ࡱ> z` ^bjbjss  U%>>>>   8B D D("   MMM2444444$hX @MX>>  m~>8  22H[v0`  GW |]6i0N]^4h0`0`2a\M3[MMMXXjMMMF~F>>>>>>m MARY ANN HODOROWICZ CONSULTING, LLC Nutrition, Health Promotion, Diabetes Education and Insurance Reimbursement for Professionals for the Healthcare and Food Industry 12921 Sycamore ( Palos Heights, Il. 60463 ( 708. 359.3864 (  HYPERLINK "mailto:hodorowics@comcast.net" hodorowicz@comcast.net www.maryannhodorowicz.com   EMBED MS_ClipArt_Gallery  SUCCESS CHECKLIST FOR MNT and DSMT PROGRAMS EOCEpisode Of CareS-F-P-PsSystems Forms Policies - ProceduresS-R-OsSupport - Resources - OpportunitiesEBSCEvidence-Based Standards of Care QOCQuality Of CareNCPMNutrition Care Process and ModelDSMTDiabetes Self-Management TrainingMNT-EBGMNT Evidence-Based Guides for PracticeNSDSMENational Standards for Diabetes Self-Management Education  A PROCEDURES and RESOURCES APPLICABLE TO MNT and DSMT PROGRAMS THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotesCOMPETENCY of RD To Provide MNT and DSMT1. Initial training given to RDs in all aspects of Medicare MNT, MNT-EBG and NCPM to insure excellent competencies 2. Initial and ongoing training given to RDs, RNs + other DSMT team members on Medicare DSMT, NSDSME and other EBSC related to diabetes3. S-R-Os for RDs and DSMT team to keep skills current4. Determine RDs scope of practice in states dietitian licensure law or certification act (skin piercing allowed?)PRE-PROGRAM1. Support of hospital administration for program2. Business plan: ( Plan includes detailed marketing plan, which calls for RD (for MNT) and team members (for DSMT) to visit physician offices to survey this target markets needs re: program and to increase awareness3. Knowledge of MNT and/or DSMT reimbursement4. Pro forma (income statement with projected expenses, revenue and net income in yr 1 plus subsequent yrs (with +/- 10% variance) until breakeven point reached 5. Cost centers specific for dietitian services (MNT, nutrition counseling, etc.) and DSMT programs with own operating budgets + regular financial reports6. Financial resources for start-up + ongoing expenses7. Accounting and bookkeeping systems Dietitian services chargemaster Pt data base (can include outcome tracking)8. Pt registration (registers into cost center for dietitian services and/or DSMT cost center): HIPAA notice Verifying Medicare Part B coverage Financial responsibility statement for signature Cancellation policy and notice (fee, no fee?) Payment policy Consent to treat All above in Welcome to Our Office brochure9. Hospital is provider with major health plans + Medicare10. Marketing and advertising resources: Flyer or brochure > For menu of services > For special promotions > For start of program (when offered q ___wks) Employee newsletters Community newsletters Newspaper ads, free publicity11. Sources of non-MNT, non-DSMT revenue: weight loss program; exercise, pre-diabetes, healthy heart classes 12. Sources of unrestricted funds to offset uninsured pts (from hospital auxiliary, pharmaceutical companies)13. Large, stable physician referral base (= large pt base)14. Customized Dietitian and DSMT Referral forms, or use of one form when for both programs15. Dietitian services (MNT, etc.) and DSMT fees appropriately determined by evaluating competition, insurance payment rates, expenses and required revenue for time period16. DSMT, MNT, nutrition counseling fees that are charged are same for all pts, including Medicare pts17. EBSC compliance aids and procedures (real time prompts) to assure that pts scheduled for 1st MNT and 1st DSMT visit asap when faxed referrals received, or when pt calls for appointment18. Medicare MNT and DSMT not provided on same day19. Electronic management information system20. Electronic system for patient appointment scheduling 21. Clerical staff for pt scheduling: Who schedules pts? What process is used for initial apptment scheduling What process is used for apptment reminder calls