Update on CMS re: DME (Infusion Pumps, supplies) per #cures

I Published the information, about Policy Article A52507 in reference to CMS billing, codes, payment criteria, and general information of Infusion related DMEs and medication on 12/28/16. Since, Policy Article A52507, has been superseded with Revised Policy Article L33794, revisions begin implementation 01/01/17.

Since last posting , CMS reports that the External INFUSION PUMPS – Policy Article (A52507) has been superseded. Reviewing the policy article from A52507, may give the reader a comparison to the implementation of the revised Policy Article L33794.

Policy Article “Local Coverage Determination (LCD) External Infusion Pumps”(L33794) Revisions seem to supersede Policy Article A52507. Of note, Revisions;  JW Modifier instructions, Denial verbiage for JW Modifiers when coverage criteria is not met, and more.

I would encourage any patient, or any person, to check the changes and decide if the changes will affect your current medical situation.

My perspective, the #cures has moved forward. How this will affect DME needed for SCIG infusions, is not yet clear. However, as educated and concerned patients we certainly need to keep aware of what is occurring with the DME exclusions. As well, continue to check any strategic movement that may, or may not, affect the PID community.

Link To .pdf:

Local Coverage Determination (LCD): External Infusion Pumps (L33794)

Link to docs.com with Both CMS Coverage Articles available:

CMS ARTICLES

 

Sources and Attribution:
http://docs.house.gov/billsthisweek/20150706/CPRT-114-HPRT-RU00-HR6.pdf

Over 700 Groups Stand Behind #Cures2015: https://energycommerce.house.gov/news/press-release/over-700-groups-stand-behind-cures2015/

Life Changing Lessons

ou never know, one day, this, or another medical problem will end the old life as you know it. Believe it, or not, the new you, will emerge

When your first diagnosed with a “chronic” illness, life sure does change. I’m not just talking about the everyday illness. I’m talking about you really face an uphill battle when it comes to the medical institutions, the insurance companies, and figuring out where and what all the new terminology  means. In all honesty, I was quite alone in this. I have always been a research nut. However, there were so many new, to me, vocabulary and scenarios. I had no advocate. It was quite the ordeal. Of importance: Do not give up! You have come this far, to turn back now.

Believe it or not, many primary doctors have not heard of this diagnosis. Specialists turned me away, telling me, that I was to “difficult” a case (yes, it’s in my records). I had no idea where to begin with getting my treatment, I was turned down, and turned away, and sent on many a wild goose-chases. I spent countless hours on the phone (Tip: Document all calls, date, time, contact and content), all in the attempt to get treatment. If your ever in my shoes, and you have BLANK Health Insurance, if you can get rid of that God awful insurance, do so now. You never know, one day, this, or another medical problem will end the old life as you know it. Believe it, or not, the new you, will emerge. That’s left probably for my treatment blog, so I won’t bore you any longer. Life sure does change, in a lot of ways.

Through the process of the last year, I began doing specific research, not Google, or Wikipedia, but real, research backed by National Institute of Hearth, and other various, well versed entities. A leader in the field of CVID is Charlotte Cunningham-Rundles, I was able to hear her speak briefly at one of the national conferences this year. She is eloquent as a speaker.

Click on the link below for further research from Cunningham-Rundles:

Cunningham-Rundles, C. (2010). How I treat common variable immune deficiency. Blood, 116(1), 7–15. http://doi.org/10.1182/blood-2010-01-254417
How I Treat Common Variable Immunedefeciency  Cunningham-Rundles, C. (2010)