Nutrition Diabetes Education Diabetes Education Health Promotion Insurance Reimbursement
Home
About Mary Ann
Why Hire a Consultant?
Consulting: Scope of Services and Turn Key Programs
Professional Publications
Seminars, Workshops, Presentations and Continuing Education Programs for Professionals and Consumers
Wellness and Health Promotion Program
Partial Client List
Client Testimonials
FAQs
Reimbursement and Other Updates
Sign Up for Mary Ann's Preferred Mailing List
Contact Mary Ann


Consulting: Medical Nutrition Therapy
Why Hire a Consultant?   Scope of Services    Turn Key Programs
 
In this Section:
1.
Components of MNT and DSMT Program Consulting (pdf)
2.
Why Hire Mary Ann as a Consultant for Medicare MNT and DSMT?
3.
Her Consulting and Training Services Can Be Used in Your Organization To...
4.

Developing Medicare MNT Program

5.

Designing Outpatient MNT Clinic

6.

Training RDs on MNT Practice Guides, Reimbursement and Newest Intervention Models and Technologies

7.
Medicare's New Chronic Care Improvement Program and the New Beneficiary One Time Physical Exam
8.

Turnkey Medicare MNT Program and RD Training Workshop

9.

FAQs on Medicare Part B Medical Nutrition Therapy and Diabetes
Self-Management Education Benefits

10.

A Quick Guide to the Medicare MNT and DSME Benefit

FAQs on Medicare Part B Medical Nutrition Therapy and
Diabetes Self-Management Education Benefits

  1. What exactly are the health outcomes of MNT?
  1. What are the four basic components of MNT that are consistent with the new "Nutrition Care Process and Model"?
  1. For what diseases and conditions is MNT an integral component of the treatment plan?
  1. Who is best qualified to deliver MNT?
  1. Do Registered Dietitians follow proven, standard guidelines when delivering MNT?
  1. What is the role of MNT in Managed Care Organizations (MCOs)?
  1. Is MNT reimbursed by Medicare? Is MNT reimbursed by private and commercial payers?
  1. Should diabetes MNT be provided to a patient who is also receiving diabetes self-management education? Will Medicare pay for both in the same year?
  1. Is there a handy, inexpensive, up-to-date resource that clearly spells out for dietitians, billers and other health professionals how to successfully obtain Medicare and private payer reimbursement $$$$ for Medicare MNT and Diabetes Self-Management Education?
  1. Where can I obtain high quality Medicare compliant MNT forms and worksheets? I don't want to reinvent the wheel!

What is Medical Nutrition Therapy?

Through the nutrition care process, medical nutrition therapy (MNT) is a specific nutrition intervention used to treat an illness, injury, or condition. MNT and lifestyle counseling have been proven scientifically to be an essential and cost-effective component in the comprehensive treatment plans in many disease states and disorders.in short, MNT does produce positive health outcomes.

>> Back to FAQs


What exactly are the health outcomes of MNT?

Numerous studies have proven that MNT, provided by a registered dietitian, does produce these much desired health outcomes:

  • Slows down the progression of many diseases
  • Eases the uncomfortable symptoms of many diseases
  • Delays the onset of diseases
  • Prevents the diseases entirely
  • Reduces the need for:
    • Expensive prescription medications
    • Hospitalizations
    • Expensive therapies
    • Doctor visits
    • Time off work or lost time for normal daily activities
  • Increases overall health and well-being by:
    • Helping to normalize bio-chemical health indicators.just a few examples are:
      • Total cholesterol
      • LDL (bad) cholesterol
      • HDL (good) cholesterol
      • Blood triglycerides
      • Blood sugar
      • Blood pressure
      • Blood potassium

>> Back to FAQs


What are the four basic components of MNT that are consistent with the new "Nutrition Care Process and Model"?

  • Nutrition Assessment
  • Nutrition Diagnosis
  • Nutrition Intervention
  • Diet therapy
  • Lifestyle and behavior modification counseling
  • Specialized nutrition supplements
  • Nutrition Monitoring and Evaluation

>> Back to FAQs


For what diseases and conditions is MNT an integral component of the treatment plan?

MNT is required for optimal control of many medical conditions and their associated symptoms. It has also been proven to be VERY cost-effective (i.e., yields significant health benefits for very little cost), to lower morbidity and mortality and to produce VERY positive health outcomes for many chronic conditions, especially:

Diabetes
Malnutrition
Metabolic syndrome (pre-diabetes)
Polycystic ovary syndrome
Blood lipid disorders
Gastrointestinal disorders
Obesity

Inflammatory bowel syndrome

Hypertension
Parkinson's disease
Osteoporosis
Malabsorption disorders
Cardiovascular disease
Seizure disorders
Cerebrovascular disease
Chronic obstruction pulmonary disease
Congestive heart failure
Immune system diseases, including HIV
Renal disease
Pediatric failure to thrive
Liver disease
High risk pregnancy
Cancer
Food allergies

It is the position of the Academy of Nutrition and Dietetics that the application of medical nutrition therapy (MNT) and lifestyle counseling as a part of the Nutrition Care Process is an integral component of the medical treatment for management of specific disease states and conditions and should be the initial step in the management of these situations.