Use of Initial Intake and Appointment Form22. Hours of operation: evening + Sat. hours23. Office or room for furnishing MNT and/or DSMT24. Office for MNT RD and/or DSMT team members with: ( Lockable cabinets for charts ( Dedicated phone line 25. System for pt eligibility screening for MNT and/or DSMT ( Pt has Medicare Part B; copy of insurance card made ( Documentation of lab criteria (see Pre-MNT and Pre- DSMT sections)26. Documentation of non-Medicare pts health insurance, ID number, phone, address and copy of card made27. Pt-signed HIPAA privacy statement + copy of to pt28. Pt-signed financial disclosure statement + copy of to pt29. Attempt made to determine number of previously used initial + follow-up Medicare MNT or DSMT hrs elsewhere30. Pts called 24 - 48 hours prior to appointment to confirm31. Miscellaneous: Customized fax cover sheets RD business cards Pt appointment cards Notice to physician when services not renderedMNT and/or DSMT PROGRAM INTERVENTION1. Pt Attendance and Charge Submission Form used for each visit (individual and group)2. Up-to-date, professional educational materials for pts Based on standardized curriculum, protocols, EBGP3. Customized behavior change tools for pts: ( Exercise and food diaries, blood glucose logs, hunger fullness rating logs, etc.POST-PROGRAM1. Effective billing and claims processing system and staff2. Effective system for submitting charges to billing dept. or staff responsible for on same day as DSMT/MNT visit3. Effective system for tracking all claims sent to insurers 4. Good working relationship with billing department staff5. Effective process for taking action (A) on denied claims: First, ID reason (R) for denial R = Lack of medical necessity A = Assure use of correct diagnosis code(s) A = Write appeal letter and cite own outcomes and MNT/DSMT cost-effectiveness studies ( R = Incorrect or missing entry in data field A = Make corrections and resubmit claim ( R = Invalid or incorrect CPT procedure code A = Make corrections and resubmit claim ( R = Provider not certified by payer A = Request provider application and submit ( R = Service not a covered benefit A = Write appeal letter and cite own outcomes and MNT/DSMT cost-effectiveness studies6. Documentation of reason for additional Medicare DSMT hrs and Medicare MNT hrs in initial and/or follow-up EOC beyond number stipulated in benefit7. Copy of DSMT and/or MNT documentation sent to PCP and to referral source (may be different)8. Billing only for face-to-face Medicare DSMT and MNT9. Neither DSMT nor MNT is given free to Medicare pts10. Billing private insurers for all MNT and DSMT provided11. Knowledge that CMS1500 claim used for billing non- hospital MNT and DSMT12. UB04 claim form for hospital billing of DSMT, MNT13. Revenue code 942 on UB04 claim formMNT and DSMT OUTCOMES MANAGEMENT SYSTEM 1. Outcomes management system for MNT/DSMT programs: ( Primary outcomes* routinely measured + evaluated to measure QOC and effectiveness of programs and benchmarked against best practice outcomes * Behavior, clinical, cost-savings and pt satisfaction ( S-F-P-Ps revised when QOC sub-standard2. Pt. satisfaction outcomes measured via pt evaluations3. To help insure QOC, S-R-Os for RDs and/or DSMT team members to find and communicate with best practice MNT and/or DSMT programs4. Per policy, pts allowed to bring pets to MNT visitB PRE MNT: SPECIFIC MNT PROCEDURES and RESOURCES THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotes1. RDs are certified Medicare providers, or submit CMS 855I form to local CMS Carrier to receive individual NPI#2. If RDs are employees, reassign Medicare payment to hospital by submitting CMS 855R form to local Carrier3. Hospital submits CMS 855B (business) form to Carrier to become single supplier of RD group furnishing MNT and obtains group NPI# which is used on MNT claims 4. MNT fee stated per 15 minute or 30 minute unit of time5. Physician MNT referrals for all pts including