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Reimbursement | Healthcare Providers

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Reimbursement

In 2008, Medicare approved PT/INR patient self testing for patients with:

  • Mechanical heart valve (MHV)
  • Chronic atrial fibrillation (AF)
  • Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism
  • Primary hypercoaguable state

Medicare supports weekly testing to provide patients and physicians with an increased number of data points to actively manage INR. Many major insurance providers also cover up to 52 PT/INR self tests per year.

More Revenue. More Data. Less Effort.
Patient self testing offers significant advantages for your patients — and your practice!

  • You'll have a new, recurring revenue source from the review and interpretation of patient self-testing results
  • Your nursing staff will be free to focus on other patient-care tasks
  • You'll be able to maintain a regular patient office visit schedule — possibly increasing the number of Level 4 office visits annually

Point-of-Care Testing vs. Patient Self Testing
Here's how point-of-care testing in your office compares to patient self testing:

Point-of-Care Testing Patient Self Testing

Monthly office visits, including two Level 4 office visits annually

• Staff required to conduct tests in office

• Practice responsible for test strip inventory and wasted supplies for tests with errors

• Limited to 12 INR data points annually

Weekly patient self testing and four Level 4 office visits annually

• Staff time limited to receipt of faxed INR results

• Real-Time Diagnostics responsible for service and supplies

• 52 INR data points annually

• Real-Time Diagnostics can manage dosage adjustment (if you choose)

• Your staff can conduct the initial patient training and bill for it

Earn More with Patient Self Testing
Based on the above scenario, here's an estimate of what you can bill for point-of-care testing vs. patient self testing

Point-of-Care Testing Patient Self Testing
Level 1 office visits x 10
*99211 MI '11 Loc 1 Rate
$20.52 $205.20
Level 4 office visits x 2
*99214 MI '11 Loc 1 Rate
$107.90 $215.80
PT fingerstick tests x 11
*$5.00 avg. strip cost
less reimbursement
(86510 MI '11 Loc 1 Rate)
$0.49 $5.88
Level 4 office visits x 4
*99214 MI '11 Loc 1 Rate
$107.90 $431.60
 Interpretation of Results x 12
*G0250
 $9.71  $116.52
 Initial patient training x 1
*G0248
 $143.90  $143.90
Annual Revenue to Your Practice $426.88 *Annual Revenue to Your Practice $692.02

* Annual revenue first year includes 1x charge for initial patient training. Annual ongoing revenue = $548.12
** Billing rates from Medicare 2011 MI Loc 1 Rate Schedule