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Designed by Paula D. Estridge Director of Corporate Supply Bird and Bear Medical, Inc. Incontinence & Diabetic Products for the Aging Choosing the Proper.

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Presentation on theme: "Designed by Paula D. Estridge Director of Corporate Supply Bird and Bear Medical, Inc. Incontinence & Diabetic Products for the Aging Choosing the Proper."— Presentation transcript:

1 Designed by Paula D. Estridge Director of Corporate Supply Bird and Bear Medical, Inc. Incontinence & Diabetic Products for the Aging Choosing the Proper Products and Getting them Paid for by Medicaid and other Insurances

2 HOW TO TALK COMFORTABLY WITH YOUR INCONTINENCE CLIENTS You are providing your clients a very valuable service if you can help them live a more full life by managing their incontinence. Here are a few tips to help bring up the conversation in a comfortable way for your clients:  “Bladder Leakage”: Use terms like this to describe incontinence or ask if they wear pads for urine leakage. Incontinence is not a word everyone is familiar with or comfortable using.  They are not alone: Assure your client that incontinence is not a disease but it does impact many people; over 25 million in the U.S. alone.

3 Facts about Bladder Leakage Affects up to 25 million Americans each yearAffects up to 25 million Americans each year 15% of men over 65 experience bladder leakage15% of men over 65 experience bladder leakage Over 80% of those who are incontinent are womenOver 80% of those who are incontinent are women It is not a disease, it is a symptom with many causes.It is not a disease, it is a symptom with many causes. Some causes are: Some causes are: job related activity like heavy lifting job related activity like heavy lifting high impact activities high impact activities lung disease due to chronic coughing lung disease due to chronic coughing certain foods/beverages certain foods/beverages poor nutrition poor nutrition constipation constipation anatomical predisposition anatomical predisposition obesity obesity previous urinary tract or renal problems previous urinary tract or renal problems loss of pelvic muscle tone loss of pelvic muscle tone pregnancy & childbirth pregnancy & childbirth menopause menopause pelvic surgery or trauma pelvic surgery or trauma neuromuscular or cognitive impairments neuromuscular or cognitive impairments medication side effects and the use of diuretics. medication side effects and the use of diuretics.

4 There are Six Different Types of Incontinence Stress Incontinence: Leakage if you laugh, sneeze, or exercise: involuntary loss of a few drops, most common in women, usually occurs with a laugh, cough, sneeze, or exertion. Common causes: Pregnancy & Childbirth, pelvic surgery or trauma, obesity or weak pelvic muscles.Stress Incontinence: Leakage if you laugh, sneeze, or exercise: involuntary loss of a few drops, most common in women, usually occurs with a laugh, cough, sneeze, or exertion. Common causes: Pregnancy & Childbirth, pelvic surgery or trauma, obesity or weak pelvic muscles. Urge Incontinence: Can’t get to the bathroom on time: awareness of the need to go, frequent, strong & sudden urges but cannot always make it to the bathroom on time. Common causes: Bladder irritants, urinary tract infections, or tumors and stones.Urge Incontinence: Can’t get to the bathroom on time: awareness of the need to go, frequent, strong & sudden urges but cannot always make it to the bathroom on time. Common causes: Bladder irritants, urinary tract infections, or tumors and stones.

5 6 Types of Incontinence continued Reflex Incontinence: Urine loss with no warning. Can not tell they need to go. Common Causes: Stroke, brain tumors, or spinal cord injuries.Reflex Incontinence: Urine loss with no warning. Can not tell they need to go. Common Causes: Stroke, brain tumors, or spinal cord injuries. Overflow Incontinence: Bladder too full. Leakage when the bladder reaches a level of fullness, often accompanied by dribbling, frequency & urgency of urination increases. Common Causes: Medications, urethral obstruction, neurological conditions, or benign prostatic hyperplasia (BPH). (BPH is a non-malignant enlargement of the prostate gland occurring in men after the age of 50, and sometimes leads to compression of the urethra and obstructions of the flow of urine.)Overflow Incontinence: Bladder too full. Leakage when the bladder reaches a level of fullness, often accompanied by dribbling, frequency & urgency of urination increases. Common Causes: Medications, urethral obstruction, neurological conditions, or benign prostatic hyperplasia (BPH). (BPH is a non-malignant enlargement of the prostate gland occurring in men after the age of 50, and sometimes leads to compression of the urethra and obstructions of the flow of urine.)

6 6 types of Incontinence continued Functional Incontinence: A barrier when getting to the bathroom. Immobility or cognitive impairment hinders ability to get to the toilet, person may be a fall risk or bathroom may be inaccessible. Common causes: Cognitive impairment, functional disability, psychological impairment, or environmental barriers.Functional Incontinence: A barrier when getting to the bathroom. Immobility or cognitive impairment hinders ability to get to the toilet, person may be a fall risk or bathroom may be inaccessible. Common causes: Cognitive impairment, functional disability, psychological impairment, or environmental barriers. Mixed Incontinence: A combination of two or more types. Symptoms can include a combination of the other types of incontinence.Mixed Incontinence: A combination of two or more types. Symptoms can include a combination of the other types of incontinence.