Medicare for: ( Initial MNT ( Follow-up MNT ( Additional MNT hours in initial and/or follow-up EOC beyond number stipulated in benefit 6. Documentation of reason for additional Medicare MNT hrs in initial or f/up EOC beyond # stipulated in benefit7. MNT program format = combination group + individual MNT to utilize time effectively: 2 hr group + 1 hr individual for customized meal plan & behavior change counseling8. Required documentation on Medicare MNT referrals: ( Order for MNT ( Pts name ( Physicians signature ( Covered diagnosis or 5 digit ICD-9 code (diabetes or pre-dialysis renal disease or condition for 36 months after kidney transplant ( Physicians Medicare NPI# ( Date (preceeds, or is same as 1st MNT visit)9. Documentation of one lab criteria for Medicare MNT:* Diabetes MNT: ( FBS > 126 mg/dl on 2 tests ( 2 hr post glucose challenge test of > 200 mg on 2 tests ( Random BG > 200 mg w/symptoms of uncontrolled DM Non-dialysis MNT: ( GFR > 13 50 * If lab criteria not on referral, must obtain from other source before furnishing MNT benefit: e.g., lab report or copy of physician chart note in which lab value noted. Medicare does not allow lab values to be obtained from home-based or inpt (bedside) BG meter.10. ABN form used when potential exits that Medicare may not pay for covered MNT as time limit in EOC will be exceeded: > 3 hrs in initial EOC, > 2 hrs in follow-up ( CPT code modifier GA on claim form when ABN used C MNT INTERVENTION: SPECIFIC MNT PROCEDURES and RESOURCES THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotes1. EBSC: ADAs MNT Evidence-Based Guides for Practice (Nutrition Protocols or Practice Guidelines) 2. EBSC: ADAs 4 step Nutrition Care Process and Model: Nutrition Assessment + Nutrition Diagnosis + Nutrition Intervention + Nutrition Monitoring/Evaluation/Reporting 3. EBSC compliance aids (real time prompts) to assure proactive scheduling of pts at 1st visit (or prior) of initial 3 hrs within calendar year 4. For nutrition counseling: standardized protocols, latest Research/standards of care/treatment from healthcare associations5. Customized disease-specific MNT forms for RDs: ( Nutrition assessment + MNT documentation form ( MNT flow sheet + MNT outcome tracking form6. Customized MNT worksheets for RDs: Nutrition Diagnosis Worksheet Specific for Diabetes Nutrition Diagnosis Worksheet for Any Disease Nutrition Calculation and Prescription Worksheet Worksheet for Calculating Carb-Pro-Fat-Calorie LevelD POST MNT: SPECIFIC MNT PROCEDURES and RESOURCES THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotes1. Documentation by RD of NCPM steps in providing MNT2. Billing Medicare for only diabetes and pre-dialysis MNT 3. Not billing Medicare for non-covered MNT ( Billing Medicare pts directly for non-covered MNT4. RD accepts assignment of Medicare MNT payment ( Hospital not charging beneficiary, nor supplemental insurance, for difference between hospitals MNT fee and Medicares allowed, adjusted MNT payment 5. MNT CPT codes on Medicare claims. CPT code used only 1 time on claim but # of units provided are entered: ( 97802: Initial EOC, 1st calendar yr, 1 unit = 15 min. ( 97803: F/up EOC, each yr after 1st, 1 unit = 15 min. ( 97804: Group MNT, > pts, 1 unit = 30 min. ( G270: Initial or f/up individual MNT, time > 3, > 2 hrs per second physicians referral in same year ( G271: Initial or f/up group MNT, time > 3, > 2 hrs per second physicians referral in same year6. Billing with NEW Education and Training CPT Codes As of 1/1/06, 3 new CPT codes approved by AMA for education, training and self-management for pts with established diseases to treat or prevent co-morbidities. Codes can be used for nutrition services other than MNT, such as for pt with HTN, gout, etc.: 98960 Education and training for pt self-management by qualified, non-physician health-care professional using standardized curriculum, face-to-face with pt (could include caregiver/family) each 30 