most DME requests
(this workflow EXCLUDES: compression stockings, incontinence supplies, splints, wound care, enteral feeds, ostomy supplies, shoes)
Send an Epic chat to: MSH LandauerMedstar:
1) Attach the chart of the patient
2) Include your attending in the chat
3) Be prepared to update your note with requested text
all other DME requests (compression stockings, incontinence supplies, splints, wound care, enteral feeds/Ensure, ostomy supplies, shoes)
Epic dot phrase is .IMADME, which includes the information below:
- Wrote and printed a prescription including: specific supply, and associated ICD10 code, duration of use
- Wrote a letter of medical necessity
- Placed a social work consult in EPIC, including need for consult, e.g., "DME required, prescription printed along with letter of necessity and placed in the firm mailbox"
Enteral Nutritional Therapy including Ensure
For enteral nutritional therapy for nasogastric, jejunostomy, or gastrostomy tube feeding please complete .MSENSURE and route to p IMA Medication Prior-Auth Req. You will also need to provide a physical script and letter and route to SW.
For oral nutritional therapy like ensure insurance will likely not cover unless there is documented malabsorption or BMI < 18.5 in which case use the above process. A nutritionist can be helpful in gathering the appropriate documentation. Do not send a prior authorization request to p IMA Medication Prior-Auth Req for these cases.
CGM
Medicare
Use the MSH LandauerMedstar workflow above. A CGM will be mailed to the patient.
All other insurances
Send an E-prescription for the following to the patient's pharmacy:
1) Dexcom G7 1 sensor q10d
2) Dexcom G7 receiver x 1
3) Freestyle Libre 2 - 1 sensor q14d
4) Freestyle Libre 2 reader x 1
The pharmacy can figure out which of those is covered! Would suggest including a note to pharmacy about the particular indication for CGM, for example:
* requires BG check 4x/d
* frequent hypoglycemia or hypoglycemia unawareness or history of severe hypoglycemia requiring intervention
* multiple insulin injections per day