7 Managing Incontinence Behavioral Therapy Diet Modification MedicationSurgery Incontinence Products Behavior Therapy involves understanding your body. Certain foods act as diuretics and may be removed from the diet. Certain medications for unrelated issues can trigger incontinence. All surgery must be considered carefully. Assess for the proper product needs based on the type of incontinence the client has. You may create toileting schedules to proactively visit the bathroom Eliminating one or all of the foods may improve your urine control. Look into medications that are bladder irritants. Surgery comes with risks and potential complications. Patients may need a variety of products. For example, pantyliners or pullups during the day and diapers at night. Use a diary to create a schedule & discuss with your physician. Look into foods & beverages that are bladder irritants. Other medications can help treat bowel/fecal incontinence. Discuss with MD. Talk to the MD. For women: Kegal exercises are also sometimes recommended to strengthen the pelvic muscles.

8 Choosing the right product Types of Products Information on Product StressUrgeOverflowFunctionalReflex Bladder Control Pads (pantyliners, pads or male guards) Available in a variety of sizes and absorbenciesAvailable in a variety of sizes and absorbencies Individually wrapped for discretion and convenienceIndividually wrapped for discretion and convenienceXXX Belted Shields (belted undergarments or open sided belted pads) One size fits mostOne size fits most Reusable elastic strapsReusable elastic straps Reinforced buttonholesReinforced buttonholesXXX Protective Underwear (pullups, DPU, briefs, overnight pants) SIZED BY HIP SIZE Pull on & off like regular underwearPull on & off like regular underwear Available in a variety of sizes, styles & absorbenciesAvailable in a variety of sizes, styles & absorbenciesXXX Adult Briefs (diapers) SIZED BY WAIST SIZE Ideal for heavy & fecal incontinence protectionIdeal for heavy & fecal incontinence protection Available in a variety of sizes & absorbenciesAvailable in a variety of sizes & absorbenciesXX Underpads (Chux, bed pads) Placed under client in bed/chairPlaced under client in bed/chair Protects when leakage may occurProtects when leakage may occurXXXXX

9 Food & Beverages that affect Incontinence Common Bladder Irritants Alcoholic Beverages: beer, wine, liquor in any form are dehydratingAlcoholic Beverages: beer, wine, liquor in any form are dehydrating Carbonated BeveragesCarbonated Beverages Soft Drinks with CaffeineSoft Drinks with Caffeine Coffee (Caffeine stimulates the bladder.)Coffee (Caffeine stimulates the bladder.) TeaTea HoneyHoney SugarSugar Artificial SweetenerArtificial Sweetener Corn SyrupCorn Syrup ChocolateChocolate Tomatoes (these are acidic)Tomatoes (these are acidic) Citrus Fruits & JuicesCitrus Fruits & Juices Helpful Foods & Beverages Fiber: Found in oat bran, applesauce, prune juice, and in the form of additives, can improve bowel habits and help ease constipation which can lead to incontinence. Grape, cranberry, cherry and apple juice are thirst-quenchers that usually are not irritating. Water: the best beverage of choice. Important Note on Liquids Many people who have bladder control issues reduce the amount of liquids they drink thinking that will help. This only causes more concentrated urine (dark yellow, strong smelling). This can irritate the bladder and increase the potential for a urinary tract infection and more incontinence.

10 Medications that affect Incontinence MedicationsEffect Bladder Symptoms Diuretics (water pills): Hydrodiuril (HCTZ), Lasix (furosemide), Maxzide (HCTZ-triamterene) More urine is produced Frequency, urgency, increased amount of urine output Sedatives, muscle relaxants: Valium (diazepam), Librium (chlordiazepoxide), Ativan (lorazepam) Sedation and drowsiness Possible lack of appreciation of bladder events Antihistamine: Benadryl (diphenhydramine) Antipsychotics/Antidepressants: Elavil (amtriptyline), Prolixin (fluphenazine), Haldo (haloperidol), Prozac (fluoxetine HCl) Calcium channel blockers: Calan (verapamil), Procardia (nifedipine), Cardizem (diltiazem) Retention of urine because the bladder is relaxed or bladder outlet resistance is increased Difficulty in starting the urinary stream, straining to void, voiding with a weak stream, leaking in between urinations, frequency, urinary retention Anticholinergics: Oxybutynin, tolterodine tartrate, trospium chloride Possible difficulty in passing urine due to relaxation of bladder muscle Possible decrease in bladder emptying; rarely urinary retention, overflow incontinence Alpha adrenergic agonist: Entex, Sudafed (pseudoephedrine) Increases the resistance of the bladder outlet muscle Urinary retention, difficulty in starting the urinary stream, straining to void, voiding with a weak stream, leaking between urinations, frequency

