Reimbursement Corner - July 2018

I am sharing information from a great webinar I viewed, provided by Mary Ann Hodorowicz, RDN, MBA, CDE: Billing and Reimbursement for Diabetes Outpatient Services. Mary Ann is a true expert in the dietitian-related billing and coding arena, and provided great tips on how we can identify and increase opportunities for insurance reimbursement!

As Mary Ann points out: reimbursement can be confusing, complex, complicated, convoluted, copies, cumbersome, and constantly changing. To bring some clarity to the topic, she conducted 2 two-hour webinars – WOW!

I will share some key tips over the next few months.

How to optimize billing, coding, and reimbursement for nutrition, DSMES (Diabetes Self-Management, Education, and Support), and related health insurer benefits: tips 1 to 7.

#1. Identify the potential health insurance carriers you will be billing for nutrition-related services:

  • Medicare

  • Medicaid

  • Commercial health insurance carriers that cover residents of Iowa (Wellmark Blue Cross & Blue Shield, United Health Care, Aetna, Cigna, etc.).

#2. Know that each carrier/plan typically has a ‘coverage policy’ for benefits that may apply to most or all of its’ health plan offerings. However, each plan can have varying: deductibles, out-of-pocket maximums, premiums, reimbursement rates, etc.

#3. Determine IF MNT, DSME, and related benefits are covered by each respective insurance carrier. Use these categories:

  • Preventive Medicine and Behavioral Therapy

  • Diabetes Prevention

  • MNT and Nutrition Counseling / Classes

  • Obesity Counseling and Weight Management

  • Diabetes Management and Education

  • Continuous Glucose Monitoring & Insulin Pump Initiation

  • Patient Education for Disease Self-Management

  • Remote Monitoring and Chronic Care Management

#4. For each covered benefit, identify the associated procedure codes, the frequency of coverage (hours, visits) and time frames (calendar year, or rolling year) for initial and follow-up interventions.

#5. For each covered benefit, identify:

  • Payable ICD-10 diagnosis codes.

  • Approved billing providers, and rendering physicians

  • Reimbursement rates

  • Approved places of service

  • Patient eligibility

#6. Know ‘rules of thumb’ for coding, billing, and reimbursement.

More information coming next time!

In the meantime, though, if you have questions, please contact me at

Reimbursement Corner By Susie Roberts, RDN, LD


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