Reimbursement Nutr 564: Summer 2002

Objectives Identify the components of reimbursement Describe the barriers Identify resources for MNT reimbursement

The following information refers to a topic that is not logical. Topics of Discussion Reimbursement WARNING The following information refers to a topic that is not logical. Write it down

Reimbursement Details about this topic The Third Party System 1st party = the patient 2nd party = the provider 3rd party = the insurer who manages the payment

Reimbursement Billing systems to connect the service to the compensation Standards Who are qualified professionals to provide the service? RD Credential Continuing Education Regulatory oversight - Dept of Licensing

Reimbursement Billing systems to connect the service to the compensation Insurers recognize the standards Example: CAM process

Reimbursement Billing systems to connect the service to the compensation Documentation system - INPUT Identifies the type of service provided Nutrition Counseling Identifies the scope of the intervention Initial Assessment Follow-up Identifies the duration 15 min intervals

Reimbursement Outpatient Billing - Codes Universal Bill 1992 UB-92 Form Standardized bill used in most facilities for services billed to third party payers Requires two types of code numbers to be included on the bill ICD codes Revenue codes Urbanski P: 2001

Reimbursement ICD codes International Classification of Diseases Diagnosis codes ICD - 9 CM Codes HCFA (CMA) provides updates and training Contains 5 numbers first 3 are general disease system 4th and 5th specific details on disease system, age, severity, etc. Urbanski P: 2001

Reimbursement ICD codes Example 250 codes for diabetes Physician sets the diagnosis Urbanski P: 2001

Reimbursement CPT Codes Common Procedural Coding system which defines actual procedure or service that the healthcare professional performed Level I Level II Urbanski P: 2001

Reimbursement New CPT Codes for MNT 97802 = MNT; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes. 97803 = Re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 97804 = group (2 or more individual(s)), each 30 minutes. Urbanski P: 2001

Reimbursement Provider Number Each RD should have a provider number. Urbanski P: 2001

Reimbursement Billing systems to connect the service to the compensation Documentation system - Authorization Documentation of nutrition risk * Diagnosis * Age * Guidelines

Reimbursement Nutrition Support Client not able to take 50% of estimated nutritional needs Calorie Count or Nutrition Intake Assess Physician confirmation Updated to revised periodically

Reimbursement Billing systems to connect the service to the compensation Documentation system - Submission ICD codes

Actual compensation is a Reimbursement Does the reimbursement take place? WARNING Actual compensation is a Secret of the universe

Reimbursement Resources American Dietetic Association Web site Annual Meeting - workshops Dietetic Practice Groups Managers in Clinical Care Consultants in Dietetics Dietetics List Serves Note: Specific discussion of fee rates is illegal. Equates to price fixing. Networking with local practitioners

Reimbursement Medicaid is very specific for the states. Cannot compare between states.

Reimbursement Barriers Insurance Policies Changing regulations Medicaid policies for coverage Private insurers’ practices Should be the same as Medicare or Medicaid Changing regulations Details of submitting a claim ICD codes Lack of systematic feedback / QA

Reimbursement Professional Activities Support MNT Legislation Keep informed Communicate to your representatives

Reimbursement Involve your clients Ask about reimbursement experience Do they know if they got compensated? What has worked? Share this information with other clients Warn clients if insurance may not cover a service