Special Open Door Forum: Home Blood Glucose Monitor and Supplies Templates and Clinical Data Elements (CDEs)

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Home Blood Glucose Monitor and Supplies Templates and Clinical Data Elements (CDEs)

Thursday, March 15, 2018

3:00-4:00 pm Eastern Time Conference Call Only

PCG will host a Special Open Door Forum (ODF) to allow physicians, provider and supplier professional associations, and/or all other interested parties to provide feedback on the Home Blood Glucose Monitor and Supplies Templates and CDEs that are posted on the CMS.gov website. The printable clinical templates and suggested CDEs describe the data elements that CMS believes would be useful in supporting the documentation requirements for coverage of Home Blood Glucose Monitor and Supplies as follows:

1. Order,
2. Face-to-Face Encounter, and
3. Lab Test Results.

The Home Blood Glucose Monitor and Supplies Templates and CDEs are available on the CMS.gov website which can be accessed through the link below: https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and- Systems/Electronic-Clinical-Templates/DMEPOS-Templates/DMEPOS-Home-Blood- Glucose.html

Providers and IT vendors can choose whether or not to use the printable clinical templates and/or the suggested CDEs. The suggested CDEs aren't a form, but a tool that IT vendors can integrate into electronic health record (EHR) systems to create prompts to assist providers with their medical record documentation for Medicare purposes. The templates and CDEs are intended to be a helpful guide but every section may not apply to all patients’ services and/or Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Providers can choose the information or CDEs that do apply. Once completed by the physician or other practitioner, the resulting documentation would become part of the medical record.

In fiscal year (FY) 2016, the Comprehensive Error Rate Testing (CERT) program reported an improper payment rate of 40.3 percent for Glucose Monitor claims. Of the CERT-reviewed claim lines in error, approximately 65.5 percent were found to have errors related to insufficient documentation with a majority of these errors resulting from a lack of documentation in medical records to justify Medicare coverage. The total projected improper payments for these claims was over 119 million dollars.

To better assist providers in medical record documentation, for Medicare Fee for Service purposes, CMS has developed lists of clinical elements within a printable clinical template. This development will allow EHR vendors to create prompts to assist the practitioner when documenting. These Home Blood Glucose Monitor and Supplies Templates and CDEs are some of the first of many on the list of topics that CMS is currently working to address.

Feedback and questions on our drafts can be sent to: clinicaltemplates@cms.hhs.gov. We look forward to your participation.

Special Open Door Participation Instructions:

Participant Dial-In Number: 1-(800)-837-1935 Conference ID: 2797399

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html  for downloading under downloads section as well as the IMPACT Act Downloads and Videos webpage.                 

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.