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Obtaining Separate Reimbursement for Nutrition Services

Obtaining Separate Reimbursement for Nutrition Services. Judy Stark V.P. Health Management and Accreditation CoOportunity Health. Obtaining separate reimbursement for Nutrition Services. Cannot be services that are part of a package of care that are already reimbursed via another claim

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Obtaining Separate Reimbursement for Nutrition Services

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  1. Obtaining Separate Reimbursement for Nutrition Services Judy Stark V.P. Health Management and Accreditation CoOportunity Health

  2. Obtaining separate reimbursement for Nutrition Services • Cannot be services that are part of a package of care that are already reimbursed via another claim • Nutrition counseling/services delivered to patients in a hospital or SNF under per diem or case rate payments • Nutrition counseling that is packaged as part of a global medical/surgical package (i.e. bariatric surgery package or OB package) billed by a provider

  3. Obtaining separate reimbursement for Nutrition Services • Identify health plans that cover nutrition counseling, not all do • The Affordable Care Act requires Qualified Health Plans (those sold on the Exchanges) to cover the following preventive nutrition services at no cost share to the member: • Counseling and behavioral interventions of obese children and adults • Intensive healthy diet counseling for adults with high cholesterol, CVD risk factors, diet-related chronic disease https://www.healthcare.gov/what-are-my-preventive-care-benefits/

  4. Obtaining separate reimbursement for Nutrition Services • For healthplans that DO cover nutrition services, determine if they separately credential RDs/Nutritionists to provide these services. • Some healthplans cover these services but do not credential, and therefore separately reimburse, RDs/Nutritionists. • Some healthplans reimburse for these services when billed by a medical physician or chiropractic clinic, although the services are delivered by a employed RD/Nutritionist.

  5. Obtaining separate reimbursement for Nutrition Services • If an RD/Nutritionist wishes to establish an independent practice and bill healthplans that do cover nutrition services and do credential RDs/Nutritionists, they need to: • Complete an application for network participation, negotiate a provider contract • Submit their credentialing application for verification and approval • Identify appropriate CPT and billing codes • Identify appropriate billing forms (i.e CMS1500 form)

  6. Additional Resources • https://etools.cooportunityhealth.com/coop-public/coverage-criteria/dietitian-consultation/ • S:\Policies and Procedures\Medical Management Policies\Policy CRED007 Credentialing Program Criteria for Network Participation.docx • http://www.midlandschoice.com/Provider/Credentialing/Index.html • https://www.midlandschoice.com/Provider/Credentialing/RequestAnApplication.html • C:\Users\jstark\SkyDrive Pro\Documents\Presentations\Dietitians Nutritionists\09 ProviderAgreement-Sample.docm • http://www.wellmark.com/Provider/CommunicationAndResources/PDFs/S5780_ContractsandCredentialingProviderGuide.pdf

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