09
JUL
2018

Reimbursement Corner July 2018

Reimbursement Corner
By Susie Roberts, RDN, LD

I am sharing information from a great webinar I viewed, provided by Mary Ann Hodorowicz, RDN, MBA, CDE: Billing and Reimbursement for Diabetes Outpatient Services. Mary Ann is a true expert in the
dietitian-related billing and coding arena, and provided great tips on how we can identify and increase opportunities for insurance reimbursement!

As Mary Ann points out: reimbursement can be confusing, complex, complicated, convoluted, copies, cumbersome, and constantly changing. To
bring some clarity to the topic, she conducted 2 two-hour webinars – WOW! I will share some key tips over the next few months.

How to optimize billing, coding, and reimbursement for nutrition, DSMES (Diabetes Self-Management, Education, and Support), and related health insurer benefits: tips 1 to 7.

#1. Identify the potential health insurance carriers you will be billing for nutrition-related services:

  • Medicare
  • Medicaid
  • Commercial health insurance carriers that cover residents of Iowa (Wellmark Blue Cross & Blue Shield, United Health Care, Aetna, Cigna, etc.).

 

#2. Know that each carrier/plan typically has a ‘coverage policy’ for benefits that may apply to most or all of its’ health plan offerings. However, each plan can have varying: deductibles, out-of-pocket maximums, premiums, reimbursement rates, etc.

#3. Determine IF MNT, DSME, and related benefits are covered by each respective insurance carrier. Use these categories:

  • Preventive Medicine and Behavioral Therapy
  • Diabetes Prevention
  • MNT and Nutrition Counseling / Classes
  • Obesity Counseling and Weight Management
  • Diabetes Management and Education
  • Continuous Glucose Monitoring & Insulin Pump Initiation
  • Patient Education for Disease Self-Management
  • Remote Monitoring and Chronic Care Management

 

#4. For each covered benefit, identify the associated procedure codes, the frequency of coverage (hours, visits) and time frames (calendar year, or rolling year) for initial and follow-up interventions.

#5. For each covered benefit, identify:

  • Payable ICD-10 diagnosis codes.
  • Approved billing providers, and rendering physicians
  • Reimbursement rates
  • Approved places of service
  • Patient eligibility

 

#6. Know ‘rules of thumb’ for coding, billing, and reimbursement.

 

More information coming next time!

In the meantime, though, if you have questions, please contact me at sroberts1209@gmail.com

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