before becoming a member.

Janet
 
I'll have to double check but I believe they mandate once a week testing and that you must be followed by someone. In other words, be calling your INR in to a manager or Doctor.

Welcome to the funny farm! Watch out for Cooker, he may assult you for bananas, Duff man may try to steal you away from me, and Me, I'm the VR flirt! :D
 
Here it is, as it's worded in the CMS manual

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.)

http://www.cms.hhs.gov/Transmittals/Downloads/R90NCD.pdf

I would take that to mean that you must test no more then once a week, but it doesn' say squat about 2 weeks, 1 month ect,. I'd say your safe to test less frequently.
 
Thank you for the welcome Ross and Cooker!

The information you provided was excellent, Ross. Exactly what I wanted to hear. Now I can go on my merry way and not concern myself with testing so often. I do call my results in to a manager, by the way.

Thank you again for your prompt, accurate help!!! I just knew you'd come through!

Janet
 
At least one curious mind wants to know:

If you already own an INR tester and then become eligible for Medicare, how does it work -- i.e., testing strips, etc.?

Do we have any people in that situation on board here?
 
My guess is that Medicare would cover the supplies (or even a new monitor) for a new beneficiary just as they would for someone who has been on Medicare for a while. It doesn't make sense to me that they wouldn't.

Something to look forward to!

Janet
 
Janet L. said:
My guess is that Medicare would cover the supplies (or even a new monitor) for a new beneficiary just as they would for someone who has been on Medicare for a while. It doesn't make sense to me that they wouldn't.

Something to look forward to!

Janet
Click to expand...

Janet:
Are you renting the CoaguChek or did you purchase it? Was this before or after becoming eligible for Medicare?
 
Catwoman,

I actually waited to enroll in Medicare before applying to QAS for the CoaguChek XS. QAS took care of getting the prescription and other documents from my doctor and they also made all arrangements with Medicare. I have a supplemental medical insurance plan besides Medicare, but I believe Medicare is footing the whole bill. I have not paid and will not pay a single penny for the monitor or the other supplies. As to whether the monitor was rented or paid for by Medicare, it may seem strange, but I do not know. Does it matter, since I don't have to contribute to the cost? I feel really, really fortunate to have the coverage. I would still be going to the lab without it.

Janet
 
Hensylee,

Thank you for the warm welcome! This place is hoppin'.

Janet
 
njean said:
Just wanted to say welcome to VR Janet, good to have you.

And......watch out for the Ross, aka VR flirt ---- he is feeling much much better!!! :D:p:)
Click to expand...

Thanks for the welcome and the warning, Norma Jean! If Ross is feeling much much better, that must be good. I guess. ;)
 
catwoman said:
Janet:

How long have you been on warfarin? (Your profile doesn't indicate when your surgery was.)

This is a great place to learn about living with warfarin and home-testing.
Click to expand...

Looks like I just deleted my response. I'll start over, hoping that it doesn't appear in the forum twice.

I have been on warfarin for eleven and a half years. My aortic valve was replaced at Johns Hopkins Hospital. I have a St. Jude valve. (I will update my profile one of these days.)

My husband, a clinical chemist, did not think the early monitors were reliable enough, so off I trudged to the lab more often than I'd like to think. When the newer models came out, they met with my husband's approval, but by then I was almost Medicare-eligible and I knew the monitor and supplies would be covered so I decided to wait rather than go through the hassle of finding out if my insurance plan at the time would cover them.

I have lurked on this site for a long time. If I had a question, I would search the forums and would usually find what I was looking for and lots more besides. Today, I had this Medicare question that I couldn't find the answer to, so I became a member of the site in order to ask it. Lo and behold, it didn't take Ross long to come up with the exact answer I needed. This is a great forum!


Janet
 
Janet:

My PCP has a new RN who used to work for a cardiologist. She & I talked ahout home-testing. She assumed that I called in results to the doctor & that he adjusted my warfarin.

I told her I used a dosage algorithm chart, who I purchased it from, how I compensated if I forgot one day's dosage, etc., etc. She asked who I checked with if I ran into problems. I told her that thanks to this website and forum, I haven't run into any problems that I couldn't resolve/understand.
 
Catwoman,

At the moment, it seems that I am monitoring myself and doing my own dosing. I phone my results in to an automated place that tells me that I am in range or not (and if not, that I should contact my doctor). They, in turn, fax my doctor's office with the results. Sometimes my doctor's nurse calls me to say, "Keep doing what you're doing for another month" and sometimes she doesn't call. That's okay with me because with Lodwick's algorithms I feel like I can handle it all myself. I have been testing more than once a month because I thought I had to, but now I think I'll stretch it out, as long as I'm in range.
 
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