The Importance of Health Insurance - Assignment Example

The Importance of Health Insurance I. Executive Summary: Purpose. The project aims to acquire knowledge on the rudiments of quicker reimbursements of the diabetes mellitus patients’ medical nutrition therapy. The project aims to clarify the importance of health insurance in reducing the healthcare expenses of the patients. The project aims to show how to easily apply as provider. Findings. Reimbursements help reduce the diabetes mellitus patients’ healthcare expenses. The patients can avail of Medicare’s and other healthcare insurance companies’ reimbursement of medical nutrition therapy visits. The findings indicate some insurance companies do not offer reimbursements of the diabetes patients’ medical nutrition therapy. It is easy to apply as reimbursement provider. Conclusion. By implementing the required processing steps, the provider applicant can easily seek approval as official medical nutrition therapy service provider. Proper coding helps ensure all medical nutrition therapy billings are reimbursed. Many health insurance providers offer 100 percent medical nutrition therapy reimbursements to diabetes mellitus patients. Evidently, Medicare and several insurance companies offer reimbursement of medical nutrition therapy. II. Description of the project topic: Reimbursement is information to dietetics professionals because they are confident their services can be paid quicker. By implementing the reimbursement steps, insurance companies or organizations can easily reimburse the patients and registered dietitian service providers. Further, the project objectives include learning whether diabetes patients can avail of reimbursements of medical nutrition therapy sessions. Another objective is to learn the importance of coding in the immediate release of reimbursements. A third objective is to learn the importance of health insurance in reducing the rehabilitation expenses of the diabetes mellitus patients. Furthermore, the MNT reimbursement requires the proper coding and billing to ensure quicker reimbursement processes. Each Code 97803 equates to 15 minutes follow up MNT visit. Each Code 97804 equates to 30 minutes Group MNT visit. Telehealth Codes are used for real time interactive and video communication activities. The ICD Codes annually updated diagnosis. Code 250.00 represents diabetes. Moreover, the diabetes mellitus medical condition occurs when the patient is diagnosed with a chronic lifetime ailment. The ailment indicates the patient loses the normal capacity to maximize energy found in swallowed food. There are different types of the ailment. Type 1diabetes is characterized by the patient’s body attacking its own pancreas body part. Consequently, the destroyed pancreas is prevented from producing the required insulin. The medical relief is done by injecting insulin into the patient’s body (Kumar et al., 2012). Next, type 2 diabetes usually occurs during the patient’s adult life. Obesity is one of the possible causes of type 2 diabetes. Under this type, pancreas does not produce enough insulin. Another possibility is that the body does not use the pancreas’ insulin amounts (Kumar et al., 2012). Further, gestational diabetes occurs during the pregnancy stage. The ailment normally occurs during the middle of the woman’s pregnancy. In other cases, the ailment may start at a later stage of the woman’s pregnancy. The ailment may progress to the woman’s falling prey to type 2 diabetes after the child’s birth (Kumar et al., 2012). Furthermore, the body normally processes energy to fulfill the human body’s daily routines. Without energy, the body cannot function perfectly. The normal body function is to metamorphose the food’s carbohydrate and sugar elements into a special kind of sugar, glucose. The body uses the glucose as fuel to run the body’s daily functions. Next, the normal human body uses the body’s insulin hormone use the glucose as. When a patient has diabetes mellitus, the body’s low glucose supply prevents the body’s use of glucose. In another patient, the diabetes mellitus patient is not able to effectively use the body’s insulin. A third patient may have the symptoms of the first two patients (Kumar et al., 2012). Moreover, there are unhealthy effects of untreated diabetes mellitus. The excess glucose will pile up in the patient’s blood. The excessive unused glucose amounts can trigger kidney ailments and heart attacks. Uncontrolled glucose levels may lead to the patients’ blindness (Kumar et al., 2012). III. Reimbursement Guidelines (A.N.D.) Medical Nutrition Therapy The Academy of Nutrition and Dietetics established the Medicare reimbursement guidelines. For reimbursement of Telehealth site amounts, the must first be seen in approved original sites. The sites include the medical doctor’s office or the practitioner’s office. Next, the patient was treated in a healthcare facility or hospital site. Third, the site included a skilled nurse attending