11 Medications that affect continued MedicationsEffect Bladder Symptoms Over-the-counter cold remedies: Nyquil, Theraflu, Alka Seltzer Plus Cold Relief, Afrin, long-acting nose drops Retention of urine (Either because the bladder is relaxed or the strength of the bladder outlet muscle is increased, depending on the particular medication) Urinary retention, difficulty in starting the urinary stream, straining to void, voiding with a weak stream, leaking between urinations, frequency Alpha adrenergic antangonist: Hytrin (terazosin), Cardura (doxazosin), Flomax (tamsulosin) Relaxes the bladder outlet muscle Leaking when coughing, sneezing, laughing, exercising, etc. DDAVP (desmopressin acetate) Decreases urine output made by the kidneys Possible decrease in blood levels of salts. Decreased urine production.

12 Troubleshooting Guide for Products Leakage: Is the client in the proper product? Is the client in the proper product? Is the client in the proper size for their height and weight. Briefs too large will leak and sag. Is the client in the proper size for their height and weight. Briefs too large will leak and sag. Is the product making contact with the body? It should be a snug fit. Is the product making contact with the body? It should be a snug fit. For briefs, are the bottom tabs angled up to cup the buttocks? For briefs, are the bottom tabs angled up to cup the buttocks? For briefs, are the top tabs angled at a downward angle for a snug fit at the waist? For briefs, are the top tabs angled at a downward angle for a snug fit at the waist? Are barrier creams being used? Overuse may diminish the wicking action. Are barrier creams being used? Overuse may diminish the wicking action. Has the product been “doubled-up” in an effort to maximize absorbency? Products are designed to be used as a single product. Pads inserted into the brief will hinder the absorbency process and may cause leakage. (Unless a diaper doubler, designed for an extra layer in the brief for more absorbency. These are just made of the fluff, no lining at all. Has the product been “doubled-up” in an effort to maximize absorbency? Products are designed to be used as a single product. Pads inserted into the brief will hinder the absorbency process and may cause leakage. (Unless a diaper doubler, designed for an extra layer in the brief for more absorbency. These are just made of the fluff, no lining at all. Skin Irritation: Is the skin “scalded” at the mid-thigh area? Product may not be close enough to the body. Postion product close to the body for a snug fit. Is the skin “scalded” at the mid-thigh area? Product may not be close enough to the body. Postion product close to the body for a snug fit. Is the skin blistered at the upper thigh? Elastics may be positioned incorrectly. Leg elastics should rest on the natural creases of the groin. Is the skin blistered at the upper thigh? Elastics may be positioned incorrectly. Leg elastics should rest on the natural creases of the groin. Other potential causes of skin irritation: Infrequent absorbent product changes, inadequate skin care of pericare, and lack of repositioning. Other potential causes of skin irritation: Infrequent absorbent product changes, inadequate skin care of pericare, and lack of repositioning.

13 Troubleshooting Guide continued Absorbency: Is the client in the proper product? Is the client in the proper product? Is the client using the proper sized brief? A product too large will leak because of sagging. Is the client using the proper sized brief? A product too large will leak because of sagging. Is the product making contact with the perineal area? Fit should be snug. Is the product making contact with the perineal area? Fit should be snug.Odor: Is the client receiving thorough pericare after each incontinence episode? Is the client receiving thorough pericare after each incontinence episode? Are soiled products being rolled up and secured before disposal? It is recommended wrapping used items in plastic shopping bags or plastic gloves before disposing. Also, make sure you are using a trash receptacle with a secure lid. Are soiled products being rolled up and secured before disposal? It is recommended wrapping used items in plastic shopping bags or plastic gloves before disposing. Also, make sure you are using a trash receptacle with a secure lid. Medicaid is the only insurance that will cover incontinence products. They pay $ a month from date delivered!!!! Medicaid is the only insurance that will cover incontinence products. They pay $ a month from date delivered!!!! Wipes ARE NOT a covered item!!!! Wipes ARE NOT a covered item!!!!

