show me the money! mnt reimbursement 101...show me the money! mnt reimbursement 101 cdr diane...
TRANSCRIPT
![Page 1: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/1.jpg)
Show Me the Money! MNT Reimbursement 101
CDR DIANE PHILLIPS, RDN, LDNUTRITION MANAGER
SANTA FE INDIAN HOSPITAL505-946-9390
![Page 2: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/2.jpg)
Objectives and OutcomesAs a result of completing this training, participants will be able to:
ā¢ Locate and use the IHS Step-by-Step Guide to MNT Reimbursement.
ā¢ Identify one change you can make to reduce administrative inefficiencies in your MNT billing process at your site.
ā¢ Identify one change you can make to maximize MNT reimbursements at your site.
2
![Page 3: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/3.jpg)
Payers
ā¢ Medicare
ā¢ Medicaid
ā¢ Private Insurance
3
![Page 4: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/4.jpg)
MedicareMedicare is the federal health insurance program for:ā¢ People who are 65 or older.ā¢ Certain younger people with disabilities.ā¢ People with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant).
The different parts of Medicare help cover specific services:ā¢ Medicare Part A (Hospital Insurance)
ā¢ Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
ā¢ Medicare Part B (Medical Insurance)ā¢ Part B covers certain doctors' services, outpatient care, medical supplies, and
preventive services.
4
![Page 5: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/5.jpg)
Medicaid
ā¢ Medicaid provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities.
ā¢ The Childrenās Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs.
ā¢ Medicaid and CHIP are both administered by states, according to federal requirements.
ā¢ The both programs are funded jointly by states and the federal government.
5
![Page 6: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/6.jpg)
Private Insurance
ā¢ Private health insurance is often offered through employers, organizations or purchased on your own.
ā¢ Cost and coverage vary greatly.
6
![Page 7: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/7.jpg)
What services are billable by Payer for Registered Dietitians?
ā¢ Medicare, Part B Coverageā¢ Qualifying Diagnoses
ā¢ Diabetes Type1 and Type 2ā¢ Nonādialysis kidney diseaseā¢ Post transplant within the past 6 monthsā¢ **Obesity (detailed in next slide)
ā¢ Medicaidā¢ Qualifying Diagnoses will vary by Stateā¢ Under EPSDT-infants, children, prenatal and post natal
MNT services are coveredā¢ Private Insurance
ā¢ Research the PI coverage in your area
7
![Page 8: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/8.jpg)
Medicare, Part B Coverage for Obesityā¢ November, 2011: CMS allows a benefit called āIntensive Behavioral Therapyā for obesity if a
Medicare recipient has a BMI of 30 or greater.
ā¢ Is provided by a qualified primary care physician or other primary care practitioner in the following specialty types:
ā¢ 01 - General Practice ā¢ 08 - Family Practice ā¢ 11 - Internal Medicine ā¢ 16 - Obstetrics/Gynecology ā¢ 37 - Pediatric Medicine ā¢ 38 - Geriatric Medicine ā¢ 50 - Nurse Practitioner ā¢ 89 - Certified Clinical Nurse Specialist ā¢ 97 - Physician Assistant I
ā¢ Medicare will cover only sessions that take place in the following primary care setting:ā¢ 11 - Physicianās Office ā¢ 22 - Outpatient Hospital ā¢ 49 - Independent Clinic ā¢ 71 - State or local public
health clinic
ā¢ If a patient is referred to other facilities or specialists such as a nutritionists, the patient will be responsible for payment of these services.
ā¢ Can RDs bill āincident toā the provider visit?ā¢ Within the IHS, no
8
![Page 9: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/9.jpg)
Treat and Reduce Obesity Act of 2017ā¢ H.R.1953 and S.830 - Treat and Reduce Obesity Act of 2017
ā¢ Authority to expand health care providers qualified to furnish intensive behavioral therapy, adding the following: ā¢ A physician (as defined in subsection (r)(1)) who is not a qualified primary
care physician.ā¢ Any other appropriate health care provider (including a physician assistant,
nurse practitioner, or clinical nurse specialist (as those terms are defined in subsection (aa)(5)), a clinical psychologist, a registered dietitian or nutrition professional.
ā¢ Additional Practice Settingā¢ An evidence-based, community-based lifestyle counseling program.