to the patient. Fourth, the patient visited a site classified as health center. Lastly, the site is classified as a rural healthcare clinic (CTEL, 2014). Further, the second requirement is the site included healthcare professionals treating the patients. The professionals include the medical doctor. Two other healthcare professionals are the nurse and the midwife. A third professional is the clinical psychologist. Another qualified professional is the registered dietitian or nutrition professional. Other healthcare professionals include the clinical social worker and the medical doctor’s assistant (CTEL, 2014). Furthermore, there are two other remaining requirements. The third requirement states the patient was engaged in interactive video and audio conversation with the healthcare profession on the site. There must be real time communication between the patient and the medical professionals. Lastly, the patient must be a qualified member of Medicare. The fourth requirement states the Medicare beneficiary lives within or uses the telemedicine system classified as rural Health Professional Shortage Area (CTEL, 2012). IV. Market Research on MNT provision by private & government health insurances agencies: The Blue Cross and Blue Shield group of insurance providers offers 100 percent reimbursement of the diabetes mellitus patients’ medical nutrition therapy. However, the company requires only registered dietitians and nutrition professionals are allowed to deliver the required therapy (Roth, 2013). Further, the Center for Medicare and Medicaid Services or CMS granted reimbursement for medical nutrition therapy expenses of the diabetes mellitus patients. Section 105 of the Medicare, Medicaid, as well as SCHIP Benefits Improvement Protection Act, BIPA, allowed the medical nutrition therapy benefits to the diabetes patients under the government’s Medicare Part B program. The Government’s Medicare program includes zero coinsurance rates and zero co-payment rates for diabetes mellitus patients. However, the benefits are granted only if registered dietitians or nutrition professionals conduct the beneficial medical nutrition therapy counseling. The government’s Medicare program reimburses the registered dietitians or nutrition professionals for their hours-based counseling services. The diabetes patients’ medical doctor must give a referral. The referral states the therapy is necessary. The referral indicates the registered dietitian or nutrition professional who will conduct the therapy visits (Diabetes.ihs.gov., 2013). Furthermore, the medical nutrition therapy includes several activities. One activity is initial nutrition as well as assessment of the diabetes mellitus patients’ lifestyle. Another activity is the standard nutrition or diabetic food choice counseling. A third activity is the follow up medical nutrition therapy visits (Medicare.gov, 2013). Moreover, nongovernment entities offer medical nutrition therapy. The Blue Cross and Blue Shield organization offers $0 copay rate for the diabetes mellitus patients’ visits (Blue Cross and Blue Shield, 2012). Similarly the Wellcare organization offers similar $0 copay rate for the diabetes mellitus patients’ visits (Wellcare, 2012) both organizations offer free medical nutrition therapy for diabetes mellitus patients. The therapy requires diabetes mellitus patients use the therapy services of registered dietitians and nutrition professionals. The organization allows three full hours of one-on-one therapy visits for the first year. Next, the diabetes mellitus patients can an additional two hours of therapy visits for the second and future years. If the diabetes patients’ medical issues a referral for additional therapy, the additional therapy is an allowed reimbursement. V. Nation’s average rate of reimbursement for Medical Nutrition Therapy. First, Medicare is a government insurance agency. The agency covers reimbursement for medical nutrition therapy for diabetes patients under the Medicare Part B program. The reimbursement rate is 100 percent. The patients do not pay a single cent to avail of the medical nutrition therapy services done by specified healthcare professionals. The healthcare professionals include the registered dietitian and the nutrition professionals (Medicare.gov., 2013). Second, United Healthcare implements 100 percent reimbursement rate of the diabetes mellitus patients’ medical nutrition therapy. Confidential email (uhg_webmail@uhc.com) received states www.broker.uhc.com can assist in the reimbursement issues. This is in compliance with the Medicare’s therapy provisions. The reimbursement is filed under the CMS 1450 code. Section 1861 of the Social Security law mandates the implementation of Medicare Part B benefits. Medicare pays for the first year’s 3 hours of registered dietitian or nutrition professional. The medical doctor can issue a referral requiring registered dietitians to fill the needed medical nutrition therapy requirements (www.unitedhealthcareonline, 