Jamie Lynn Lewis presentation

9/10/2014
“Reform, Reimbursement, & RDNs:
Implementing change
for the Bottom Line”
Jaime Lynn Lewis, RD, LDN
CEO/President, Contemporary Nutrition, Inc.
Past-Chair of Coding & Coverage Committee
Academy of Nutrition & Dietetics
Session Objectives
By the end of the session the RDs will be able to
 Understand the dietitian’s role in shifting your
strategy from reactive to proactive
 Discuss recent changes in healthcare and
opportunities for the RDN
 Discuss billing practices and challenges
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Entrepreneur Dietitian…at your service
Registered
Education
Dietitian Billing
Department Development
…Coverage
& Benefits
Software
Expert…
EMRs
Human
Resources
Claim
Denials
Complaint Department Scheduling
Department
1
9/10/2014
Entrepreneur Dietitian…at your service
Registered
Education
Dietitian Billing
Department Development
…Coverage
& Benefits
Software
Expert…
EMRs
Human
Resources
Claim
Denials
Complaint Department Scheduling
Department
The Secrets of Success lie in each of us…
Are we willing to share
to improve our profession as a whole?
Current Referral System
Dietitian
Cardiology
Therapist
Dr. Doe for
Patient Sam
Labs
Xray
Endocrinology
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9/10/2014
Current Referral System
Dietitian
Therapist
Depression
Cardiology
Xray
Dr. Doe for
Patient Sam
Labs
Elevated TG
Low Vit D
High A1C
Borderline
Diabetic Endocrinology
Fee for Service
Patient Centered Medical Home
1. Comprehensive Care
2. Patient-Centered
3. Coordinated Care
4. Accessible Services
5. Quality and Safety
http://pcmh.ahrq.gov/page/defining-pcmh
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9/10/2014
Accountable Care Organizations
Patient Centered Medical Neighborhood
Registered
Dietitian
How do you fit
in to this new world
of Medicine?
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9/10/2014
Patient Protection and
Affordable Care Act (“PPACA”)
 requires health care plans to cover certain
preventive services on a first dollar basis
without any cost-sharing requirements
(e.g., co-payment, co-insurance and/or
deductible requirements).
 it affects all plans that are
Non-Grandfathered health plans
with the exception of Self-Funded
(non-insured parts of the health plan)
Patient Protection and
Affordable Care Act (“PPACA”)
 A grandfathered policy is a something
that had been in effect and actively
enforced prior to to September 23, 2010
 “Grandfathered health plans” are subject
to only certain provisions of the
Affordable Care Act. The entire policy or
only parts of the policy may be
grandfathered.
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9/10/2014
Billable Nutrition Services
U.S. Preventive Services Task Force
Healthy Diet Counseling
The USPSTF recommends intensive
behavioral dietary counseling for adult
patients with hyperlipidemia and other
known risk factors for cardiovascular
and diet-related chronic disease.
Intensive counseling can be delivered
by primary care clinicians or by referral
to other specialists, such as
nutritionists or dietitians.
http://www.ama-assn.org/ resources/doc/public-health/cpt-preventive-services-card.pdf
http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm
http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm
http://www.uspreventiveservicestaskforce.org/uspstf/uspsphys.htm
We want to be respected as the Nutrition Expert.
We want to be paid for our service.
We NEED to document OUTCOMES!!!
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9/10/2014
Coverage is
determined
by the
enrollee
specific
benefit
document!!!
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9/10/2014
Negotiating Reimbursement Rates
 Clear, concise, and CONFIDENT!
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9/10/2014
Negotiating Reimbursement Rates
The Institute of Medicine (IOM) identified
registered dietitians as “the single identifiable
group of health-care professionals with
standardized education, clinical training,
continuing education and national credentialing
requirements necessary to be directly reimbursed
as a provider of nutrition therapy.
Medicare Annual Wellness Visit (AWV)
What: Annual visit designed to develop a
personalized plan for preventive
services
Who: Medicare Part B beneficiaries
When: Within 12 months or enrolling in
Medicare Part B and annually
thereafter
Medicare Annual Wellness Visit (AWV)
What does it include?
 Health Risk Assessment
 Medical/family history
 Height, weight, BMI, blood pressure and other routine
measurements
 List of current providers and suppliers
 Screening for cognitive impairment
 Screening for depression
 Assessment of functional status
 Establishment of a written screening schedule
 Establishment of a list of risk factors and conditions for
which treatment is being received or
recommended
 Personal health advice and appropriate referrals
for education or preventive services
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9/10/2014
Hope for change in NC…
The Alliance for a Healthier Genration
Alliance Healthier Generation Benefit
Prevention, Assessment & Treatment
The Alliance for a Healthier Generation
convened national medical associations,
leading insurers and employers to offer
comprehensive health benefits to children
and families for the prevention and
treatment of childhood obesity.
Insurers and employers offer:
• at least four follow up appointments
with a primary care provider
• at least four visits with a registered
dietitian
www.eatright.org/coverage
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9/10/2014
Academy Resources For Your Practice
 MNT Provider Newsletter: a monthly newsletter to help RDs
understand the complexities of Medicare through timely articles,
analysis and advice on key aspects of practice and business
strategies.
 Evidence Analysis Library
(www.adaevidencelibrary.com/)
 Data on MNT Effectiveness
 Data on impact of the RD and
additional cost-savings data
ADA Resources For Your Practice
 Making Nutrition Your Business:
Private Practice and Beyond:
a resource for any RD considering private
practice.
 AND state dietetic association &
DPG reimbursement representatives:
to assist RDs with local coverage and
coding issues
(check ADA or affiliate/DPG web page for
rep contacts information)
Keep up to date with the MNT Provider Newsletter
www.eatright.org/mntprovider
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