Medical Nutrition Therapy Reimbursement

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Rachel Cole
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1 Medical Nutrition Therapy Reimbursement W H A T A R E T H E ISSUES? H O W WILL I NAVIGATE T H E M? HOW LONG W I L L IT TAKE? W H E R E CAN I FIND GUIDANCE? Kristin Hatch, RD,LDN,CDE N u t r i t i o n f o r L i f e Inc.

2 WHAT TO CONSIDER Steps for setup Professionals to include Options for reimbursement Where to go for help Tracking it all The insurance companies

3 Setup Sarah Butler, RD, Reimbursement Essentials,MDA website Legislation and Advocacy. ICD 9 has now changed to ICD 10 North Carolina Health and Wellness Trust Registered Dietitians Billing Guide 2011 Become a RD State licensure---consumer Affairs and Business Regulation Allow 6 month minimum for business setup/credentialing Liability insurance through Academy of Nutrition and Dietetics

4 Establish a Business Business plan a must prior to startup/business consultant S Corporation, LLC, sole proprietor---tax advantages of each Confer with accountant, bookkeeper and lawyer Consider carefully the business name

5 Business ID Information EIN Employer Identification Number/Federal ID number is the corporate equivalent to a SS number used to report withholding tax to apply online W-9 form is a request for taxpayer ID number and certification. This is needed for the CAQH or each insurance company with which one is credentialed

6 Reimbursement Options Private pay/out of pocket Do your own billing/office staff to do billing Billing company Boston Billing Solutions, Inc Bill through a practice management company Office Ally

7 Credentialing How to decide which insurance companies/medicare? Ins. co. will limit number of RDs in one geographic area NPI=National Provider Identifier identifies RD as a provider in claim submission with insurance companies Apply through the National Plan and Provider Enumeration System (NPPES) CAQH Council for Affordable Quality Healthcare This is a Universal Provider Datasource which allows the provider to enter all data used for credentialing into database

8 Medicare Credentialing CMS 8551 form to apply to be Medicare Part B provider PTAN=Provider Transaction Access Number identifies who rendered services to a Medicare beneficiary in the Medicare claims processing system EFT Electronic Funds Transfer for Medicare to assure that reimbursement is deposited into your business banking account

commercial payers NPI, CAQH, ongoing maintenance of participating

9 Credentialing Professional Consider using a credentialing professional for assistance with enrolling with government and commercial payers NPI, CAQH, ongoing maintenance of participating status throughout the year Expedited Credentialing Services Denise Stevens in Seekonk, MA

10 Insurance Coverage Each employer chooses specific benefits from benefit menu, based on how much they want to spend for total health insurance benefits Therefore 2 clients insured by the same insurance plan may have different benefits in terms of coverage eligibility, copay amount, number of visits, referral requirement, deductible amount Client is responsible for identifying their coverage before visit. Signed encounter form notes client responsibility for denied reimbursement

11 First Visit Communicate prior to visit what to expect Encounter form, copy insurance card/license, copay collected at beginning of visit Note 24 hour cancellation policy/charge if less Must have signature on file Encounter form is the template for billing 1500 form

12 Visit Check-In Patient Name: Age: Address: # Street Town/City State Zip Telephone: Home Work Cell Date of birth: Employer: Marital status (check one): Single Married Other Primary care physician: Insurance Co.: Insurance policy or group number: Insured s employer: Patient s relationship to insured (check one): Self Spouse Child Other Insured s name (if different than patient): Insured s address: # Street Town/City State Zip Insured s date of birth: Sex: male: female I have received the privacy form (HIPAA) and the above information is correct. THE INSURANCE CARDS USED ARE VALID. I UNDERSTAND THAT I NEED TO PAY FOR SERVICES RENDERED IF THEY ARE NOT COVERED BY INSURANCE. I hereby give my authorization, pursuant to HIPAA and other privacy laws, for my health care provider to disclose my protected health information to my doctor/other (name): I authorize my physician to release laboratory reports from my medical record to RD, LDN. I authorize payment of medical benefits to company name for the services described above and to forward bills to my health insurance carrier with my signature on file. *PATIENT S SIGNATURE Date: There will be a charge of $25 for all appointments not kept unless a 24 hour notice is given. How did you hear about us? Circle: My doctor Friend Phone book Other: Main reason for visit: ions

