Upcoming DSMES Webinars

January 12  Tools to Maximize Virtual and Live Patient Learning and Behavior Change and Provider Communications

March 23  Remote Patient Monitoring Reimbursement

Target Audience

DSMES program staff.

Purpose

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.

Learning Objectives

• 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.

Outline

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

Educational Need

• 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.