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Greetings!!
Fall is in the air and the holidays
are on their way! Time is flying by
as we head into the second half of
our membership year. For those
of you who were able to attend
FNCE this year, I hope you were
able to attend our member reception and take full advantage of
the endless networking opportunities. It was wonderful to see
familiar faces, good friends I have
made throughout the years, make
new acquaintances and meet new
DPG members. I am consistently
amazed at the talent, diversity
and passion to be found within
our organization.
While in Atlanta, we also had one
of our two face-to-face Executive
Committee meetings during
which we had a robust discussion
and review of our Strategic Plan. I
Fall, 2014
Volume 33, No 4
13-16
Featured
Member
17
CNM Executive
Committee
18
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Fall 2014
CPT
Code
97802
97803
97804
G0270
G0271
Description
Medical Nutrition Therapy; initial
assessment and intervention, individual, face-to-face with the patient,
each 15 minutes
Medical Nutrition Therapy; reassessment and intervention, individual, face-to-face with the patient,
each 15 minutes
Group Medical Nutrition Therapy; (2
or more individuals), each 30 minutes
MNT reassessment (2nd referral) for
change in condition /diagnosis /
treatment, individual (15 minute
units)
MNT reassessment (2nd referral) for
change in condition /diagnosis /
treatment, group (30 minute units)
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derstanding that some of this professional education will be done on the RDs own time, i.e. above
and beyond the normal work day. In our outpatient practice, up to five days per year may be
blocked from each full time RDs schedule to allow them to attend educational conferences.
This time, therefore, is not revenue generating
and should be accounted for when determining
the costs for providing care.
In addition to essential professional education
time that can be considered non-productive or
non-revenue generating, RDs accrue paid time
off (PTO) benefits that can be used for vacation
and/or sick leave. This time needs to be accounted for in the same way as professional education time, and may vary depending on the RDs
length of service with the company.
Many healthcare organizations pay the costs of
registration, licensing, and/or professional certifications, and memberships for their clinical staff,
including registered dietitians. Membership in
the Academy of Nutrition and Dietetics, as well as
annual registration dues through the Commission
on Dietetics Registration should be covered. Dietetic Practice Groups and/or Member Interest
Group membership can assist the RD in providing
excellent patient care, and therefore membership to at least one of these should be paid for
each RD. Some organizations will also pay for a
professional certification every five years, such as
the Certified Diabetes Educator or Certified Specialist in Pediatrics credentials. Additionally, malpractice insurance is almost always paid by the
healthcare organization on behalf of their clinicians, including RDs. All of these expenses contribute to the overall cost of providing MNT in
the outpatient setting.
Client Scheduling / Registration Costs
Registration, scheduling, and billing functions
should be completed by support staff, not the
RD. Dietitians may not find these tasks to be professionally satisfying, which can lead to reduced
employee satisfaction and possibly increased RD
Fall 2014
turnover. Equally important is the fact that most medical record and communicating with other
RDs are not always competent at these tasks,
healthcare providers for care coordination.
especially when it comes to navigating the billing
Therefore, time should be blocked out of the paprocess and negotiating / communicating with
tient care schedule periodically to ensure RDs
insurance providers. If working within a healthhave time to document the patient care encouncare facility, RDs can usually utilize the expertise
ter in a timely manner. This is considered nonrevenue generating time, yet these activities are
of staff members who are specifically dedicated
essential to providing care and seeking reimto handling these functions on behalf of the orbursement. The time dediganization. It may be difficult
to determine exactly how
RDs can bill for time spent cated towards these activities should be considered in
much time support staff memface-to-face
with
clients,
but
the overall costs for providbers dedicate to the MNT visits, but they are costs that
not for time spent document- ing MNT.
need to be considered when
determining the overall cost of ing in the medical record and For example, if documentcommunicating with
ing the initial visit and colproviding the MNT service.
other healthcare providers laborating with other
healthcare providers to coAssessing the time required to
ordinate care generally
receive referrals, follow up
takes 20 minutes for a new client, the RD specific
with potential patients, and send appointment
labor plus benefits cost would be divided by the
and other pertinent letters may help determine
4 or 5 units of MNT for an initial visit to assess
how many minutes are required to schedule and
the specific cost per 15 minute unit of an initial
register each new client. This total cost can be
visit. A typical scenario includes the RD spending
divided by the average of 4 or 5 units of MNT,
20 minutes documenting the 1 hour initial MNT
depending on the duration of an initial visit, and
visit, so 20 minutes 4 units = 5 minutes of docuthen added into the total cost. Generally less
time is required for scheduling, etc., for follow up mentation/care coordination time per 15 minute
increment. For follow up clients, both charting
clients.
and follow up may be of shorter duration, so the
costs should be calculated appropriately.
