hit the mnt jackpot: its all about marketing! jane v. white, phd, rd, fada, ldn emeritus professor,...

Hit the MNT Jackpot:

Its All About Marketing!

Jane V. White, PhD, RD, FADA, LDNEmeritus Professor, Family Medicine-UTK

ADA Coding and Coverage Committee

Session Objectives• Review codes used by RDs to bill for MNT

services.

• Learn steps to expand billable nutrition services within your facility’s outpatient clinic or your own private practice.

• Recognize payer types and procedures to establish direct reimbursement for MNT

• Identify key factors to manage patients’ visits that can help build a steady client base.

• Recognize new tools and resources included on ADA’s website to help RDs accomplish these tasks

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ADA Coding and Coverage Committee (CCC) Advocacy Among AMA, CMS and Private Payers

•Monitor Medicare fee schedule and work with CMS regarding Medicare MNT services. •Outcome: Increased payment to RD providers

•At AMA coding meetings, committee members Jane White, Milton Stokes and Keith Ayoob represent RDs’ interests. •Outcome: Additional codes for billing services provided by RDs; physician recognition and increased referrals to RDs

• Partner with external groups, e.g. Alliance for a Healthier Generation, to increase RD-provided MNT coverage. •Outcome: Reimbursement for RD-provided MNT services for obese/overweight children

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Terms and Acronyms

CMS = Centers for Medicare & Medicaid ServicesMedicare Part B = medical insurance covered by the government that helps pay for doctor's services, outpatient hospital care (e.g. MNT services for diabetes and renal disease), lab and x-ray services, durable medical equipment, and some medical services that aren't covered by Medicare Part A.

HIPAA = Health Insurance Portability andAccountability Act or Privacy Rule. See handout for additional terms

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Terms and AcronymsNPI = National Provider Identifier- standard unique identifier that replaces other provider numbers used on healthcare claims.

Diagnosis codes (ICD-9) = Describe an individual's disease or medical condition; physicians and trained billers determine these codes

CPT codes = Current Procedural Terminology codes (procedure codes) that describe the service performed by the healthcare professional

HCPCS codes = Healthcare Common Procedure Coding System developed by payers to describe services where no CPT code exists

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ICD-9 Diagnosis Codes (determined by MD)

Chronic Kidney Disease (CKD) - 585.Xmust include a 4th digit

• 585.4; chronic kidney disease, Stage IV (severe)[Kidney damage with severe decrease in GFR (15-29)]

 Diabetes Mellitus – 250.XXmust include a 4th digit which indicates the type of complication, and must include a 5th digit which indicates the diabetes type and control• 250.00—type II or unspecified type, not stated as uncontrolled, without complication • 250.01—type I, not stated as uncontrolled, without complication• 250.02—type II or unspecified type, uncontrolled, without complication• 250.03—type I, uncontrolled, without complication

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Coding Manuals

Opportunities to expand nutrition practice and reimbursement

Step 1: Are You Ready?

Evaluate your teams readiness and abilities

Are you comfortable asking for money

Educate yourself on how to run a business or outpatient department

Step 2: Decide Payer Mix

Fee for Service or self pay

Insurance and Managed Care

MedicareMedicaid

Additional Factors to ConsiderWith Payer Types

• Medicare Part B (very specific regulations in place for MNT for diabetes and renal/post transplants)

• Medicaid (Ambulatory MNT coverage driven by state specifications)

• Private payers (specific coverage and provider policies determined by the plan)

Step 3: Network

Identify major providers in your community State Dietetic Association

State Reimbursement Representative Other private practitioners Hospital departments and staff

Make contactColleaguesInternet

Phone book (local medical directory)

State insurance commissionLocal biller

Step 4: Becoming a Qualified Provider (Credentialing)

• Ask for provider relations or the credentialing department.

• Request a credentialing (enrollment) packet for RDs.

• Evaluate alternatives

• Consider CAQH enrollment (Council for Affordable Quality Healthcare); http://www.caqh.org/ucd.php

National Provider Identifier (NPI)

• All health care providers who conduct any Health Insurance Portability and Accountability Act (HIPAA) transactions must use NPI• Individuals• Organizations

• NPI – 10 digit number used to recognize the provider on claims transactions

• Lasts indefinitely and does NOT expire or become deactivated; it does NOT contain “intelligence”

• An individual (e.g., RD) is assigned only ONE NPI, regardless of the number of practice offices

• Contact the National Plan & Provider Enumeration System- Apply over the Web: https://nppes.cms.hhs.gov;

- Fill out a paper application and mail it to the NPI

Enumerator (1-800-465-3203)

Step 5: The Credentialing Packet

CompletenessKeep a final copyPatience

Step 6: Review contract

•Contract details•Reimbursement rate/adjustments•Allowed codes•Covered services/ limitations

Step 7: Review and Understand Payer Rules

• Know the claim processing ruleso Who gets the claim (payer or patient?)

o Paper or paperless• Verify allowed codes and diagnosiso Procedure AND diagnosis codes o Update Charge Master

Consider Policies & Laws Regarding Referrals

Check Payer Policy

Check state licensure law(s) A handful of states have criteria for physician referrals for nutrition servicesAlabama, California, Connecticut, Florida, Illinois, Indiana, Massachusetts, Maine, South Carolina and Tennessee

Search licensure law(s) for “referral” (review licensure laws from www.eatright.org, go to “Advocacy and the Profession,” then “State Affairs-Licensure & Certification”)

• Registration• Forms and referral• Dedicated phone • Collecting fees/co-pay• Scheduling• Determine Start Date

Step 8: Managing the visit

Step 9: Billing

1. Self bill2. Billing service3. Share a biller4. Follow the claims

Learn the language--Denied claims--Secondary payers--Forms

• CMS 1500 (revised 8/05)

• UB-04 (CMS1450)• Revenue codes

Step 10: Marketing

1. Make a plan- promote your servicesGrand Opening/Open House

2. Face to face contact Visit physiciansReferral forms

3. Write a article; flyer; announcements

in community or facility

Being Persistent Pays!

RD Opportunities- What’s in it for You?

• Payment for MNT • Maintain or expand staff (FTEs)• Business opportunities • Recognition within healthcare

marketplace• Pay for performance (bonus)

Summary

• Networko Engage others (hospital departments or local healthcare professionals or business groups)

• Know the language

• Keep up with payer policies, eg. get a NPI and know payer enrollment policies

Web resource: www.eatright.org/mnt

[Or from home page, click on Advocacy & the Profession and then MNT]

ADA Resources… to Market and Promote MNT Services

Third Party Payer Brochure: For Private Payer CEOs, Medical Directors and Provider Relations executives

MNT Works Kit: A marketing tool designed to increase MNT coverage and consumer access to MNT services provided by RDs

ADA Resources… For Your Practice

MNT Provider Newsletter: a monthly newsletter to help RDs understand the complexities of Medicare through timely articles, analysis and advice on key aspects of practice and business strategies.

Evidence Analysis Library (www.adaevidencelibrary.com/)• Data on MNT Effectiveness• Data on impact of the RD and cost-savings data

ADA Guide to Private Practice: a resourcefor any RD considering private practice.

ADA state dietetic association & DPG reimbursement representatives: to assist RDs with local coverage and coding issues (checkADA or affiliate/DPG web page for rep contactsinformation)

Go to www.eatright.org/mnt

ADA Resources For Your Practice

Questions: Contact me at: (jwhite13@utk.edu) or

ADA at reimburse@eatright.org