3/2/2016 Disclosures Billing for MNT: Past, Present, and Future I - PDF document

3/2/2016 Disclosures Billing for MNT: Past, Present, and Future I have no commercial relationships to disclose relevant to the topic being presented. 3/2/2016 Objectives • What key things do I need to know related to fee-for- service billing? • What’s happening in health care delivery and payment? • What are the new opportunities and how might I seize them? • What resources does the Academy provide? Bottom line: Practice, Build, Grow, Succeed! 3 4 5 6 1

3/2/2016 Current Opportunities: Current Opportunities: Fee-for-Service Fee-for-Service Medicare: Private Market MNT and DSMT • • Preventive services • Annual Wellness Visit* • Waived co-pays and • Intensive Behavioral Therapy deductibles for preventive for Obesity* services Chronic Care Management* • Healthier Generation Waived co-pays and deductibles • •  Includes Medical Nutrition Benefit Therapy • Telehealth *Billed by the physician (“incident - to”) 3/2/2016 3/2/2016 Essential Health Benefits Required Coverage Categories Under the ACA and Examples of Coverage Healthy diet counseling to prevent cardiovascular disease 1 6 Maternity Care Hospitalization Includes care before and after a baby is Includes services like surgery The USPSTF recommends offering or referring adults who are overweight or obese and have born additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling 2 7 interventions to promote a healthful diet and physical activity for CVD prevention. Rehabilitative and Habilitative Services Laboratory Services Includes services and devices that help Includes routine blood tests Grade B gain or regain mental or physical skills Obesity screening and counseling: adults 3 8 Pediatric Services Prescription Drugs The USPSTF recommends that clinicians screen all adult patients for obesity and offer Includes medicine prescribed by a doctor Includes oral and vision services for patients intensive counseling and behavioral interventions to promote sustained weight loss for obese under the age of 19 adults. 4 9 Mental and Behavioral Health Treatment Ambulatory Patient Services Grade B Includes services like counseling and Includes outpatient care without being psychotherapy admitted to a hospital Obesity screening and counseling: children 5 10 The USPSTF recommends that clinicians screen children aged 6 years and older for obesity Emergency Services Preventive and Wellness Services Includes services that maintain health, like Includes response services to medical and offer them or refer them to comprehensive, intensive behavioral interventions to promote immunization vaccines emergencies improvement in weight status. Grade B Does not define provider 10 EHB Benchmark Plan Health Plans and EHBs Maryland CareFirst BlueChoice, Inc. – BlueChoice HMO HSA Open Access (2014-2016) Exceptions create new mysteries in coverage Blue Choice HMO HSA-HRA $1500 (2017) 11 12 2

3/2/2016 Private insurance It’s complicated… Private insurance is not “one size fits all” • Verifying Coverage is vital to ensuring reimbursement • Prior to visit: • Call the 800 number with patient’s insurance ID # and date of birth National Provider Identifier (NPI) Insurance-Where to begin? A 10-digit number used to recognize the provider on claims transactions. • Preliminary steps to CREDENTIALING… All providers who bill 3 rd party payers must have one (HIPAA requirement) • Lasts indefinitely; does NOT contain “intelligence” • • Each provider gets ONE NPI, regardless of the number of practice offices. 1. NPI Group practices, hospitals, and corporations get an NPI (see CMS Medlearn • 2. EIN article: http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/Enrollment 3. Liability coverage Sheet_WWWWH.pdf Contact the National Plan & Provider Enumeration System NOW! • • Apply over the Web: https://nppes.cms.hhs.gov/NPPES/Welcome.do • Apply by phone: 1-800-465-3203 (NPI Toll-Free) 3/2/2016 Professional Liability Insurance Coverage requirements vary Tax ID number (TIN also known as an Employer  Examples: Identification number, EIN) -minimum of .5 million dollars per claim and 1.5 million It is a nine digit number (9), valid in all states for banking, dollars aggregate tax filing and other business purposes (billing insurance) -minimum of 1 million dollars www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Apply- per claim and 3 million dollars for-an-Employer-Identification-Number-(EIN)-Online aggregate OR Social Security Number (SSN)   Visit http://www.academypersonalinsurance.com/ for details 3

3/2/2016 Private insurance: procedure codes Become a Qualified Provider Medicare (few weeks) Complete process online: • http://www.cms.gov/Medicare/Provider-Enrollment-and- * There is no standard for each insurance company Certification/MedicareProviderSupEnroll/index.html • MNT codes: 97802, 97803, 97804, G0270, G0271 • MNT codes with 33 modifier Private payers (6-8 months) • 99401-99404 Ask for provider relations or the credentialing department. • Request a credentialing (enrollment) packet for RDNs. • S9470 • Evaluate alternatives. • • MNT codes and z codes (for diagnosis code) • Consider CAQH enrollment or E66 family when treating obesity (Council for Affordable Quality Healthcare) under preventive services policy; http://www.caqh.org/ucd.php G0447 for obesity counseling • Diagnosis codes, number of visits: coverage varies Procedure Codes Applicable to RDNs ICD- 10: It’s Here! 98960 – 98962 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family). 98966 – 98968 Telephone assessment and management service provided by a qualified nonphysician health care professional. 98969 Online assessment and management service provided by a qualified nonphysician health care professional, internet or electronic communications. 99071 Educational supplies, such as books, tapes, and pamphlets, provided by the physician (or other qualified health care professional) for the patient’s education at cost to physician. Effective October 1, 2015 claims for services 99366 and 99368 Medical team conference, with and without the provided on or after this date must use ICD-10 patient and/or family. codes (all HIPAA covered entities) (Not billable to Medicare; check payer policies to determine use of codes) 22 ICD-9 Versus ICD-10 Structure: Added Specificity Category Etiology, anatomic site, Extension first 3 seventh severity characters character Characters 4,5, and 6 (if applicable) (if applicable) No one-to-one match between ICD-9 and ICD-10 23 24 4

3/2/2016 Specificity!!! Tools and Resources V97.33XD: Sucked into jet engine, subsequent encounter. Online Tool to Search for codes http://www.icd10data.com W55.41XA: Bitten by pig, initial encounter​. Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter​. Z63.1: Problems in relationship with in laws. 25 26 Resources Resources www.eatrightpro.org EatrightPro.org Practice -> Getting Paid -> Nuts and Bolts -> ICD-10-CM • • MNT Provider, August 2015, September 2015 • Links to videos on CMS website 27 28 Is your organization billing? Changing Times in Health Care Many organizations may be/have: • Not billing for MNT services • Cutting out DSMT or outpatient services • Medical professionals asking for RDN services but unaware of how to pay for services RDNs may be able to create a plan to support hiring additional RDNs or increase pay/hours 5

3/2/2016 IHI Triple Aim Initiative Comparative Health System Performance • Improve the health of the population served • Improve the experience of the individual • Affordability as measured by the total cost of care Source: the Commonwealth Fund 31 32 Patient-Centered Medical Home Shifting Delivery and Payment Models Parlez-vous health care delivery and payment??? “A PCMH is not a house, hospital or other building and should not be confused with home -health or home-care. The PCMH is a model for care provided by physician practices that seeks to strengthen the physician-patient relationship by replacing episodic care based on illnesses and patient complaints with coordinated care and a long-term healing relationship. Each patient has an ongoing relationship with a personal physician who leads a team that takes collective responsibility for patient care. The physician- led care team is responsible for providing all the patient’s health care needs and, when needed, arranges for appropriate care with other qualified physicians.” National Committee for Quality Assurance 33 34 Patient-Centered Medical Neighborhood 6