Reimbursement - Academy News

The Oregon Academy's Reimbursement Chair is John Gobble, DrPh, RD, LD.  John will regularly provide information regarding reimbursement and available resources. 
Questions regarding reimbursement?
  Email John.


April 2015 Update:

Breaking News: Congress Averts 21% Medicare Pay Cut In a historic act, in the evening hours of April 14, 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly. This law eliminates the negative update of 21% scheduled to take effect as of April 1, 2015, for the Medicare Physician Fee Schedule. CMS will immediately begin work to implement these provisions. What does this mean for RDNs who are Medicare providers? For the present moment, reimbursement rates for Medicare Part B MNT and DSMT services will continue at the pre-April level. If you have already submitted claims to the Centers for Medicare & Medicaid Services (CMS) for MNT or DSMT services on or after April 1, 2015, you do not have to do anything. CMS has been holding these claims for 10-business days in an effort to minimize financial effects on providers as they were waiting to see if this legislation was passed. While the Medicare Administrative Contractors (MACs) have been instructed to implement the rates in the legislation, a small volume of claims will be processed at the reduced rate based on the negative update amount. The MACs will automatically reprocess claims paid at the reduced rate with the new payment rate. On July 1, payment rates will increase by 0.5%, followed annually by the same percentage increase through 2019.

The rest of the good news… In addition to reconfiguring Medicare payments for the next decade-plus, the bill includes two years of funding for the Children’s Health Insurance Program (CHIP) and an additional $7.2 billion for community health centers over the next two years.

Stay tuned to the MNT Provider newsletter for a more complete analysis of this historic legislation and its impact on RDNs working in a wide variety of practice settings. Thanks to all Academy members who responded to the Action Alert urging your Senators to pass this bill.

Marsha Schofield


March 2015 Updates:

Attention Health Professionals: Information Regarding the 2015 Medicare Physician Fee Schedule The negative update of 21% under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015. Medicare Physician Fee Schedule claims for services rendered on or before March 31, 2015, are unaffected by the payment cut and will be processed and paid under normal procedures and time frames. The Administration urges Congress to take action to ensure these cuts do not take effect. However, until that happens, CMS must take steps to implement the negative update. Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will notify you on or before April 11, 2015, with more information about the status of Congressional action to avert the negative update and next steps.

In Response To: Medicare Denials for Renal Claims It has been brought to our attention that at least in some states correct and legitimate claims submitted to Medicare for Part B MNT services for patients with renal disease are suddenly being denied for payment. Upon initial investigation by Nutrition Services Coverage staff, it appears there may be an error in the list of ICD-9 codes being used by at least some of the Medicare Administrative Contractors when processing such claims. Since the issue appears to impact Academy members on a widespread basis, we have been in touch with personnel in the coverage area of CMS. They are aware of the issue and are conducting an investigation. Once they complete their investigation they will inform us of the outcome. We will provide you with further updates as soon as they are available.

The Academy continues to be in regular contact with CMS officials about this ongoing issue. We have shared with CMS that the local MACs are awaiting official communication from CMS before changing any claims processing decisions. While from the Academy’s perspective this issue seems to be easily resolved, apparently it is more complex from CMS’s perspective. Trust us when we say we will continue to contact CMS on a regular basis until this issue is resolved.


Fall 2014 Update and info:

New! Coding and Billing Handbook: A Guide for Program Directors and Preceptors The Academy of Nutrition and Dietetics Coding and Coverage Committee is proud to announce that the Coding and Billing Handbook: A Guide for Program Directors and Preceptors is now available and ready for use with dietetic interns. This tool (free to Academy members, $40 for non-members) includes vocabulary, sample case studies, recommended resources and other materials for use in supervised practice programs to help interns achieve competency in coding and billing for nutrition services. The content may also help RDNs new to coding and billing for MNT services to set up and implement processes in both health care facilities and private practice.  Download your copy today

CMS approves Intensive Behavioral Therapy for Obesity as a group service Beginning January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) will now pay for Intensive Behavioral Therapy for Obesity for Medicare Part B beneficiaries as a group service, in addition to the existing coverage for individual services. In the Final Rule for the 2015 Medicare Physician Fee Schedule, CMS has established a new G-code for group obesity counseling, G0473 Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes. This new code will pay similar to the MNT group code 97804 and services must still be furnished in compliance with the existing criteria for the benefit.

