Secondary to information one of my predecessors got somewhere, our agency has required Medicare, or MA plan, patients with a diagnosis of DM to have a current hemoglobin A1C, and to have it repeated every 3 months. We have gotten pushback from some physicians over the request for this frequency.
I have searched and cannot find a rule or standard stating that we must collect an A1c every 3 months. I have found a LCD, L35132, which states that testing "quarterly in patients whose therapy has changed or who are not meeting glycemic goals is supported by the American Diabetes Association Standards of Medical Care in Diabetes - 2016 (ADA Standards)," and that "[b]ased on Palmetto GBA's claims data and the increased risk of emergency department (ED) encounters and acute inpatient admissions related to hypoglycemia in this population, physicians and HH agencies should consider the inclusion of HbA1c testing in the HH POC."
None of this points to a requirement to retest this so frequently. If there is some standard or rule out there for this, would someone please point me in the right direction, otherwise, we are going to decrease this burden on our clinicians and the patients' providers.
Thanks
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J Scott Lambert MPT, JD
Director
Washington Regional Home Health
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