Mid-levels and dietitian services

[sbellin]

As PA in a rural area that has a practice focus on treating diabetics I was informed today by our hospital dietitian that Medicare will not pay for dietitian services ordered by a mid-level. Like home health services, dietitian counseling can only be ordered and signed by a physician. Has anyone else encountered this obstacle.

[TXPA23]

i order home health and nutrition consults all the time...this person has been misinformed.

[coloradopa]

As PA in a rural area that has a practice focus on treating diabetics I was informed today by our hospital dietitian that Medicare will not pay for dietitian services ordered by a mid-level. Like home health services, dietitian counseling can only be ordered and signed by a physician. Has anyone else encountered this obstacle.

Find a new nutritionist. If you really care you can show them this:

https://questions.medicare.gov/app/answers/detail/a_id/2181/~/what-diabetic-services-does-medicare-cover%3F

 

The specific part they need to understand:

If you’ve been diagnosed with diabetes, Medicare may cover up to ten hours of initial diabetes self-management training. You may also qualify for up to two hours of follow-up training each year if

 

• it is provided in a group of 2 to 20 people*,
  
• it lasts for at least 30 minutes,
  
• it takes place in a calendar year following the year you got your initial training, and
  
• your doctor or a qualified non-physician practitioner ordered it as part of your plan of care.
  

My discussion with their supervisor usually is along the lines of "you provide great service, its a shame that we can't continue to use you".

 

For what its worth a lot of the regs say "physician", but if you have even the most basic understanding of Medicare you would understand that this means physician and NPP.

 

David Carpenter, PA-C

[tainolee]

I am a registered dietitian and Medicare indeed covers Diabetes and Renal Disease (as of last yr when I stopped counseling) As long as the dx code is on the prescription (for example 250.01).... there are tons of dx codes for diabetes and renal diseases.... but if they aren't 5 digit than Medicare won't accept. Also the Rx needs to be renewed every year...... and in order for medicare to cover the fasting BG must be above 126 mg/dl.... Medicare has lots of rules for counseling, I had to keep my f/u sheets separately from a "narrative" after each visit. There is also a separate chart/check sheet I had to fill out showing the pt's progress.

[coloradopa]

For further information you can look here, which are the actual Medicare guidelines for physicians and providers:

https://www.cms.gov/MLNProducts/downloads/mps_guide_web-061305.pdf

 

Start around page 65. But for a quote from the reasons claims are denied:

Reasons for Claim Denial

The following are examples of situations where Medicare may deny coverage of DSMT services:

 

The beneficiary has exceeded the 10-hour limit of training,

The physician or qualified non-physician practitioner did not order the training, or

The individual furnishing the DSMT is not accredited by Medicare.

 

David Carpenter, PA-C