DSMES Learning Series: DSMT Reimbursement
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If you have questions, please email Laurene Hendricks at firstname.lastname@example.org.
Upcoming DSMES Webinars
DSMES program staff.
This presentation will discuss current Medicare coverage guidelines including those related to DSMES/T referrals, lab criteria, utilization limits in first and follow-up years, structure of initial and follow-up benefits, beneficiary entitlement, provider eligibility, DSMES/T telehealth, procedure, diagnosis and revenue codes for accurate claims, quality standards, allowed practice settings, and the benefits/tiered payment rates. Attendees will receive a modifiable referral form that is designed to be Medicare-compliant, created to increase reimbursement success and quality assurance, and a 10 Step Plan to Increase Private Payer Reimbursement Success.
- Describe Medicare beneficiary eligibility for DSMT.
- List three of the key Medicare coverage guidelines for telehealth DSMT.
- Describe the key Medicare coverage guidelines for DSMT.
RENDERING PROVIDER ELIGIBILITY: Individual, entity, billing for another Medicare benefit first
BENEFICIARY ELIGIBILITY: Part B insurance, labs, ICD-10 dx codes
QUALITY STANDARDS: NSDSMES, ADCES accreditation, and ADA recognition
REFERRAL REQUIREMENTS: Required documentation and referring provider eligibility
STRUCTURE of INITIAL and F/UP BENEFIT: Utilization limits, sites and regulations, time frames, individual and group hours, and criteria for all individual
BILLING and CODING: Billing providers, procedure, revenue, and ICD-10 codes
PLACES OF SERVICE: Allowed and prohibited
REIMBURSEMENT RATES: 2021 rates
PRIVATE PAYER COVERAGE: Current status
TELEHEALTH DSMT: Originating vs. distant sites, allowed rendering and billing providers, and key billing requirements
- Identified gap(s): Successful insurance reimbursement for DSMES/T is critical for sustaining DSMES/T programs. DCESs are lacking in knowledge of the specific required Medicare and private payer coverage guidelines for DSMES/T.
- Description of current state: DCESs should be responsible for the financial management of their DSMES/T programs, and this includes being responsible for increasing reimbursement success.
- Gap to be addressed by this activity: Knowledge, Skills, Practice.
Mary Ann Hodorowicz, RD, LDN, MBA, CDE, CEC
Ms. Hodorowicz is a professional consultant, educator, speaker, writer and spokesperson for the health and food industry. She is a registered, licensed dietitian, certified diabetes educator and certified endocrinology coder with multiple skills and years of experience in the food, nutrition and diabetes care and healthcare industries. Her clients include both small or large organizations and individuals in private practice.
Ms. Hodorowicz's consulting and training services are designed to provide you with a high level of expertise to achieve your short or long-term goals in a cost-effective and timely manner. Mary Ann's excellent verbal and written communication skills, expertise in project management and a creative spirit all combine to meet your unique needs and goals.
- Nurse: Des Moines University is Iowa Board of Nursing approved provider #112. This live activity has been reviewed and approved for 2.0 continuing education contact hour(s). No partial credit awarded.
No commercial interest company provided financial support for this continuing education activity.
Relevant to the content of this educational activity, the following individual(s) have no conflict(s) with commercial interest companies to disclose.
- Alexandra Grossman, MA, RDN, LD, moderator and planning committee member
- Laurene Hendricks, activity director and moderator
- Mary Ann Hodorowicz, RDN, MBA, CDCES, CEC, speaker
The speaker(s) will disclose if any pharmaceuticals or medical procedures and devices discussed are investigational or unapproved for use by the U.S. Food and Drug Administration (FDA). Determination of educational content and the selection of speakers is the responsibility of the activity director.
The information provided at this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. The content of each presentation does not necessarily reflect the views of Des Moines University.
- 2.00 CE Contact Hour(s)
- 2.00 IBON