1. Reimbursement
Nutr 564: Summer 2002

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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

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

11. 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

12. 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

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

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

15. 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

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

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

18. 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

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

20. 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

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

22. 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