14 Diabetic Products based on the diagnosis INSULIN DEPENDENT INSULIN DEPENDENT 6 boxes of strips MAXIMUM PER QUARTER (300 STRIPS TOTAL) and 3 boxes of lancets. 6 boxes of strips MAXIMUM PER QUARTER (300 STRIPS TOTAL) and 3 boxes of lancets. This is for supply up to 3 times a day testing (TID) ****You only give them the quantity of strips and lancets needed per the prescription on file, not automatically 300 strips**** This is for supply up to 3 times a day testing (TID) ****You only give them the quantity of strips and lancets needed per the prescription on file, not automatically 300 strips**** NON-INSULIN DEPENDENT 2 boxes of strips MAXIMUM PER QUARTER (100 STRIPS TOTAL) and 1 box of lancets. This is for supply up to 1 time a day testing INFORMATION BASED ON MEDICARE GUIDELINES & STANDARDS

15 Medical Documentation Required Medical documentation is required every 6 monthsMedical documentation is required every 6 months Prescription from physician with testing frequency and diagnosisPrescription from physician with testing frequency and diagnosis Physician notes documenting the testing frequency, reason for testing frequency,Physician notes documenting the testing frequency, reason for testing frequency, follow- up notes pertaining strictly to the diagnosis requiring the diabetic testing and treatment.follow- up notes pertaining strictly to the diagnosis requiring the diabetic testing and treatment.

16 Types of Glucometers Covered and the Requirements Standard Glucometer: (E0607) Patient must meet all the following criteria: 1.Diagnosed with and treated for Diabetes (ICD-9 codes ) 2.Monitor and related supplies must be ordered by the physician treating the diabetes 3.Patient or caregiver must have completed training on the use of the equipment 4.Patient is capable of using the test results to control their glucose levels 5.The device is designed for home use Special Feature Monitors (for the visually challenged) E2100: visually impaired or E2101: manual dexterity impaired) 1.All the above basic criteria are met AND 2. 2.The treating physician certifies severe visual impairment (20/200 or worse in both eyes) (for E2100 or E2101) 3. 3.Specific visual acuity is documented (for E2100 or E2101) 4. 4.Treating physician certifies the patient’s severe impairment of manual dexterity (Physician’s narrative statement must be on file) (for E2101 only-is not dependent upon a visual impairment)

17 Covered Accessories and Supplies Covered Supplies Blood glucose test strips (A4253) 1 unit=50 stripsBlood glucose test strips (A4253) 1 unit=50 strips Lancets (A4259) 1 unit=100 lancetsLancets (A4259) 1 unit=100 lancets Glucose control solutions (A4256)Glucose control solutions (A4256) Spring powered lancing device (A4258)Spring powered lancing device (A4258) Non-Covered Supplies Alcohol or peroxide (A4244, A4245) Betadine or phisoHex (A4245, A4247) Urine reagent strips or tablets (A4250) Home glucose disposable monitor (A9275) Continuous glucose monitor Reflective colorimeter devices

18 Not Medically Necessary Laser skin piercing device (E0620)Laser skin piercing device (E0620) Replacement lens shield cartridges (A4257)Replacement lens shield cartridges (A4257)

19 Normal Utilization Guidelines Patients not Patients not treated with insulin injections: 100 test strips, 100 lancets every 3 months100 test strips, 100 lancets every 3 months Patients being treated with insulin: 100 test strips and 100 lancets every month. Medicare, the only insurance that does; allows supplies shipped for a 3 month period at time. That would be 300 test strips and 300 lancets a quarter (every three months).100 test strips and 100 lancets every month. Medicare, the only insurance that does; allows supplies shipped for a 3 month period at time. That would be 300 test strips and 300 lancets a quarter (every three months).

20 Guidelines for Excess Utilization Patients who exceed normal guidelines must meet all the following criteria: 1.All basic criteria 1 through 5 are met (on the Standard Glucometer page) 2.Supplier maintains order in the patient’s record 3.Patient’s supply on hand is nearly exhausted 4.Treating physician ordered a frequency of testing that exceeds utilization guidelines (documented with specific reason in medical record required) 5.Treating physician has seen the patient and evaluated their diabetes control within six (6) months of prior to any order for quantities that exceed the normal utilization guidelines Must be documented in the physician’s medical recordsMust be documented in the physician’s medical records Additional physician visits are not requiredAdditional physician visits are not required 6.There is documentation that frequency of testing matches physician’s order A copy of the patient’s testing log, orA copy of the patient’s testing log, or A statement in the physician’s medical record indicating the log was reviewed and how often testing was doneA statement in the physician’s medical record indicating the log was reviewed and how often testing was done New documentation required every six (6) monthsNew documentation required every six (6) months

21 Documentation Requirements A detailed written order is required prior to billing for the product; which has to include: Patient’s namePatient’s name All items to be dispensed (details)All items to be dispensed (details) Options or additional features needed by the patientOptions or additional features needed by the patient Specific frequency of testingSpecific frequency of testing Treating physician’s signature and dateTreating physician’s signature and date Start date if different from the signature dateStart date if different from the signature date ***Note: If the physician’s order only lists frequency of testing as PRN or “as needed”, it is not medically necessary…you must get a set frequency.*** A new written order is required when: There is a change in the frequency of testingThere is a change in the frequency of testing There is a change in supplier for the glucose monitor and/or suppliesThere is a change in supplier for the glucose monitor and/or supplies


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