To maximize a patient's health outcomes, the utilization of a coordinated multidisciplinary team approach to the patient's care is essential. This is especially true due to the long-term nature of treatment for chronic diseases, such as diabetes and heart disease.

A team is typically comprised of a:

  • Primary care physician
  • Nurse or clinical nurse specialist
  • Registered dietitian
  • Pharmacist

In obesity, the multidisciplinary teams have been expanded to include clinical psychologists, exercise specialists, and other allied health professionals. Benefits of such teams have included improved patient safety and clinical outcomes and cost savings.

>> Back to FAQs


Who is best qualified to deliver MNT?

In reporting on the role of nutrition in Medicare, the prestigious Institute of Medicine addressed the issue of identifying qualified nutrition providers. The IOM distinguished between basic nutrition education, which can be provided by diverse professionals, and more complex MNT. Registered dietitians were marked as the "single identifiable group of health professionals qualified to provide nutrition therapy". This recommendation was made on the basis of the specific academic and clinical training of dietitians, which includes nutrition science, food science, nutrient composition of foods, behavioral skills and teaching and learning theory to promote lifestyle changes.

In addition to functioning as lifestyle coaches, today, more and more registered dietitians assume roles as directors, case managers and disease management program coordinators for healthcare entities, managed care organizations, corporate wellness programs, etc.

>> Back to FAQs


Do Registered Dietitians follow proven, standard guidelines when delivering MNT?

Evidence-based, standardized protocols for MNT have been written by the Academy of Nutrition and Dietetics for nutrition professionals who provide MNT in GROUP format, or INDIVIDUAL format. Adhering to these nutrition practice guidelines is also a Medicare Part B requirement for RDs when they furnish MNT for diabetes and renal disease to Medicare beneficiaries. These " MNT Evidence-Based Guides for Practice" have been written for various diseases. They provide a framework for maximizing the clinical effectiveness of the MNT, as the guides outline:

  • The specific "nutrition care process" for delivering MNT
  • The specific required activities in each of the 4 major components of MNT
  • The diet therapy principles for the disease, with each being "graded" according to the strength of the evidence
  • Behavior interventions, along with recommendations are how to customize for the unique needs of the patient

>> Back to FAQs


What is the role of MNT in Managed Care Organizations (MCOs)?

It is the position of the Academy of Nutrition and Dietetics that MNT is an essential component of disease management and healthcare provided by Managed Care Organizations, and that such care must be provided by qualified nutrition professionals.

Today, more and more MCOs and commercial payers are implementing or expanding their coverage of MNT. The reasons for this are:

  • The authorization of CPT codes for MNT
  • the implementation of MNT benefits in Medicare Part B for diabetes and kidney disease
  • Studies proving the efficacy and cost-effectiveness of MNT
  • MNT being included in national standards of care for many chronic disease conditions
  • MNT being included in the quality standards required by accreditation entities such as the:
    • National Committee for Quality Assurance
    • Joint Commission for the Accreditation of Health Care Organizations

There is a paramount need in contemporary clinical practice and in today's cost-conscience healthcare environment that patient treatment:

  • Be cost-effective
  • Be provided in ambulatory settings as much as possible
  • Consistently produce positive outcomes in as short a time as possible.

MNT meets all these needs, and thus should be a part of every MCO's and commercial payer's:

  • ¾ Demand management system
  • ¾ Disease management program
  • ¾ Case management program
  • ¾ Discharge planning processes

>> Back to FAQs


Is MNT reimbursed by Medicare? Is MNT reimbursed by private and commercial payers?

Medicare Part B reimburses for MNT in diabetes and non-dialysis kidney disease provided by registered dietitians who are certified Medicare providers. Beneficiaries must meet specific medical necessity requirements to be eligible for the MNT benefit. To bill Medicare, the MNT CPT codes must be used: 97802, 97803 and 97804. When these CPT codes became available for use among private sector and commercial insurers in November 2000, coverage of MNT by these insurers has risen significantly, and continues to rise. The Academy of Nutrition and Dietetics sought CPT codes so that registered dietitians could be paid directly for their services. According to the Academy of Nutrition and Dietetics , the three new CPT codes for MNT provided by a registered dietitian were in use by most health plans participating in their commissioned data environmental scan in 2002.

