I have recently learned that CMS (Centers for Medicare and Medicaid Services) has released a proposed rule for the Physician Fee Schedule to start in January of 2017. The DSMT (Diabetes Self-Management Training) and DPP (Diabetes Prevention Program) payments are part of this fee schedule. The new proposal would potentially improve payment accuracy for DSMT preventative services as well as expand the DPP model.
CMS requires providers adhere to rules for defined services and to the CMS standards for providers of those services. These are quite complex and confusing as they relate to reimbursement for DSMT. Several areas of concern have been expressed by the DSMT community providers and the National Accrediting Organizations (NAO).
- Concern that claims may be rejected or denied because of confusion regarding credentials of individual providers of DSMT services. The Medicare Administrator Contractor does not determine the credentialing. It is done by the NAOs.
- Questions regarding individual DSMT services rendered individually rather than by group. CMS requires documentation of special circumstances such as severe hearing, vision or language limitations requiring individual training, in order to quality for payment for services. It must be ordered by the physician or nurse practitioner.
- Confusion as to where DSMT services may be provided.
CMS acknowledges there may be other barriers to access to the DSMT services. It is asking for public comment on the concerns noted above and others that those providing DMST may have found in their practice. It is asking for comments on the accuracy of the Medicare payments and information on the actual time and intensity of service provided. Service and supplies should be included in calculation for practice expenses.
The public comment period ends September 6, 2016. The comments are reviewed and taken into consideration when developing the final rule. This is an opportunity to make CMS aware of your ideas. To access the comment page in the Federal Register, Click Here. In the comment section I suggest checking the tips for comments before writing yours in order to have your thoughts and ideas are as effective as possible. Follow the instructions to complete your comment.