min. individual pt. 98961 2 4 pts 98962 5 8 patients7. EBSC compliance aids and procedures (real time prompts) to assure that pts: ( Scheduled for 2 hrs follow-up MNT each year ( Rescheduled asap when class/appointment missed8. MNT charts audited by outside reviewer to evaluate RD compliance to MNT- EBG, Nutrition Care Process and Model and hospital requirements9. Disease-specific, customized chart audit worksheets E PRE DSMT: SPECIFIC DSMT PROCEDURES and RESOURCES THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotes1. Interpersonal skills of DSMT team: Team puts high priority on collaboration, cooperation, consideration, communication and respect2. Team member roles clearly defined 3. Team members roles match members knowledge, skills, professional license and certifications4. Curriculum and clinical protocols based on EBSC and not on opinion, turf wars or autocratic rule of team leader5. DSMT fee stated per 30 minute unit of time6. If billing Medicare, DSMT program certified by American Diabetes Association or Indian Health Services ( New 7th edition Education Recognition Program Certification requirements from A. Diab. A. scheduled for release in 20087. Referral obtained for DSMT from physician or qualified non-physician practitioner for initial DSMT and separate referral for follow-up DSMT8. Documentation required on Medicare DSMT referrals: ( Statement that DSMT is needed ( Whether DSMT to be individual or group ( For individual DSMT, substantiating reason for ( Topics to be addressed in DSMT ( Number of initial or follow-up DSMT hrs to be given ( Less than 10 may be ordered ( 10 hrs can be used for specific topics or all topics ( Whether DSMT is initial or follow-up ( On follow-up order, reason for DSMT to be given ( Diabetes diagnosis or 5 digit ICD-9 code ( Date (preceeds or is same as 1st DSMT visit) ( Patients name ( Physicians signature 9. Documentation of one lab criteria for Medicare DSMT ( FBS > 126 mg/dl on 2 tests ( 2 hr post glucose challenge test of > 200 mg on 2 tests ( Random BG > 200 mg w/symptoms of uncontrolled DM10. ABN form used when > 10 hrs of Medicare DSMT to be provided in initial EOC in rolling year to beneficiary 11. ABN form used when potential exits that Medicare may not pay for covered DSMT as time limit in EOC will be exceeded: > 10 hrs in initial EOC, > 2 hrs in follow-up ( CPT code modifier GA on claim form when ABN usedF DSMT INTERVENTION: SPECIFIC DSMT PROCEDURES and RESOURCES THAT SPELL SUCCESSIn Place or DonePartly In PlaceNot In PlaceNotes1. EBSC: National Standards for Diabetes Self- Management Education2. Knowledge that NSDSME: do not require CDE on instructional team; do require RD + RN receive specific # and type of CEUs/period, based on whether CDE or not 3. EBSC compliance aids and procedures (real time prompts) to assure proactively scheduling of pts at 1st visit (or prior) of initial10 hrs in 12 consecutive months4. Knowledge that: ( 9 hrs of DSMT to be in group and 1 hr may be used for individual instruction or assessment (unless barriers to group learning documented by referring source) ( All 10 hrs may be used for only 1 topic ( Pt may receive f/up DSMT without having recd initial5. Effective coordination of patient care delivered by different members of DSMT team6. Customized DSMT-specific forms for team: ( DSMT assessment + DSMT documentation forms ( DSMT flow sheets + DSMT outcome tracking forms7. Customized DSMT worksheets for team to: ( Log telephone reporting of pts BG ( Log all telephone messages8. Medicare beneficiary is scheduled for maximum hrs in for both MNT and DSMT (if both programs in place)G POST DSMT: SPECIFIC DSMT PROCEDURES and RESOURCES THAT SPELL SUCCESS1. Documentation by team members of DSMT provided2. Hospital bills Medicare for DSMT as Medicare provider (Note: Individual Medicare providers can bill Medicare if already billing Medicare for other services and receiving direct reimbursementthis includes RDs)3. EBSC