Medicare Nutrition Therapy - Assignment Example

What are the reimbursement requirements for non- Medicare nutrition therapy? Georgia’s Blue Cross and Blue Shield group of insurance providers: Blue Cross and Blue Shield is a conglomeration of an estimated 39 insurance companies that provide medical to its registered members. The company provides for the healthcare insurance of an estimated 99,998 million Americans (Psychguides.com, 2014). To avail of the Medicaid reimbursement, the anorexia nervosa patients must register as members of any of the group’s insurance providers. Next, the patients can choose which plan will cover the Medicaid reimbursement, known as flexible spending accounts (Psychguides.com, 2014). Next, the anorexia nervosa patients must be older than 64 years of age. In order to take advantage of Medicaid Part A reimbursement. This includes reimbursement for hospital confinement, rehabilitation as well as nursing care. The anorexia nervosa patient can also acquire Medicaid Part B benefits (Medicare, 2014). The benefits include reimbursement for medical doctor consultations and other related healthcare services. The services include X ray jobs and laboratory examinations. The patient can choose to enjoy medigap reimbursement. This includes reimbursement for costs not allowed under the Medicaid Part A or Medicaid Part B options, including payment for a portion of copays as well as coinsurance amounts. The patient can avail of reimbursement under the Medicaid’s Medicare Advantage (Medicaid Part C). The advantage allows reimbursements for other benefits not covered under the Medicaid Part A plan or Medicaid Part B plan. The patient can avail of the Medicaid’s Prescription Drug Reimbursement Plan [Medicaid Part D] (Unknown, 2014). The patient can enroll in this preferred provider organization to receive higher Medicaid benefits. The plan permits anorexia nervosa members to avail of healthcare services from healthcare providers outside the group’s umbrella of healthcare providers (Psychguides.com, 2014). The group’s anorexia patients can enroll in the nutrition therapy health reimbursement arrangement plan. The plan reimburses employee patients for actual healthcare expenses incurred. The employers pay for the plan. The group offers government –sponsored Medicaid to certain sectors of society. The sectors include low income citizens. Another sector covered is called the disabled citizen sector (BCBS, 2012). Wellcare Georgia Wellcare Georgia entity offers reimbursements. The entity implements the CMS site payment procedure. The anorexia nervosa patients must register as members of Wellcare Georgia (Wellcare 2013). For multiple healthcare procedures, Wellcare offers different reimbursement benefits. Wellcare Georgia allows reimbursements for nutrition therapy. However, the company excludes reimbursements for agents that are used to rehabilitate the anorexia nervosa patients, including drugs used to increase the anorexia nervosa patient’s weight. The exclusion includes drugs used to increase the weight of the anorexia nervosa patients (Wellcare, 2012). What is the insurer Coverage of medical nutrition therapy services for ailments outside Medicare, including anorexia nervosa? Blue Cross The group offers medical nutrition therapy to for all medical conditions, especially anorexia nervosa. Together with prescription drug intake, medical nutrition therapy helps speed the healing process (Roth, 2013). This includes nutrition therapy for the anorexia nervosa patient’s eating disorder. Anorexia nervosa is characterized by the patient starving oneself to death, with the false perception of being overweight or obese. While focusing on the anorexia nervosa patients’ eating disorders, the Blue Cross and Blue Shield provides help for the same patients’ secondary disorders related to eating disorders. The secondary disorders include depression (especially bipolar depression) as well as anxiety. The patients can choose a Blue Cross and Blue Shield insurance member provider that covers all medical conditions not covered by Medicare (Psychguides.com, 2014). Wellcome Georgia Wellcome Georgia offers medical nutrition therapy not covered by Medicare. Wellcare Georgia includes children and adolescents (Georgia Dept of Health, 2013). Normally, Wellcare Georgia healthcare service providers offer registered dietitian-based medical nutrition services to kidney patients and diabetes patients unlike the government, Medicare program that provides 20 percent co-insurance. What are the medical nutrition therapy (MNT) Limitations? 1) Number of yearly visits Blue Cross The company offers three hours of one-on-one consultation during the anorexia nervosa patients’ first year of medical nutrition therapy. This is supported by Medicare. Medicare includes the Blue Cross plan, the Medicare Advantage Plan and the original Medicare plan (BCBS, 2013). During the second year, third year and other future years, the anorexia nervosa patients are allowed two hours of medical nutrition therapy. Similarly, additional years of coverage after initial medical nutrition therapies are supported by Medicare. Medicare includes the Blue Cross plan, Medicare Advantage Plan, and the original Medicare plan. However, medical doctors are allowed to prescribe longer medical nutrition therapy visits, depending on the physical condition of the patients (BCBS, 2013). Wellcare of Georgia The company offers Wellcare Advance (HMO) plans. It also classified as Medicare Advance Health Maintenance Organization (HMO). The company offers Medicare benefits covered by Medicare Part A and Part B to its qualified anorexia nervosa patients. Unqualified anorexia nervosa patients include certain groups of end stage renal patients. Only end stage renal patients who are registered members of the Wellcare Georgia entity at the start of the end stage renal ailment, are eligible for actual coverage (Wellcare, 2012). An immunotherapy research conducted by Maver and other researchers indicated kidney ailments can be cured. The researchers’ study conducted between 1986 to 2000 indicated 17 of 24 respondent kidney patient cases had resumed ailment progression. On the other hand, the kidney conditions of the remaining seven respondent cases underwent remission (Maver et al., 2001). 