These advances in reimbursement remove barriers and are especially advantageous to dietitians in private practice and in physician-managed clinics. Patients are more likely to comply with a physician referral to a registered dietitian if MNT is covered by their insurance plan.

>> Back to FAQs


Should diabetes MNT be provided to a patient who is also receiving diabetes self-management education? Will Medicare pay for both in the same year?

YES and YES. Diabetes self-management education is "the process of providing the person with diabetes with the knowledge and skills needed to perform self-care, manage crises and make lifestyle changes required to successfully manage this disease" (1). It is the cornerstone of care for all individuals with diabetes who want to achieve successful health-related outcomes.(2). In a DSME program nutrition and meal planning is one of 10 topics taught in a 10 hour program. As such, the nutritional principles are more broad-based, and are applicable to all people with diabetes (e.g., select lower fat foods and count and control carbohydrate foods).

Medical nutrition therapy (MNT), however, is a specific and customized nutrition intervention plan, derived by implementing 4 distinct components or steps (assessment, nutrition diagnosis, nutrition intervention and evaluation and monitoring). The ultimate goal of MNT is for the dietitian to develop an individualized meal plan, i.e., one that is appropriate and 'do-able' for the patient's:

  • Negotiated treatment and behavior goals
  • Calculated nutrient needs
  • Metabolic profile
  • Medication regimen
  • Preferences
  • Lifestyle
  • Culture
  • Other medical conditions
  • Other medical treatments

In MNT, the patient is monitored in order to assess the need for changes in therapy and to ensure successful outcomes.

Thus, MNT is a key component of treatment for diabetes. It also helps prevent and delay this chronic disease when provided in the early stages of mildly elevated blood glucose.

Besides providing MNT, the registered dietitian who specializes in diabetes has an expanded role of educating the patient on pattern management; that is, how to use blood glucose data to adjust food intake, exercise, or their diabetes medications to achieve their target blood glucose goals. The support of the entire health care team is instrumental for patient self-care competence.

MNT and DSME are 2 separate benefits reimbursed by Medicare Part B for qualifying beneficiaries. Medicare will cover both benefits, to their fullest extent in the initial and follow-up years, as long as they are not provided on the same date of service.

>> Back to FAQs


Is there a handy, inexpensive, up-to-date resource that clearly spells out for dietitians, billers and other health professionals how to successfully obtain Medicare and private payer reimbursement $$$$ for Medicare MNT and Diabetes Self-Management Education?

YES! The specific coverage guidelines for both DSME and MNT are outlined in Mary Ann's manual for professionals titled "Money Matters in MNT and DSME: Increasing Reimbursement Success in All Practice Settings, The Complete Guide"©, 3rd Edition .

This manual is self-published by Mary Ann, so it is continually updated each and every time Medicare changes the coverage guidelines, and when Mary Ann learns news strategies for insuring payment success, such as an improved MNT outcome tracking system or quality assurance plan. View Mary Ann's Publications

>> Back to FAQs


Where can I obtain high quality Medicare compliant MNT forms and worksheets?
I don't want to reinvent the wheel!

Mary Ann has custom created 20 evidence-based forms and worksheets for your MNT or DSMT practice! These 'EZ Forms for the Busy RD " are available on this site's
Professional Publications
page.

>> Back to FAQs


References:

  1. Austin, Anita, Martha M. Funnell, Kathryn Mulcahy and Hope S. Warshaw. "A Diabetes Educator's Monograph: Current Concepts in the Pharmacological Management of Type 2 Diabetes." Monograph. Princeton : Bristol-Myers Squibb, 1998.
  2. American Diabetes Association ( ADA ). "National Standards for Diabetes Self-Management Education Programs, Standards and Review Criteria." Diabetes Care 25:S140-S147, 2002
 
 
 
Mary Ann Hodorowicz Consulting, LLC
12921 Sycamore
Palos Heights, Illinois 60465
Office:  708-359-3864
Email:
hodorowicz@comcast.net
Fees and Terms & Conditions
Disclaimer
Privacy Statement
©2008 Mary Ann Hodorowicz Consulting, LLC
Page Last Updated: May 7, 2012 4:21 AM
     
Mary Ann has a rare combination of consultant to both professionals and the public. She is a well known dietitian in the Chicago , IL area. She travels all over the state of Illinois presenting on health reimbursement - including insurance, medicare and self management diabetes programs (DSME). Also, she created a health, wellness, health promotion and health education program targeted for companies and organizations who want to demonstrate concern for employee well-being, and increase employee productivity and morale.

Dietician Mary Ann consults with corporations and industry as a media nutrition spokesperson in area of food and nutrition. You will often see Mary Ann speaking before large consumer audiences on nutrition for kidney disease, nutrition for cardiac health, nutrition education for adolescents and current nutrition topics. She is a true nutrition expert!