Patients occasionally do not show up for their
appointments, and without adequate notice anSupply Costs
other patient visit cannot be scheduled in that
time slot. This causes non-revenue generating
It is important to consider all supply costs intime for the RD. An adjustment factor for this
volved with providing MNT services. This can
time, based on the facilitys historical data of no include food and nutrition specific supplies, ofshow rates, can be included in the ABC account- fice supplies, equipment, and educational mateing method. These calculations can be complex
rials used in patient care. Equipment costs genand estimated differently depending on the facil- erally include phone bills, printer/fax/copier
ity. The calculations are beyond the scope of this maintenance costs, and other similar equipment
article, thus a no show factor is not included in
needs. Historical data can be used to determine
the examples provided.
monthly averages for these supplies, but projections should also be made for supply costs when
Charting / Documentation Time
new services are planned. If RDs are required to
RDs can bill for time spent face-to-face with clicarry pagers or cell phones on which clients and
other healthcare providers can reach them, this
ents, but not for time spent documenting in the
expense should be considered a supply cost.
4
Per 15
minute
$11.91
$0.16
$0.06
Education Materials
Equipment
$1.00
$0.12
Ancillary Support
$2.93
$3.97
Total cost
$20.32
$0.17
Fall 2014
Table 2: Costs to provide MNT for CPT code 97802, initial assessment and intervention, per 15
minute unit
5
Source of cost
RD Salary, Benefits &
G&A
Per 30
minute
$7.94
$0.10
Education Materials
Equipment
$1.50
$0.08
Ancillary Support
$2.34
$2.38
Total cost
$14.49
$0.04
$0.11
Fall 2014
Table 3: Costs to provide MNT for CPT code 97804, group MNT, per 30 minute unit. Assumption
made for an average of 3 participants per class, thus costs are divided by 3 in relevant categories.
Determining Expected Reimbursement
Reimbursement for MNT is dependent on the
insurance policy, and may vary based on the accompanying ICD-9 code. For example, Medicare
reimburses MNT visits for clients with diabetes
and end stage kidney disease, but not for other
diagnoses. The dollar amount reimbursed varies
depending on the insurance provider, and usually
also on geographical location. Many hospitals
and health systems have negotiated a reduced
rate with some insurance providers in order to
become the hospital of choice for that insurance
companys patients. This type of information is
important to know when determining expected
reimbursement. The CNM can work with the
hospitals billing department to determine expected reimbursement rates for MNT procedure
codes depending on the payment source. The
Centers for Medicare and Medicaid Services web6
Month
CPT Code
# Units Billed
# Clients
Fall 2014
References
1. Activity Based Costing (ABC) For Hospitals.
Yardley Management Solutions, Inc Website.
http://www.ymsolutions.com/hospital-costaccounting/45-activity-based-costing-abc-forCost / Unit
hospitals-and-health-systems. Accessed June
Expected Revenue
30, 2014.
Total Revenue
2. Franz MJ, Monk A, Bergenstal R, Mazze R.
Outcomes and Cost-Effectiveness of Medical
Table 4. Sample revenue tracker for MNT services
Nutrition Therapy for Non-Insulin-Dependent
Diabetes Mellitus. Diabetes Spectrum. 1996;
for-service or fee-for-product basis. Group pro9:122-127.
grams for health conditions such as weight man3. MNT CPT and G Codes and Definitions. Acadagement, pulmonary or cardiac disease may be
emy of Nutrition and Dietetics website.
billed in part through these codes but may also
http://www.eatright.org/Members/
include product sales such as nutrition workcontent.aspx?id=7495. Accessed June 22,
books. The time and resources to deliver services
2014.
can be systematically calculated to arrive at an
4. Shadix K, Bell-Wilson JA. Finding Your Niche
appropriate cost-based accounting fee for all ser Certification Options for the RD Todays
vices.
Dietitian. 2007;9:40.
5. Physician Fee Schedule Search. Centers for
Periodic Evaluation
Medicare and Medicaid Services website.
The costs of providing care should be rehttp://www.cms.gov/apps/physician-feeevaluated on an annual basis. Supply costs
schedule/search/search-criteria.aspx. Upshould be tracked, and a new monthly average
dated April 17, 2014. Accessed June 22,
calculated at the end of the year. Dietitians usu2014.
ally earn raises each year, which changes costs.
Additionally, the benefit cost ratio may change in Wendy Phillips is the Director of Nutrition SysJanuary of each year depending on tax rates and
tems at the University of Virginia Health System,
insurance rate adjustments, so the salary plus
and a Regional Clinical Nutrition Manager with
benefit cost needs to be updated yearly.
Morrison Management Specialists. She can be
reached at wp4b@virginia.edu.
One of the advantages of ABC accounting is that
it allows the hospital or healthcare system to neCynthia Moore is the Assistant Clinical Nutrition
gotiate an employee rate for nutrition services
that is just at or below the cost to deliver the ser- Manager for Ambulatory Care Services at the University of Virginia Health System. She can be
vice. This provides the health system with spereached at clp6g@virginia.edu.
cific knowledge of the cost of service and allows
them flexibility to negotiate discounts both for
Keith Batt is a Business Consultant in the Environthemselves (if self-insured) and other insurance
ment of Care Division for the University of Vircarriers.
ginia Health System. He can be reached at
The authors would like to acknowledge Robert
kb4u@virginia.edu.