2013). Third, the eHealthinsurance company offers zero rate reimbursement. The insurance company does not grant reimbursement of the diabetes mellitus patients’ medical nutrition therapy. Email received (noprofile@ehealthinsurance.com) states that patients must pay all expenses related to using the food and nutrition counseling of registered dietitians and nutrition professionals. Fourth, Proactive Nutrition LLC. The company offers healthcare insurance for diabetes mellitus patients. Email from Proactive Nutrition LLC, info@proactivenutrition.net, contacting Registered Dietitian Sally Hara’s contact person can affirm that company offers the automatic zero medical nutrition therapy reimbursement rate. Consequently, the patients must pay for the medical nutrition therapy visits of the registered dietitian or nutrition professional. Fifth, MDwise insurance company offers 100 percent rate reimbursement of the patient’s medical nutrition therapy (www.mdwise.com). A call to Relay Indiana will affirm the rate (https://www.mdwise.org/contact-us/). VI. Steps to becoming a MNT provider (Appendix) References: Blue Cross and Blue Shield, (2012). Medicare Advantage Overview. Retrieved August 2, 2014 from CTEL, (2012). Medicare Reimbursement Checklist Telehealth Originating Site Facility Fee. Retrieved from: www.eatright.com. Diabetes.ihs.gov. (2013). Medicare Medical Nutrition Therapy Reimbursement. Retrieved from Medicare.gov, (2013). Medicare’s Coverage of Diabetes Supplies and Services. Retrieved from < www.medicare.gov/Pubs/pdf/11022.pdf > Medicare.gov., (2013). Your Medicare Coverage. Retrieved from < http://www.medicare.gov/coverage/nutrition-therapy-services.html > MDWise.org., (2013). MDWise is Here to Help You. Retrieved from < www.mdwise.org > Proactivenutrition.com, 2013. Insurance. Retrieved from < http://www.proactivenutrition.net/insurance/ > Roth, R. (2013). Nutrition and Diet Therapy. New York: Cengage Learning. UnitedHealthcareOnline.com, (2013). Medical Nutrition Therapy. Retrieved from < https://www.unitedhealthcareonline.com/ > Wellcare, 2012. Georgia Medicaid Provider Handbook. Retrieved Appendix: The MNT provider must implement the following seven steps (Diabetes.ihs.gov, 2013): Step 1. Qualify as Recognized Medicare Provider. To qualify, the provider applicant must either be a licensed nutrition professional or a registered dietitian. Next, the provider applicant had completed more than 899 hours supervising dietetics patients’ food-related healthcare issues. Step 2. Generate new friends from your business office. The provider applicant must cordially communicate with the business office’s billing and coding staff. The provider applicant must learn from the business office staff the appropriate way to process reimbursement claims, especially the MNT superbill. Step 3. Acquire the treating medical doctor’s referral and authority to visit patient. The medical professional gives referrals for patients classified as diabetes or kidney ailments. The referral must include the statement that the MNT visiting hours are necessary and appropriate healthcare healthcare service. Step 4. Acquire adequate knowledge about the Procedural Codes as well as the Diagnosis Codes. Each Code 97802 equates to 15 minutes initial MNT visit. Each Code 97803 equates to 15 minutes follow up MNT visit. Each Code 97804 equates to 30 minutes Group MNT visit. Telehealth Codes are used for real time interactive and video communication activities. The ICD Codes annually updated diagnosis. Code 250.00 represents diabetes. Step 5. Record or document the medical nutrition therapy services. To ensure reimbursement, the Medicare requires the submission of complete and accurate information on the document. To help comply with Medicare reimbursement requirement, the Nutrition Care Process and Model reference serves a guideline for registered dietitians and nutrition professionals. The reference includes proper nutrition diagnosis, intervention, monitoring and evaluation procedures. Step 6. Track the provider applicant’s medical nutrition therapy services given as well as the related reimbursement details. The registered dietitian or nutrition professional must record the details of each patient medical nutrition therapy visit and the related MNT CPT codes. The details include hours visited, breakdown of each MNT service and amounts billed, as well as the reimbursement status. Step 7. You must market (sell) their medical nutrition therapy services. Persuade patients and their family members that the registered dietitian or nutrition professional can help patients implement a change to healthier lifestyle changes. The life changes include eating healthy foods and engaging in effective exercise routines. The registered dietitian must sell their services to medical professionals. Convinced, the medical professionals will refer the registered dietitians’ or nutritional professional’s MNT services to the patients (Diabetes.ihs.gov, 2013). Read More