|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||||||||||
New Medicare reimbursement rates that took effect at the beginning of the year are getting mixed reviews from both the policy and caregiver sides of health care. Federal officials claim that increased payment rates will expand access for Medicare beneficiaries in underserved rural and urban areas, but critics contend that the changes are a case of too little, too late.
Although the new payment rates have been in effect only a month, it's been a roller-coaster ride for those following Medicare reimbursement coverage.
First, the Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for administering the Medicare program, announced its physician payment rates and policies for 2007 this past November. The revisions included higher reimbursement rates for outpatient diabetes self-management training (DSMT) and medical nutrition therapy.
Medicare has reimbursed physicians and qualified providers for a broad range of preventive services for several years, including DSMT and medical nutrition therapy services, but CMS officials say the rates for 2007 expand reimbursement options.
DO CHANGES GO FAR ENOUGH?
"The problem with Medicare reimbursement, either this year or next, is that it's too little, in terms of both money and time," says Martha Rinker, chief advocacy officer for the American Association of Diabetes Educators. AADE would like Congress to expand DSMT reimbursement to allow more time for training and increase the number of sessions for which a beneficiary is eligible, notes Rinker. "The current rate of $10 an hour is simply not enough to cover resources."
Byproducts of the Deficit Reduction Act (DRA) of 2005, DSMT and medical nutrition therapy now are separately payable and included in the federally qualified health center (FQHC) benefit. Coverage is for Part B preventive services, but the DRA adds DSMT and medical nutrition therapy for beneficiaries with diabetes or renal disease to the list of services Medicare pays for when delivered at FQHCs. Urban FQHC payment rates for 2007 will increase from $112.96 to $115.33, and rural FQHCs are eligible for a 2.1% increase: from $97.13 to $99.17.
A patient's doctor must provide a written order to a certified diabetes self-management education program, and a plan of care must be written to include the number of sessions, frequency, and duration of the training, according to a CMS tip sheet.1
AADE wants Congress to change the physician referral requirement. "That's one of the issues we'd like to correct: that DSMT has to be MD referred. Other providers like physical therapists can refer beneficiaries, and we'd like to see that corrected for DSMT as well," says Rinker. A secondary issue, she adds, is that CMS does not recognize certified diabetes educators as qualified providers.
Medical nutrition therapy, when ordered by a physician, is covered for
beneficiaries with diabetes. A registered dietitian or Medicare-approved
nutrition professional can administer the therapy, which should include
nutritional assessment and counseling. CMS also is expanding coverage to
include individual medical nutrition therapy administered through an
interactive telecommunications system, according to the CMS Web site.
References
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
