Home Health Compliance: Insulin Injection Rules You Should Know

By Author: Jaun Paul
Total Articles: 53
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Are you providing too much help with insulin injections? If so, the HHS Office of Inspector General could just be knocking on your door.


The CMS covers assisted insulin injections when a patient can't self-inject insulin and there's no family member or caregiver to lend a helping hand. However, outlier payments for insulin injections have been let loose and putting a check on those payments is top priority for OIG as per the
2010 Work Plan.


Under the Medicare
prospective payment system (PPS) injections given daily or many times each day to patients who are physically or mentally incapacitated result in outliner payments because the cost greatly exceeds the episode payment.


CMS pays 80 percent of the excess ‘cost' based on the PPS-per-visit rate. And as the visits for insulin injections are short, the amount of money paid ...
... can be lofty.


The problem is that high payment rates for short visits provide a good opportunity to fraudsters to rake in some money.


The OIG's promised new focus is guaranteed to bring down outliner payments back to reasonable levels. Here's what you need to do:


Re-acquaint yourself on your Insulin Injection Rules


Agencies have streamlined their insulin injection program alright, but now's the time to brush up your policies and procedures. Make sure you meet each of the requirements for this benefit, including making sure that:


Patients are homebound

Patients need insulin to treat their diabetes

Patients can't inject themselves owing to physical or psychological reasons

No caregiver is available to provide the injections, and the patient cannot be taught to self-inject

You re-assess patients' every certification period to ensure they still need your help to inject insulin and that no caregiver comes forward to help

You document each above requirement as well as your efforts to locate caregivers for your patients


Meeting these requirements will certainly ensure OIG won't come down on you.


We provides the latest developments in Healthcare Compliance, and advanced Learning Opportunities about Medicare prospective payment system for healthcare executives and physician billers according to 2010 Work Plan.