Hi All,

As we all know, Medicare's coverage rules are complicated, copious and constantly changing!  This is especially true of TELEHEALTH MNT and DSMT. 

Are any of you doing MNT or DSMT telehealth?? What do you think of it?   


BELOW (RIGHT AFTER THE "DOG-PHONE" CLIP ART) is a quick guide of the Medicare rules and regs (great desk top reference!).



   
 

Individual and group MNT and DSMT (initial and follow-up) can now be provided and reimbursed as telehealth services by Medicare Part B.  

Telehealth services use a real-time audio-visual telecommunication system as a substitute for an in-person encounter between the Medicare beneficiary and the provider who are at different sites.  

MNT telehealth includes individual and group MNT (HCPCS code G0270 and G0271 and CPT codes 97802, 97803 and 97804). 


In January, 2011, Medicare approved payment for DSME/T benefits when delivered via telehealth (HCPCS codes G0108 and G0109).  
 

Telehealth services use a real time audio-visual telecommunication system as a substitute for an in-person encounter between the Medicare beneficiary and the provider who are at different sites.  Medicare’s specific telehealth coverage guidelines for billing and payment are summarized in the Table 1 of this article.

Additional information on Medicare MNT and DSME/T telehealth is available on the ADA website at <http://www.eatright.org> and on the CMS web site at <http://www.cms.org>.

Below is more of a detailed summary of Medicare’s coverage guidelines for telehealth MNT and DSMT:

1)  The beneficiary must be at an ‘originating site’ at the time the service being furnished.

 

2)  Originating sites must be located in a rural Health Professional Shortage Area or in a county outside of a Metropolitan Statistical Area. 

a.   However, entities that participate in a Federal telemedicine demonstration project approved by (or receiving funding from) the Secretary of the Department of Health and Human Services as of December 31, 2000, qualify as originating sites regardless of geographic location.

 

3)      The originating sites authorized by law are:

a.      Offices of physicians or qualified non-physician practitioners

b.      Hospitals

c.      Critical Access Hospitals (CAHs)

d.      Rural Health Clinics

e.      Federally Qualified Health Centers

f.        Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

g.      Skilled Nursing Facilities

h.      Community Mental Health Centers

 

4)      The provider is a ‘distant site” at the time the service being furnished.

5)  An interactive audio and video telecommunications system must be used that permits real-time communication between the provider at the distant site and the beneficiary at the originating site. Telephones, facsimile machines, and electronic mail systems do not meet the definition of an interactive telecommunications system.

a.   Asynchronous “store and forward” technology is permitted only in Federal telehealth demonstration programs conducted in Alaska or Hawaii
 

6)   Claims for telehealth services are submitted using the appropriate CPT or HCPCS code along with the telehealth modifier GT, “via interactive audio and video telecommunications system” (e.g., 97802 GT). By using the GT modifier, the distant site provider certifies that the beneficiary was present at an eligible originating site when the telehealth service was furnished.

a.   In the case of Federal telemedicine demonstration programs conducted in Alaska or Hawaii, providers use the telehealth modifier GQ, “via asynchronous telecommunications system” (e.g., 97802 GQ)

 

7)   For DSMT telehealth services, a minimum of 1 hour of in-person instruction in the self-administration of injectable drugs training must be furnished in-person during the year following the initial DSMT service, if the beneficiary is prescribed this type of drug therapy. The injection training may be furnished through either individual or group DSMT services.

 

8)   Providers at the distant site can bill either the Medicare Carrier or the Part A/Part B Medicare Administrative Contractor (MAC) for telehealth MNT and DSMT.  Reimbursement rates are the same as when MNT and DSMT services are delivered face to face.  

 

9)  In addition, the originating site that owns the specialized A/V equipment can bill the Medicare Carrier or A/B MAC a facility fee as described by HCPCS code Q3014 (telehealth originating site facility fee). Facility fee is separately billable Part B payment.  Providers paid according to applicable payment methodology for facility or location; usual Medicare deductible and coinsurance policies apply to this code.  For the calendar year 2012, the facility fee is $24.24.

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much

 

We have not used it yet but it is definitely 'on our radar screen' as a possibility.  I think that health departments should make use of it.  We have considered contacting our rural health departments to inquire whether or not they would like to contract with us to provide MNT over telehealth to their facilities.  I'm sure there are many people in rural areas that are not getting MNT because of the distance they have to drive to recieve it.  However, since the health departments in our state don't usually bill for services it would constitute an entirely new business model for them.  I'm interested in seeking it out but I just haven't pursued it yet.  
However, it doesn't seem there isn't 'much in it' for the originating site.  I mean, $24.24 is not really much.  Those  providing the services over telehealth at the 'distant site' are the ones who would get the biggest reimbursement.  It seems like this model would be best provided to a doctor's office that is already up and running so the low reimbursement is not an issue.  What do you think?

Thanks for the information, Maryann. I am saving it for future reference.