13 Documentation Note time of start and end of visit in medical record Note specifics of client s progress and outcome as evidence for referral extension

14 Common Insurance Companies Blue Cross Blue Shield Harvard Pilgrim Health Care Tufts Aetna United Healthcare Fallon Cigna Medicare

15 1500 form Billing

16 CPT Codes Denote length of visit in units of 15 minutes each Assign a dollar amount to 15 minute increments when billing CPT codes: 97802: Medical Nutrition Therapy, initial assessment and intervention, individual, face to face, with each patient, each 15 minute unit 97803:Re-assessment and intervention, individual, face-to-face with the patient each 15 minute unit

17 ICD10 Codes International Classification of Diseases This is a classification for assigning code to a diagnosis Assure that client s diagnosis will be covered on their plan before their first visit

18 Common ICD9 Codes Used for MNT E1065 E119 E669 E66.01 E28.2 F5000 F502 E782 type I diabetes type II diabetes class I and II obesity class III obesity PCOS anorexia nervosa bulemia nervosa hyperlipidemia

19 Limitations in Billing Medicaid, Network Health, BMC, Neighborhood Health do not pay in private practice Many insurance companies limit to 4 units maximum per visit Medicare pays only for: 1. diabetes as defined by glucose 126 or greater on two separate occasions 2. CKD as defined by GFR G0270 can be used to bill for 2 nd diagnosis

20 Billing Submission and Reimbursement Billing is best done daily for optimal cash flow and organization Submit within 90 days for corrections All clients are charged the same rate Can sign up for EFT for all companies/not able to identify deposit source in bank Check EOBs online at Payspan for actual copay amounts Reimbursement may be received in 1-6 weeks

21 Accounting Imperative to have a system from day one Track all visits/billing/date and amount received. Follow up on unpaid claims Ideal to begin with an office management system for tracking patient reimbursement Quickbooks ideal for managing business expenses Aspire to have an office manager who is talented with billing,quickbooks, dealing with insurance companies

22 Denials Telephone list of companies/contacts Be well organized ahead of time to prevent denials Causes of denials: Providing service without assuring benefit clearly Incorrect entry of patient data Incorrect information on 1500 form No referral obtained prior to visit Unclear determination of # of allowed visits Deductible not met Be sure to correct the issue and resubmit

23 Marketing Website is essential, especially to grow out of pocket Choose a person who knows SEO and will cause your website to fill the first page if searched Newsletter (Mailchimp FREE) Social media---facebook, Pinterest, Linkedin Sharing posts, boosting Advertising: Facebook + Google Adwords

24 Marketing Be sure to interface with MDs Marketing collateral: biz cards, brochures, flyers, postcards, pens, grocery lists 2x annually to offices Gift basket to primary referrers Establish brand and target audience, communicate via marketing action plan

25 Track Outcome To validate your work Have information available for call for data Evidence for MDs and clients regarding lab parameter changes

26 Resources Academy of Nutrition and Dietetics Coding Coverage and Compliance Reimbursement Online Community MNT Provider Nutrition Entrepreneurs Interise Boston Rebecca Bitzer & Associates consulting JumpStart Consulting,LLC education sessions Coding Coverage Compliance Mass. Dietetic Assn.

27 Federal Resources ICD 10 Center for Medicare and Medicaid Service National Provider Identifier (NPI) CAQH Universal Provider Datasource Medicare rates

Overcoming to Become a Provider 3 REIMBURSEMENT RELUCTANCE

Overcoming to Become a Provider 3 REIMBURSEMENT RELUCTANCE 1 Learning Objectives Assess if accepting reimbursement is appropriate for business. Establish Tax ID, NPI number, and CAQH log-in to start credentialing process. Outline process for benefits verification