Presentation on theme: "Iowa Academy of Nutrition & Dietetics Legislative Meeting February 19, 2015."— Presentation transcript:
Iowa Academy of Nutrition & Dietetics Legislative Meeting February 19, 2015
Objectives Enhance participants understanding of the current state of reimbursement Evaluate if credentialing for reimbursement is worthwhile and profitable specific to RD practice Access resources and experienced colleagues for assistance with credentialing and billing for reimbursement
Judy D. Stark, MBA, MS Vice-President Health Management CoOportunity Health Brian J. Smith, RDN, LD Clinical Nutrition Operations Manager UnityPoint Health- Des Moines Carrie J. Leiran, MS, RDN, LD Outpatient Dietitian of the Nutrition Centre UnityPoint Health- Des Moines
….To realize the mission and vision of the Academy of Nutrition and Dietetics… Mission:“ Empowering members to be food and nutrition leaders” Vision: “Optimizing the nation’s health through food & nutrition “
We will speak from our experiences. We will facilitate discussion to share ideas about the impact that we do make. We hope to learn from each other.
Identify health plans that cover nutrition counseling, not all do The Affordable Care Act requires Qualified Health Plans (those sold on the Exchanges) and ACA –compliant plans to cover the following preventive nutrition services at no cost share to the member: Counseling and behavioral interventions of obese children and adults Intensive healthy diet counseling for adults with high cholesterol, CVD risk factors, diet-related chronic disease https://www.healthcare.gov/what-are-my-preventive-care- benefits/
Cannot be services that are part of a package of care that are already reimbursed via another claim Nutrition counseling/services delivered to patients in a hospital or SNF under per diem or case rate payments Nutrition counseling that is packaged as part of a global medical/surgical package (i.e. bariatric surgery package or OB package) billed by a provider
For healthplans that DO cover nutrition services, determine if they separately credential RDs/Nutritionists to provide these services. Some healthplans cover these services but do not credential, and therefore separately reimburse, RDs/Nutritionists. Some healthplans reimburse for these services when billed by a medical physician or chiropractic clinic, although the services are delivered by a employed RD/Nutritionist.
If an RD/Nutritionist wishes to establish an independent practice and bill healthplans that do cover nutrition services and do credential RDs/Nutritionists, they need to: Complete an application for network participation, negotiate a provider contract Submit their credentialing application for verification and approval Identify appropriate CPT and billing codes Identify appropriate billing forms (i.e CMS1500 form)
Medicare & all insurances require use of codes: ICD -9 : International Classification of Diseases CPT: Current Procedural Terminology
Once charges drop, we have 4 days before the claim bills Prior to the bill dropping, there is a possibility that the claim could hit any of a number of different work cues for registration issues, direct billing issues such as NPI numbers, insurance and authorization issues If the claim is clean, it should bill to insurance provider in 4 days Insurance checks policy for benefits, CPT, ICD-9 and generates an EOB
What is in policy for benefit ? (MNT) What is in the policy for diagnosis? (DM2, Renal Failure, CHF) Where did the policy originate? Is credentialing required for the RDN/RD?
Phasing Out: “Fee for Service (FFS)” - providers being paid by the number of visits & test they order Phasing In: “Value-Base Reimbursement” - providers being paid by the value of care they deliver
Effectively managing shared savings programs to maximize reimbursement Improving operating costs to deliver care more efficiently than today Capturing an increased number of patients Tracking quality measures Improving performance Streamlining operations Reducing waste Promoting the value of RD/RDN’s!
Nutrition Experts Provide Medical Nutrition Therapy Apply Evidenced Base Practice Highly Trained Professionals Provide Better Health Outcomes Provide return on Investment Integral to Patient-Centered Medical Home Motivational Interviewing Stay positive. Be patient. Be pro-active
What are the challenges we face with credentialing, reimbursement and is it necessary? How can or do we contribute to the bottom line? How can/do we prove that we reduce readmission for heart failure, COPD, diabetes, wound care, eating disorders? How can we prove that we limit escalation of pharmaceutical therapy? How can/do we identify and treat malnutrition early?
How can we prove that we make a definitive impact in the lives of our patients? Who outside our profession knows that we make an impact? To whom do we make these cases? Who are our allies and champions? Where are the points of collaboration?
The Academy of Nutrition and Dietetics Eating Right.Store MNT References Eating Right. Pro -RD’s and PCP’s: A Health Partnership for the Comprehensive Primary Care Initiative - Medical Nutrition Therapy: MNT Works the Value of RD’s - Multiple articles