Document Type

Thesis

Degree

Master of Science (MS)

Department

Dietetics and Nutrition

First Advisor's Name

Susan P. Himburg

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Joseph Rogers

Third Advisor's Name

Michele Ciccazzo

Date of Defense

3-15-2002

Abstract

The purpose of this study was to describe and inform registered dietitians (RDs) in the State of Florida what insurance companies are providing in terms of medical nutrition therapy (MNT) coverage.

A questionnaire was developed to encompass major MNT reimbursement stipulations such as policies, specific diseases coverage, specific Current Procedural Terminology (CPT) codes and descriptors, use of the medical necessity letter and nutrition cost benefits analysis (CBA). The questionnaire, encompassing 27 plans (HMO, PPO, Indemnity, Medicare, Medicaid), also served as a MNT promotional tool for 11 top administrators from insurance companies (10 private, 1 government) around the State of Florida. The results showed that 78% of all plans reimbursed for MNT caseby- case even without specific MNT policies. Sixty-seven percent of the plans would approve for MNT reimbursement with a medical necessity letter. Half of these top administrators showed an optimistic interest in using nutrition CBAs, case studies and practice protocols for creating MNT policies. The top ranked CPT codes were found to be 99204 (1), 99202 (2), 99201 (2), 99203 (3). The most recognized corresponding descriptors with the CPT were MNT, disease management skills and training and nutritional counseling.

This questionnaire may be used to create additional MNT reimbursement audits or research. The results given in this study can aid RDs in proper documentation on insurance claim forms, usage of the medical necessity letter, nutrition CBAs, practice guidelines and case studies for successful MNT reimbursement.

Identifier

FI14052521

Comments

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