Reimbursement Index << Changes in DSMT

2007 Update: Enhancing Utilization of the Medicare MNT Benefit and the Diabetes Self-Management Education Benefit

Abstract

This article outlines how RD's can optimize their multi-disciplinary team- physicians, patients, local businesses, and even including media outlets, to effectively utilize benefits and provide quality care to their patients.

The Medicare MNT benefit and the Diabetes Self-Management Education benefit have great potential for advancing the health of qualifying beneficiaries. For this to occur, however, physicians and beneficiaries must be aware of both benefits, they must be ordered in a timely fashion and, when medically appropriate, the maximum number of allowed hours in each benefit should be furnished in both the initial and follow-up episodes of care.

Today, many DSME Programs and renal care facilities continue to seek ways to increase access to quality diabetes and renal disease self-care education, improve patient outcomes, expand their services to increase revenues and maintain financially sound programs. Furnishing the Medicare MNT benefit along with the DSME benefit can help achieve these goals. The strategies below can maximize the on-going and full utilization of the benefits and thereby maximize quality care:

• Encourage or require RDs to become Medicare providers.
• Pursue a multidisciplinary team approach to patient care by:
  • Developing an automated clinical information and data base system that allows for: unrestricted communication between the RDs and DSME instructors; a multi-disciplinary medical record (including prompts when required documentation fields are not complete); prompts that the initial benefit hours are available as well as the annual follow-up hours; red flagging of patients with abnormal lab values; and queries of each benefits’ diagnostic criteria.
• Developing a decision support system and a quality management plan to ensure staff competency and compliance with regard to: the organization’s MNT and DSME program policies and procedures; specialty certifications such as ‘certified diabetes educator’ if required by program regulations (the CDE credential is not required for the Medicare MNT nor the DSME benefit); Medicare coverage guidelines; educational aids; scope of practice for each discipline; MNT evidence-based protocols and the nutrition care process; nationally recognized standards of care for diabetes and renal disease; and, to the National Standards for Diabetes Self-Management Education.
  • Implement on-going marketing of the DSME and MNT services to the primary and secondary target markets: physicians, institution employees and administration, external clinics and people in the surrounding communities.
• Use multi-media promotion and advertising:
  • Nutrition/diabetes health fairs
  • In-house TV channel in hospital rooms
  • Direct mail
  • MNT/DSME Program sign on office door
  • Healthy cooking demonstrations
  • Pocket folders for patients
  • RD business cards with program info on back
  • Brochures, flyers, oversized postcards
  • Press releases
  • Hospital newsletters, intra-emails, magazines
  • MNT or own Nutrition Newsletter
  • Face-to-face meetings with physicians
  • Support groups
  • Grocery store tours
  • Local cable television
• Emphasize that the services are distinct, but complementary Part B benefits, why both are necessary to maximize patient care and that MNT has been proven cost-effective in several studies.
• Emphasize to physicians that programs provide what physicians always expect:
  • Their prescription for MNT and DSME is completed and the progress report is sent within a reasonable time frame.
  • Prompt notice to physicians of patient’s non-attendance of scheduled MNT and/or DSME visits.
  • Contacting patients in a timely fashion to reschedule missed appointments.
  • Assurance that the activities and duties of the RDs/educators are within their scope of practice and consistent with organizational policy.
  • Consistently positive patient outcomes:
    • Satisfaction
    • Behavior
    • Clinical
    • Quality of life
    • Cost-savings outcomes
• Emphasize to patients that programs provide what patients always expect:
  • Appointment slots are convenient and made within a reasonable time frame (i.e., program has adequate RD staffing and caters to patients’ schedules).
  • Reminders of all scheduled appointments at least 24 hours in advances.
  • Patient selection of interventions/topics to be addressed in upcoming sessions
  • Equitable fees for MNT and DSME and claims sent promptly to the insurance plans.
  • Letter of appeal sent to insurers when MNT and/or DSME reimbursement denied.
  • Competent staff (i.e., staff has active state licensure/credentialing, credentialing by professional commissions/boards, advanced degrees, specialty certifications such as CDE, etc.).
  • Improved health indicators over time (blood glucose, cholesterol, BP, etc.)
  • Improved quality of life over time (improved energy, ability to do ADL, etc.)
  • How to achieve health goals within the context of their lives:
    • Nutrition advice that can be easily understood and “fits” their lifestyle.
    • How to change their food and exercise behaviors and how to overcome barriers to change.
• Encourage referrals for both DSME and MNT (diabetes and renal) when medically necessary and in compliance with CMS’ regulations.
• Consider using the universal Diabetes Services Order Form (DSMT and MNT Services developed by a joint task force of ADA and the American Association of Diabetes Educators). The form is intended to: streamline and simplify the ordering of Medicare Part B’s reimbursable diabetes-related benefits; increase beneficiary access to, and utilization of, these benefits; and, aid physicians in supplying providers with the written documentation CMS requires for implementation of these benefits. It is available for downloading on the websites of the ADA and the American Association of Diabetes Educators (AADE) in pdf or Microsoft Word format at no charge.
  • Give pads of the form to physician offices and hospital departments who may refer patients.
  • Customize the form with your institution’s name and contact information. Print a message on the top requesting that the physician fax the completed referral to the RD before giving it to the patient (the RD can then proactively schedule the appointment).
• Conduct health screenings to identify people who would benefit from MNT and/or DSME (conduct tests on blood glucose, lipids and blood pressure, measure body weight and provide nutrition risk questionnaires).
  
• Tell the beneficiary with diabetes that additional hours of MNT are covered beyond the utilization limit in each episode of care (initial and follow-up) if medical necessity is established and another physician’s referral is obtained. Offer to obtain the referral. Explain that managing diabetes can be difficult and that most people do better with ongoing support and coaching.
  
• Utilize the additional MNT hours if the patient develops renal complications. Remember that the initial three hours can also be used for patients with non-diabetes renal disease.
  
• If medically appropriate, call physicians when only one benefit is ordered (MNT or DSME); request that the missing benefit be prescribed, explaining the reason(s) why.
  
• Collect and summarize patients’ clinical, behavioral, quality of life, cost-savings and satisfaction outcomes on a regular basis. Report them to the target markets, administration, quality assurance department, board of directors, local health insurance companies and to ADA and the American Association of Diabetes Educators.
  
• Collaborate with the billing staff to develop systems to submit claims accurately, to track the status of MNT and DSME claims (charges, receipts, co-payments, deductibles, rejected claims and denied claims), to take action on rejected and denied claims and to create timely reports of all program expenses.
  
• Contact local health-related businesses to create “win-win” incentive coupon programs for patients who complete MNT and/or DSME programs.
  

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

top

last updated 2/13/07