This decision by CMS reflects consideration of comments (link below) submitted by the Academy on the Proposed Rules published this summer. The Academy continues to work with CMS and Congress to modify this benefit to get RDNs recognized as direct providers of this benefit. To learn more about changes in the 2015 Medicare Physician Fee Schedule Final Rules impacting RDNs, read an upcoming issue of the MNT Provider newsletter 


Academy Releases Results of 2013 Survey of Coding Practices Are you looking for information on CPT code use and billing practices by registered dietitian nutritionists (RDNs)? If so, be sure to read the article in the October 2014 issue of the Journal of the Academy of Nutrition and Dietetics, “Current Coding Practices and Patterns of Code Use of Registered Dietitian Nutritionists: The Academy of Nutrition and Dietetics 2013 Coding Survey.” The Academy’s Coding and Coverage Committee periodically administers a national coding survey as part of an ongoing effort to understand the factors that impact the RDN’s ability to deliver and to be compensated for preventive and therapeutic services, including MNT. This survey data will be used by the Academy to support nutrition services code revision and/or expansion. Individual members will find the information useful as they work to better their role in billing for nutrition services.


Reimbursement for MNT Resources Understanding Reimbursement coverage for MNT can be a challenge. The Academy website contains valuable resources to clarify coding and coverage rule and regulations:
Integrating the Registered Dietitian into Primary Care:  Comprehensive Primary Care Initiative (CPCI) 

Link here
for the new obesity treatment toolkit
  •The Academy's Medicare MNT page: www.eatright.org/mnt
•The Academy's Coding, Coverage and Compliance page: www.eatright.org/coverage
•The Academy's Evidence Analysis Library and ADA’s Evidence-Based Nutrition Practice Guideline Toolkits: www.adaevidencelibrary.com/
•*MNT Works Kit: The Kit is a marketing tool that can be used during meetings and presentations to local third-party payers,employer groups and hospital finance and billing departments to expand MNT coverage. A copy of the Kit can be downloaded by members for free at www.eatright.org/coverage.
•Reimbursement Community of Interest: The NSC team manages an online tool for members to exchange information and discuss reimbursement topics. The site has a folder designated for reimbursement rep announcements and updates. Go to http://eatright.communityzero.com/reimbursement to sign up.
•Third party payer brochure: This includes key information on the impact of Medical Nutrition Therapy provided by RDs. This can be shared with health care plans and more. Download a complimentary payer brochure at http://www.eatright.org/ada/files/RDBrochure_web_(2).pdf
•The MNT Provider newsletter is a free resource for all Academy members. It has information on Medicare, private insurance, practice management and more. Read it each month at www.eatright.org/mntprovider


Adult Weight Management Resources: Meeting the Need for Obesity Treatment: A Toolkit for the RD/PCP Partnership, visit: www.eatright.org/Members/ Intensive Behavioral Counseling for Obesity benefit under Medicare, visit: www.eatright.org/Members/ Results of the Adult Weight Management Update Evidence Analysis Project can be found at: http://andevidencelibrary.com/ The Adult Weight Management Toolkit:  www.eatright.org/shop/product.aspx?id=6442451095 Certificate of Training in Adult Weight Management CDR Program and self-study module: www.cdrnet.org/weight-management -adult-program.

Pediatric Weight Management Resources: Healthier Generation Benefit: www.eatright.org/Members/content.aspx?id=6442451325 Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines: http://andevidencelibrary.com/topic.cfm?cat=2721   Pediatric Weight Management Toolkit: www.eatright.org/Shop/Product.aspx?id=6442472059. Childhood and Adolescent Weight Management, CDR Self-Study Module: http://cdrnet.org/weight-management/childhood-module.