2007 Update: Enhancing Utilization of the Medicare MNT Benefit and the Diabetes Self-Management Education Benefit posted 2/07
MNT REIMBURSEMENT UPDATE: 2007 posted 2/07
By: Mary Ann Hodorowicz, RD, LDN, CDE, MBA
IDA Health Care Financing Chair
Member: Legislative Public Policy Committee of the American Dietetic Association
www.maryannhodorowicz.com
Reimbursement
Diabetes Services Order Form
Designed to increase
physician referrals
Nearly one-fifth of persons over the age of 60 have diabetes.
While this number is disturbing in and of itself, it's particularly
alarming when you look at numbers showing underutilization of
the diabetes service benefits - diabetes self-management training
(DSMT) and medical nutrition therapy (MNT) - by Medicare beneficiaries.
Data
from the Medicare Quality Improvement Organizations (QIOs) reveals
the root causes of this under utilization are confusion or limited
awareness of the benefits and how to order the benefits for a
patient.
Responding to a request from the American Health Quality
Association (AHQA) and the QIOs, AADE and the American Dietetic
Association (ADA) joined forces to develop the Diabetes Services
Order Form, which is designed to be an easy and convenient way
for a physician to refer their Medicare patients with diabetes
to a diabetes educator for DSMT and a registered dietitian for
MNT.
The Diabetes Services Order Form is a standardized referral
form that can be used by any facility or healthcare professional.
The form includes the key referral information required to meet
Medicare regulatory requirements for MNT and/or DSMT referrals.
It is streamlined on one page for physician and/or qualified
non-physician practitioners' ease in completing the necessary
components to initiate the diabetes referral.
The form has been reviewed by the Centers for Medicare and
Medicaid (CMS) and field tested with diabetes educators, registered
dietitians and physicians.
The
field test results were positive, with the most frequent comments
acknowledging the concise one-page format that allowed sufficient
space for adding written physician instructions or comments.
Diabetes Order Form (PDF)
Reimbursement Overview
Whether you are new to MNT reimbursement, or have hands-on experience,
you know that this area of practice is as much essential as it
is overwhelming!
Our ultimate purpose is to increase MNT reimbursement success
for you, and for our profession. The site has been designed to
meet the following goals:
- Help
you easily obtain comprehensive and accurate reimbursement
information, including the details of the Medicare
MNT benefit
- Inform
dietitians about the many variables that affect insurance
payment of MNT
- Emphasize
the importance of one such variable: MNT OUTCOMES
- Provide
dietitians with “basic business” tips, such
as legally structures, tax returns, etc.
- Survey
our members’ needs on reimbursement and related
issues, and help meet these needs with future web
site offerings
- Set
the stage for member interaction in the pursuit of private
payer reimbursement
Goal: Help you easily obtain comprehensive and accurate reimbursement
information
To quickly find exactly what you need to know
now, and to keep you up-to-date in the future
- Click
on these web page links, or
- Call
the telephone numbers listed
- Subscribe
to ADA’s monthly
publication “The Medicare
MNT Provider” by calling the ADA toll free: 800-877-1600,
ext. 5000 Member Service Center
ADA “eatright” links are member-only pages
CMS = Centers for Medicare and Medicaid Services
(the governing
body of Medicare which was formerly called HCFA)
HHS = Health and Human Services (federal
government department)
IRS = Internal Revenue Service
Medical Nutrition Therapy and Reimbursement
Sections of Medicare MNT benefit, private insurance and employer-sponsored
MNT benefits, Medicare’s new patient privacy ruling titled “HIPAA” and
how and why RDs are to be compliant:
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_382_ENU_HTML.htm
Medicare MNT Benefit
List of Medicare Part B carriers: Call ADA’s fax-on-demand
service, 800-877-1600, ext. 1600, ext. 9
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1931_ENU_HTML.htm
(Medicare Part B MNT PowerPoint presentation) http://www.eatright.org/ada/files/MNTMedPtwebrevised3.pdf
HIPAA
Privacy and electronic transmission rules and resources, sample
forms, ADA’s upcoming training teleconferences, etc.
http://www.eatright.org/Member/PolicyInitiatives/83_12954.cfm
http://cms.hhs.gov/hipaa/hipaa2/default.asp
http://cms.hhs.gov/hipaa
Health Privacy Project’s web page:
www.healthprivacy.org/usr_doc/RegSummary2002.pdf
Note:
this links to a pdf file. You must have Adobe Acrobat Reader to open it. Acrobat
is available free of charge from the Adobe
Web site.
www.aha.org
HIPAA toll free hot line: 866-282-0659
For Medicare MNT Providers
ADA’s main page for information related to Medicare MNT
benefit:
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1136_ENU_HTML.htm
MNT benefit policy changes:
http://cms.hhs.gov/manuals/pm_trans/AB02151.pdf
http://cms.hhs.gov/manuals/pm_trans/AB02115.pdf
Note:
this links to a pdf file. You must have Adobe Acrobat Reader to open it. Acrobat
is available free of charge from the Adobe
Web site.