9
![Page 10: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/10.jpg)
Coverage Comparisonā¢ Current Medicare, Part B coverage for MNT the 1st year
ā¢ One, 60 minute visit and four, 30 minute follow up visitsā¢ Total of 5 outpatient visits (assuming you were the only provider seen
that day) ā¢ Collections for the 5 visits -20% = $1396
ā¢ Intensive Behavioral Therapy for Obesity (If TROA Bill is passed)ā¢ One visit per week the first month, one visit every other week in
months 2-6, and if 3 kg are lost, one visit per month for months 7-12
ā¢ 28 visits (assuming you were the only provider seen that day)ā¢ Potential collections for 28 visits -20% = $7818
10
![Page 11: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/11.jpg)
IHS Step-by-Step Guide to Medicare Medical Nutrition Therapy Reimbursement (1 of 2)
11
![Page 12: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/12.jpg)
IHS Step-by-Step Guide to Medicare Medical Nutrition Therapy Reimbursement (2 of 2)
ā¢ IHS Websiteā¢ https://www.ihs.gov/diabetes/clinician-resources/soc/nutrition/ā¢ https://www.ihs.gov/nutrition/resources/ā¢ Type in the Search box
ā¢ Internet Search Engineā¢ CMS/Novitasā¢ Directly to IHS pdf
ā¢ Medicine Dish Videocast (on YouTube)ā¢ Medicine Dish: Invest in Nutrition-Medical Nutrition Therapy and
Reimbursement
12
![Page 13: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/13.jpg)
Medicare, Part B MNT Reimbursement
ā¢ Step 1: Become a Recognized Medicare Providerā¢ Step 2: Make Friends with Your Business Officeā¢ Step 3: Obtain Treating Physician Referralā¢ Step 4: Using the right CPT and ICD-10 codesā¢ Step 5: Documentation of MNT Servicesā¢ Step 6: Track MNT Billing and Collectionsā¢ Step 7: Market Your Services
13
![Page 14: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/14.jpg)
Step 2: Make Friends with Your Business Office
ā¢ Setup up regular meetings with your billersā¢ Review billing and collection reports by
payerā¢ Troubleshoot areas of denials, non-paymentā¢ Explore your state Medicaid coverage ā¢ Explore Private Insurance coverage
14
![Page 15: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/15.jpg)
Billing Reports
Medicare OMB Rate2017: $3492018: $383Bill 1encounter per day*Currently, billing at the 2017 rate
Medicaid OMB Rate 2017: $3912018: $427NM bill 2 encounters per day*In comparison, AZ can bill up to 5 per day
*Currently billing at the 2017 rate
15
![Page 16: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/16.jpg)
Essential Partnerships
ā¢ Codersā¢ CACā¢ Chief Medical Officer
16
![Page 17: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/17.jpg)
Step 3: Obtain Treating Physician Referral
ā¢ Put policies and/or standing orders in place to cover when referred by mid level providers and that would allow the RD and other support staff to order the referrals.
ā¢ A new referral is needed for the following:ā¢ Each new calendar year
ā¢ When you have exceeded the 3 hours the first year
ā¢ When you have exceeded the 2 hours in subsequent years
ā¢ With change in condition or treatment
ā¢ It is helpful to use an EHR consult, however if the RD and providers are using the same EHR, a referral written into the providers note will suffice.
17
![Page 18: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/18.jpg)
Medical Nutrition Therapy 18
![Page 19: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/19.jpg)
Step 4: CPT and ICD-10 Codes (1 of 2)
ā¢ Set up pick lists within EHR, work with your coding department to set up these lists.
ā¢ For MNT billing, the Diabetes or ESRD needs to be the primary diagnosis, then add other non-billable Dx secondary.
ā¢ The ICD-10 code should match the medical Dx and the reason for the referral.
ā¢ As an RD you cannot diagnose, if the needed Dx is not in the IPL, you need to ask the provider to add that Dx.
19
![Page 20: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/20.jpg)
Step 4: CPT and ICD-10 Codes (2 of 2) 20
![Page 21: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/21.jpg)
EHR Historical Services/Procedures
21
![Page 22: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/22.jpg)
Dietary Nutrition āAdd IPL
22
![Page 23: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/23.jpg)
Step 5: MNT Documentation 23
![Page 24: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/24.jpg)
National Nutrition EHR Template 24
![Page 25: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/25.jpg)
EHR Nutrition Diagnosis25
![Page 26: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/26.jpg)
MNT Tracking Template 26
![Page 27: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/27.jpg)
Tools for Success
ā¢ IHS Step by Step Guide to Medicare MNT Reimbursement
ā¢ National Nutrition EHR Templateā¢ Partnership with the billing office, coders and CACā¢ Proactive member of the medical staff
ā¢ Advocate for your servicesā¢ Give lists/idea of what services you can provideā¢ Target billable services
27
![Page 28: Show Me the Money! MNT Reimbursement 101...Show Me the Money! MNT Reimbursement 101 CDR DIANE PHILLIPS, RDN, LD NUTRITION MANAGER SANTA FE INDIAN HOSPITAL 505-946-9390. Objectives](https://reader033.vdocuments.site/reader033/viewer/2022053018/5f1f95fdd751a4018357f865/html5/thumbnails/28.jpg)
Questions 28