compliance aids and procedures (real time prompts) to assure that pts: ( Scheduled for 2 hrs f/up DSMT each calendar year ( Rescheduled asap when class/appointment missed4. Hospital does not accept assignment of Medicare DSMT payment, and does charge beneficiary, or supplemental insurance, for difference between hospitals DSMT fee and Medicares allowed, adjusted DSMT payment 5. DSMT CPT codes on Medicare claims. CPT code used only 1 time on claim but # of units provided are entered: ( G0108: Individual DSMT, initial or follow-up, new or established pt, 1 unit = 30 minutes ( G0109: Group DSMT, initial or follow-up, new or established pt, 1 unit = 30 minutes6. DSMT charts audited by outside reviewer to evaluate team compliance to NSDSME and hospital requirements7. Customized chart audit worksheets MEDICARE MNT AND DSMT PLANNER FOR TOMORROWMEDICARE PREVENTIVE PHYSICAL EXAMAs of January 1, 2005, Medicare will cover 1 preventive physical examination in the first six months after a person enrolls in Part B. It is designed to determine physical conditions of new beneficiaries as they become eligible for Medicare. The exam will include: Measurement of height, weight and blood pressure and an electrocardiogram Blood and laboratory tests to screen for: ( Cardiovascular disease (tests for cholesterol, lipids and triglyceride levels) ( Individuals at high-risk for diabetes Weak bones, glaucoma and cancers of the colon, breast, cervix, and prostrate Education and counseling for preventive care (physicians can make referrals for the counseling) B. The bill provides for MNT services provided by a RD.NATIONAL PROVIDER IDENTIFICATION (NPI) NUMBERCMS goal is to establish NPI number is 10 digit number that will uniquely identify a healthcare provider in standard transactions, such as on healthcare claims, prescriptions, etc. All HIPAA-covered entities must use their NPI numbers by the compliance dates. Disclaimer: This information is intended for educational and reference purposes only. It does not constitute legal, financial, medical or other professional advice. The information does not necessarily reflect opinions, policies and/or official positions of the Center for Medicare and Medicaid Services, private healthcare insurance companies, or other professional associations. Information contained herein is subject to change by these and other organizations at any moment, and is subject to interpretation by its legal representatives, end users and recipients. Readers should seek professional counsel for legal, ethical and business concerns. The information is not a replacement for ADAs MNT Evidence-Based Guides for Practice. The readers clinical judgment and professional expertise must be applied to any and all information in this document. The following professional resources are available via Mary Anns website: Money Matters in MNT and DSMT: Increasing Reimbursement Success in All Practice Settings, The Complete Guide , 3rd. Edition, 2008 Establishing a Successful MNT Clinic in Any Practice Setting The Complete Guide EZ Forms for the Busy RD : CD-r or diskette, modifiable; Microsoft Word Package A: Diabetes and Hyperlipidemia MNT Intervention Forms Package B: Diabetes and Hyperlipidemia MNT Chart Audit Worksheets Package C: MNT Surveys, Referrals, Flyer, Screening, Intake, Analysis and Many Other Business/Office/Operational/Record Keeping Forms and Clinical Forms     PAGE  PAGE 4 UPDATED 2008! $/A   3 4 S ̾v^vKv$hZhv[0J5B*OJQJph33/jhZhv[5B*OJQJUph33)jhZhv[5B*OJQJUph33& jhZhv[5B*OJQJph33hv[5B*OJQJph33 hZhv[5B*OJQJph33hJ5B*OJQJph33h@j5B*OJQJph33 hAGh@j5B*OJQJph33(hah@j5B*CJ OJQJaJ ph33$S T  > $Ifgdkgdavgd*?$a$gd*?$-D`M a$gda$&d-D`M Pa$gda ] ^^S T U V Y Z u v w x Ź{l]QC4ChN?hN?CJOJQJaJhN?5B*CJ aJ ph33hN?CJOJQJaJhyhN?CJOJQJaJhN?5CJ OJQJ^JaJ #hN?hn5CJ OJQJ^JaJ jhnhaOJQJU$j ? hHCJUVmHnHuhHCJ8OJQJjhHOJQJUhn5B*CJ aJ ph33jhXEUmHnHujhN?UmHnHu h\.h>]5B*OJQJph33  > ? 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