2) Cost percentage reimbursement covered Blue Cross For in-network classification, the anorexia nervosa patients pay $0 copay for each medicare-covered medical nutrition therapy visit. For the out of network classification, the patients pay $0 for each Medicare covered consultation. Wellcare Georgia The company does not cover the anorexia nervosa patients’ prescribed drugs needed under the Medicare Part B classification or Medicare Part D classification. The company offers 20 percent coinsurance coverage for medical nutrition therapy for anorexia nervosa and other patients who have diabetes and those with kidney ailments, if the medical doctor prescribed the medical nutrition therapy. However, patients who are on dialysis do not qualify for the Wellcare Georgia benefits. Similarly, patients who underwent kidney transplant do not qualify for the Wellare Georgia benefits. This falls under the original Medicare plan. Next, Georgia’s Wellcare advance (HMO) members enjoy $0 co-payments for the self-monitoring training of diabetes patients. Georgia Wellcare diabetes patients can enjoy $0 copayment for medical nutrition therapy. Further, the same Georgia Wellcare patients enjoy $0 copayment for all diabetes supplies used. To enjoy the benefits of the Georgia Wellcare medical nutrition therapies, the patients must retain the medical nutrition therapy services of registered dietitian (Wellcare, 2012). 3) State variations Blue Cross Each Blue Cross and Blue Shield state has a different set of healthcare service providers. Different providers offer different competitive health services. Consequently, one service provider in one state may not offer the same medical nutrition therapy benefits. However, the Blue Cross and Blue Shield state generally offers medical nutrition therapy to its patients. The group offers the Medicare Preferred (PPO) Standard plan, and the Standard Senior Rx Plus benefits in all the states (BCBS, 2013). Medical nutrition therapy is a benefit given to patients afflicted with anorexia nervosa (BCBS, 2013). Wellcare Georgia The entity offers the Wellcare Advance HMO benefits to certain Georgia area anorexia nervosa patients. The areas include Cobb, Paulding, Fulton, DeKalb, and Douglas counties. Only Wellcare Georgia offers the Wellcare Value (MHO-POS) plan. The plan includes a point of service choice (Wellcare, 2012). Section 105 of the Benefits Improvement Protection Act of 2000 indicates that Medicare will pay for the medical nutrition therapy of the patients. The Act requires that benefits be allowed only if professionals implement the medical nutrition therapies. The professionals should either be registered dietitian or nutrition professional. Wellcare Georgia adheres to this government policy. 4) Plan type variations. Blue Cross Blue cross offers different plans to its anorexia nervosa and other patients. The Medicare Advantage HMO plan allows the group’s registered members reimbursement for health care services from the group’s member healthcare providers. The providers include medical doctors and hospitals. Next, the Medicare Advantage POS plan allows its anorexia nervosa and other patients to avail of services from healthcare providers that are not members of the group. The Medicare Advantage PPO allows its patients to enroll and share their reimbursements with the other service providers share in the patient’s healthcare expense reimbursements. The Medicare Advantage PFFS allows its anorexia nervosa members to avail reimbursement for healthcare services on a fee for services basis. The plan allows Medicaid Part A, Medicaid Part B and other related healthcare service reimbursements. The Blue Cross and Blue Shield group directly pays the healthcare service providers (BCBS, 2013). Wellcare Wellcare Georgia offers anorexia nervosa and other patients different healthcare plans (Wellcare, 2012). The Wellcare Value plan is classified as HMO-POS plan. Another plan is the original Medicare plan which includes the fee payment for each healthcare service delivered. A second choice is the Medicare Health Plan, which offers similar benefits under the HMO–POS plan. Anorexia nervosa patients covered by Medicare’s Part A and Medicare Part B plans will enjoy the benefits under the Wellcare Value plan or HMO–POS plan. The Wellcare Georgia anorexia nervosa plan holders are normally required to undergo medical care services of the entity’s member providers. However, Wellcare Georgia allows its members to seek medical care from healthcare providers outside of the entity’s umbrella under certain permissible conditions. References: Blue Cross and Blue Shield, 2012. Access Your Benefits. Retrieved August 2, 2014 from < http://www.bcbs.com/already-a-member/access-your-benefits.html > Blue Cross and Blue Shield, 2012. Medicare Advantage Overview. Retrieved August 2, 2014 from Georgia Dept of Health. (2013). Validation of Performance Measures. Phoenix: Health Services Advisory Group. Maver et al., (2001). Immunotherapy of Metastatic Kidney Cancer. International Journal of Cancer , 94 (1), 109-120. Medicare, 2014, Medicare Coverage of Medical Nutrition Therapy. retrieved from Read More