Hi Micki and Others:

You are right...it is the distant site provider (educators, RDs) who reap Medicare's financial reimbursement rewards, as it is this provider (individual or entity) who bills Medicare for the MNT and/or DSMT benefits furnished to the beneficiaries who are at the rural area originating site.

So what's in it for the originating site provider who buys the A/V equipment, installs the software and allows the beneficiary to use an exam room or conference room in his/her office or facility for the telehealth visits, besides a $24 "facility fee" for EACH visit?

Drum roll, please:

Improved:

1) Knowledge outcomes for the patients, which can lead to:

2) Behavior outcomes, which can lead to:

3) Clinical outcomes, which can lead to:

4) Cost savings outcomes for the patients, which can lead to:

5) Satisfaction outcomes BY the patients, which can lead to:

6) Loyalty from the patients to their originating site provider (e.g., physician), which can lead to:

7) Retention of patients in the practice and also the "show rate" for all other provider visits, which can lead to:

8) Financial bottom line for provider

9) Sustainability of the provider's practice!

So now the question is....another drum roll, please....why would an originating site provider NOT want to do this??

Thoughts, comments?

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder

PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much

Unfortunately I think lack of vision is a big one.  They are not going to see these benefits if they don't have the $$ returns with them.  However, diabetes education is slowly being valued by insurance companies and other entities without the huge immediate pay off.  How long did it take for that to happen?  I think all the research that was developed and sponsored by diabetes educators and the AADE showing the proof that diabetes education saves money in the long run is what changed that tide.  And I imagine that is what will change this tide too.  I just had a great idea for a grant proposal!  :,) 

Regarding MNT and Medicare.  We are an ADA recognized diabetes program. As such, Medicare indicates they will cover 3 hours of MNT if provided by an RD or "certain nutrition professionals."  Does anyone know if Medicare considers an RN, CDE a "certain nutrition professional?'  I have been teaching nutrition in group classes and individually since I became a CDE over 12 years ago.  Would love some clarity.  Thank you.

Question was:

Regarding MNT and Medicare. We are an ADA recognized diabetes program. As such, Medicare indicates they will cover 3 hours of MNT if provided by an RD or "certain nutrition professionals." Does anyone know if Medicare considers an RN, CDE a "certain nutrition professional?' I have been teaching nutrition in group classes and individually since I became a CDE over 12 years ago. Would love some clarity. Thank you

ANSWERS:

1) The ADbA recognition is for your DSME program (which is required in order to bill Medicare for DSME; can also obtain accreditation from AADE as another option); this has no connection to the Medicare MNT coverage guidelines. DSME and MNT are 2 completely separate benefits in Medicare and each have their own set of coverage guidelines.

2) In the statutory language of the MNT benefit in Medicare, it states that only registered dietitians and "qualified nutrition professionals" can provide the benefit and direct bill for it.

The definition of a "qualified nutrition professional" is a person who has met the SAME educational requirements* as a RD, which also includes, after receipt of the BS degree, a supervisory practice experience in a program/entity approved by the Commission Dietetic Registration of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), OR achievement of a Master's degree in an approved field from an accredited university. BUT, this person has NOT taken the national registration exam to become a "Registered Dietitian".  The taking of the exam is the only difference between a RD and a qualified nutrition professional.

*Obtains a BS degree in nutrition or an approved related field from an accredited university/college.

3) The Medicare MNT benefit covers 3 hours of initial MNT in the first calendar year and 2 hrs of follow-up (established pt) MNT in each subsequent calendar year, if the beneficiary is eligible and entitled to the benefit in these time frames, and the provider adheres to all of the provider's payment regulations.

Medicare will also cover additional MNT above and beyond the initial 3 in the first year and above and beyond the 2 hrs in subsequent years, IF the specific payment rules for this are also met.

4) The Medicare DSME benefit covers 10 hours of DSME in the first rolling year and 2 hrs in each subsequent calendar year after the first year...again, only if all provider and beneficiary coverage guidelines have been met.

5) The Medicare MNT and DSME benefits are complimentary. Both can be received by the eligible beneficiary in the same year.  But Medicare will not pay if both are furnished on the same day (go figure!!)

Research has proven that pt outcomes are improved when both the MNT and DSME benefit are received by the beneficiary to their fullest degree/maximum allowable hours; this is exactly why Medicare pays for both, despite their bankrupt status!

Hope this helps everyone...it is all VERY confusing and convoluted!  Don't ask me why my brain gets around this stuff...I'm a bit weird, I guess!

P.S.  Check out my website....I self-publish a Manual on MNT and DSME Reimbursement, and as such, update it continuously, as Medicare and private payer reimbursement regs are always changing (220 pages).

Mary Ann Hodorowicz, RD, CDE, MBA, Certified Endocrinology Coder
PresentDiabetes Author of MNT and DSMT Reimbursement Audio Lectures

Eat Well, Laugh Often, Love Much

Thank you so much.  That is exactly the confirmation I needed.  Best regards - Laura