Reimbursement

1. Reimbursement Nutr 564: Summer 2002

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

3. 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 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. 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 • 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