Nunley, Manager of Cost Accounting, Medical
Center Finance, University of Virginia Health System, for his assistance.
7
97802
97803
97804
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Fall 2014
Fall 2014
References
1. Brun J. Nutrition education: A model for effectiveness a synthesis of research. J Nutr Educ.
1985;17(2):iiS44.
2. Ho M, Garnett SP, Baur L, et al. Effectiveness
of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics.
2012;130(6):e164771.
3. Contento I. Review of nutrition education research in the Journal of Nutrition Education
and Behavior, 1998 to 2007. J Nutr Educ Behav. 2008;40(6):33140.
4. Gillespie AH, Brun JK. Trends and challenges
for nutrition education research. J Nutr Educ.
1992;24(5):222226.
5. Spahn JM, Reeves RS, Keim KS, et al. State of
the evidence regarding behavior change theories and strategies in nutrition counseling to
facilitate health and food behavior change. J
Am Diet Assoc. 2010;110(6):87991.
6. Nation M, Crusto C, Wandersman A, et al.
What works in prevention: Principles of effective prevention programs. Am Psychol.
2003;58(6-7):449456.
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12
Features Editors:
Interested in contributing an article to
Leigh-Anne Wooten, MS, RD, LDN the newsletter? Topics of interest in704-355-6660
clude leadership, management, innoleighannewooten@yahoo.com
Amanda Nederostek, MS, RD, CD
(801) 662-5303
amanda.nederostek@imail.org
Fall 2014
Fall 2014
14
Fall 2014
Fall 2014
No
No
No
No
If you answered Yes to any of the questions, public policy impacts the way you work. So how do
you make a difference in policy?
The Academy actually takes care of a lot of the leg work for us. The Policy Initiatives and Advocacy
(PIA) Team in Washington, D.C. identifies opportunities and challenges in legislative and regulatory
activity. That team then provides guidance to grassroots advocates, like myself, on how to help our
members take action. Our efforts are bi-partisan, so you can get involved in the political process
without getting caught up in the politics.
To take action, you can simply complete an Action Alert when you see it in your in-box. It literally
takes two minutes (I timed myself). Did you know that only 3.3% of Academy members sent letters
to congress to support the National Diabetes Clinical Care Commission Act? We can do better than
that!
Please click on the next Action Alert you see. If you have any questions or suggestions on information
you would like me to present to our DPG, you can reach me at Julie.haase@wfhc.org or at
414.213.6875.
16
Fall 2014
Fall 2014
Secretary
Jennifer Wilson, MS, RD, LDN
wilsonjs@ph.upmc.edu
Treasurer
Janet Barcroft, RD, LDN
Janet.Barcroft@H2U.com
Newsletter Managing Editor
Jennifer Doley, MBA, RD, CNSC, FAND
jdoley@carondelet.org
Features Editors
Lisa E. Trombley, MA, RD, CNSC
ltrombley@dhs.lacounty.gov
Leigh-Anne Wooten, MS, RD, LDN
leighannewooten@yahoo.com
Amanda Nederostek, MS, RD, CD
Amanda.nederostek@imail.org
Nominating Committee Chair
Lisa Cherry, MS, RD, CNSC
lisacherry@gmail.com
Kelly Danis, RD, LDN
daniska@upmc.edu
Chair Elect
Wendy Phillips, MS, RD, CNSC, CLE
Wp4b@virginia.edu
Committee Members
Tamara Smith, RD, LD
tsmith@kmc.org
CNM DPG Delegate to the HOD
Mary Jane Rogalski, MBA, RD, LDN
mrogard@charter.net
18
Research Co-Chairs
Susan DeHoog, RD
sdehoog@u.washington.edu
Barbara Isaacs Jordan, MS, RD,
CDN
jordanb@mskcc.org
Research DPBRN Liaison
Jessie Pavlinac, MS, RD, CSR, LD
pavlinac@ohsu.edu
Committee Members
Debby Kasper, RD, LDN, SNS
debby_kasper@premierinc.com
Barbara Lusk, RD, LDN
blusk@stanfordchildrens.org
Quality and Process
Improvement Chair
Sherri L. Jones,
MS, MBA, RD, LDN, FAND
jonessl@upmc.edu
Quality and Process
Improvement Vice-Chair
Cynthia Hamilton, MS, RD, LD
hamiltoc@ccf.org
Fundraising Chair
Sharron Lent, RD, LD
Lent-sharron@aramark.com
Immediate Past Chair
Monica Milonovich, MS, RD, LD
mmilonov@yahoo.com
Academy of Nutrition and
Dietetics Manager, DPG / MIG
Relations
Mya Wilson, MPH, MBA
mwilson@eatright.org