ReimbursementNutr 564: Summer 2002

Objectives Identify the components of

reimbursement Describe the barriers Identify resources for MNT

reimbursement

Topics of DiscussionReimbursement

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

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 -

AuthorizationDocumentation of nutrition risk

* Diagnosis

* Age

* Guidelines

ReimbursementNutrition 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

Does the reimbursement take place?

Reimbursement

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• 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