Non-clinical Professional Development/Leadership Development/Quality Improvement-Medicare Update From a MAC Medical Director

Video Transcription

Video Summary

Dr. Caldarella, a Medicare MAC director, discusses the importance of proper documentation in medical records for Medicare claims. He focuses on criteria for coverage of diabetes treatments like CGMs and BGMs, emphasizing recent updates in CGM criteria. Dr. Caldarella stresses the need for patients to have diabetes, receive training on devices, and align prescriptions with FDA indications. He also highlights the significance of medical records supporting justification for additional supplies and patient testing frequency. Dr. Sloan delves into criteria and regulations for Medicare coverage of diabetes management tools, emphasizing the necessity of accurate documentation in supporting medical necessity. He addresses concerns about billing codes, Incident 2 billing, Medicare Advantage plan deviations, and the need for understanding Medicare policies and proper documentation for appropriate coverage of diabetes management services. Overall, both speakers underscore the complexities of Medicare coverage criteria and the importance of detailed documentation for successful claims processing in diabetes treatment.

Asset Subtitle

Speaker: Felice Caldarella, MD, FACP, MBA, FACE – Contractor Medical Director, Noridian Healthcare Solutions

Moderator: William C. Biggs, MD FACE ECNU – Managing Partner, Amarillo Medical Specialists, LLP

Learning Objectives:

At the conclusion of this presenation the attendee will be able to understand Medicare Administrative Contractors
At the conclusion of this presenation the attendee will be able to understand Medicare Regulations
At the conclusion of this presenation the attendee will be able to understand Medicare benefits for persons with Diabetes and other Endocrine disorders

Keywords

Medicare claims

medical documentation

diabetes treatment

CGM criteria

BGM coverage

FDA indications

medical necessity

billing codes

Incident 2 billing

Medicare Advantage

claims processing