Medicare Fiscal Intermediary and Carrier Contact Information
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_statecarriers_ENU_HTML.htm
Implement the Medicare Benefit
Sections of pre-MNT encounter guidelines, implementing ADA’s “MNT
Evidence-Based Guides To Practice”, MNT claims processing,
and “Medicare MNT RD Payment Chart 2003 Excel File"
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_1934_ENU_HTML.htm
CMS Resources
Medicare’s new Web page, the “Medicare Learning Network”,
has quick reference guides, Web-based training modules, publications
and pamphlets, videos, and CD-ROMS:
http://www.cms.hhs.gov/medlearn/default.asp?
Other MNT Reimbursement Resources
Section on billing essentials, HCFA 1500 (CMS-1500) claim form,
MNT superbills, expenses and denied claims:
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/nutrition_2818_ENU_HTML.htm
Goal: Inform dietitians about all the variables that affect insurance
payment of MNT
FOR MNT REIMBURSEMENT TO BE COLLECTED,
YOUR SYSTEMS, FORMS AND PROCEDURES MUST SPELL C.O.L.L.E.C.T.E.D
C = Collect MNT outcomes regularly, and report and market them
to insurers,
management, employees, community, physician, colleagues…everyone!
O = Observe correct CPT coding and claim form rules
L = Link yourself directly with payers by becoming certified providers;
be persistent and
patient in this process
L = Learn all variables affecting reimbursement: payer, practice
setting, type of MNT,
provider status, program certifications, managerial directives,
interpretations of payer
benefits, and billing requirements
E = Elect to use letters of appeal to insurers when MNT reimbursement
denied
C = Charge equitable fees
T = Track MNT reimbursement:
if payment consistently denied, despite letters of appeals,
review and revise systems, forms, procedures
E = Educate insurers, managers,
employees, clients, community about MNT…Emphasize
outcomes, Especially cost-savings/cost prevention outcomes
D = Document patient’s Diagnosis, Details of MNT visit,
and key Data in chart and in
progress note to physician
Goal: Emphasize the importance of one such reimbursement variable: MNT OUTCOMES
Why are outcomes important, and why do RDs
have to track and document them?
- Demanded
by managed care: medical services are approved as reimbursable
insurance benefits ONLY if they produce positive OUTCOMES
in cost-effective
manner
…Without positive outcomes, MNT reimbursement will eventually decline or
be denied
…Insurers want providers to maximize outcomes and minimize cost of medical
service
- Demanded
by patients: reason for patients seeking therapy is an
expected outcome
- Outcomes
prove effectiveness of MNT and are: end result of MNT;
goal of MNT; basis for standardized MNT protocols
What is a MNT outcome?
A measurable, positive change in patient’s clinical,
functional, financial indicators/time period as a direct
result of MNT (or
in medicine, of a healthcare process, system or episode of
care)
What are the most common types of MNT outcomes?
- Clinical
- Functional/behavioral
- Quality
of life/patient satisfaction
- Financial/cost-savings/cost-prevention
How does a RD document MNT outcomes?
Track outcomes data “before and after” MNT,
or at initial visit AND same data after MNT, at timed
intervals or at final visit. Documenting
your MNT outcomes is much easier than you think,
and much more essential to reimbursement than you can
ever imagine! You can do it!!
Questions? Email coordinator of the project:
Mary Ann Hodorowicz, RD, LD, MBA, CDE at hodorowicz@comcast.net
Goal: Provide dietitians with "basic business" tips
RDs who are self-employed, and Medicare RD providers, should think about the business implications and tax consequences of providing MNT services. These links will provide helpful information. We also advise you to consult with a tax advisor and an attorney on these very important issues.
www.irs.gov/formspubs/index.html
http://www.mycorporation.com/llcnow.htm
Goal: Survey our members' needs on reimbursement and related issues
Please let us know how we can serve you better! Send an email to:
Mary Ann Hodorowicz, RD, LD, MBA, CDE hodorowicz@comcast.net
Please phrase your request by answering questions such as:
- Medical Nutrition Therapy and Reimbursement
- Sections of Medicare MNT benefit, private insurance and
employer-sponsored
Three dozen detailed MNT and diabetes self-management training FAQs http://www.maryannhodorowicz.com/faq/index.asp
Goal: In quick fashion summarize critical pieces of Medicare MNT
Reimbursement for Medical Nutrition Therapy (MNT) and Diabetes Self-Management Training (DSMT) is essential for dietetic professionals and diabetes educators who wish to attain and maintain a permanent position on today's health care team. But Medicare's coverage guidelines for these benefits can be confusing and complicated. The two benefits appear to overlap in some areas and payment requirements are very detailed.
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links updated 1/17/06
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