PATIENT SELF TESTING at home is one of the easiest ways to monitor the PT/ INR levels for patients who undergo anticoagulation therapy. Blood thinners or anticoagulants are chemical substances which prevent the formation of harmful blood clots in our body. For example, patients who are diagnosed with Arrhythmias are prescribed anticoagulation therapy.
WARFARIN [COUMADIN] is an anticoagulant drug which helps blood to flow smoothly. Doctors use this crucial information to adjust the dosage of WARFARIN according to the results of the PT/INR test. PATIENT SELF TESTING at home is very convenient. To perform the test you just need to puncture your fingertip with the help of a small needle. You then put the drop of blood onto the test strip and get the reading in seconds. The results are called into the PATIENT SELF TESTING monitoring center where the result is graphed and compared to the patient’s prescribed therapeutic range and faxed to your doctor. Your doctor is responsible for the dosage of WARFARIN and can be adjusted accordingly.
INSURANCE GUIDELINES :
Both MEDICARE and many private insurers usually cover in home PT/INR testing. Most private companies generally follow the policies established by MEDICARE but they may differ slightly. MEDICARE has strict guidelines regarding coverage.
These important guidelines are described below –
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Effective March 19, 2008, Medicare covers the use of home PT/INR monitoring for Chronic, Oral Anticoagulation management for patients with –
- Mechanical Heart Valves
- Chronic Atrial fibrillation
- Venous Thromboembolism (inclusive of deep venous thrombosis and pulmonary embolism) on WARFARIN.
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Keep in mind that the monitor and the home testing must be prescribed by a treating physician and all of the following requirements must be met :
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The patient must have been anti-coagulated for at least 3 months prior to use of the home INR device.
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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.
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The patient continues to correctly use the device in the context of the management of the anticoagulation therapy following the initiation of home monitoring.
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Self-testing with the device should not occur more frequently than once a week.
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Demonstration, prior to initial use, of home INR monitoring for patients who meet Medicare coverage criteria, under the direction of a physician includes:
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Face-to-face demonstration of use and care of the INR monitor.
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Obtaining at least one blood sample.
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Provision of instructions for reporting home INR test results.
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Documentation of a patient’s ability to perform testing prior to its use.
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Medicare coverage criteria include provision of materials (strips) for use in the home and reporting of test results to the physician not occurring more frequently than once a week.
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Physician review, interpretation, and patient management of home INR testing includes face-to-face verification that the patient uses the device correctly in the context of the management of the anticoagulation therapy and home INR monitoring not occurring more frequently than once a week.
IMPORTANT POINTS TO REMEMBER :
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The monitor is lent to the patient while on a home testing program.
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Test materials strips are provided.
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Frequency of testing not occurring more frequently than once a week.
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Porcine valves are not included in this NCD [National Coverage Determination], so Medicare will not make payment on Home INR Monitoring for patients with porcine valves unless covered by local Medicare contractors.
WHEN CLAIMS CAN BE DENIED ?
Your Medicare contractors will deny claims for PT/INR monitoring services that are not delivered in accordance with the above guidelines. However denied claims are subject to appeal, and medical review override of denials for appeal purposes will be allowed. Learn More on Role of Insurance in expanding the use of Home PT/INR Monitoring