The Impact of Gaining Provider Status in the Medicare Program: What All Dietetics Professionals Need to Know

Abstract

Along with recognition as Medicare providers∗∗CMS allows persons credentialed as “registered dietitians” with CDR to use that credential as proof of the education and experience requirements. The statutory intent to recognize state licensure is clear, and dietitians in states with licensure or certification must have obtained the state license or certification to become providers. If RDs practice in more than one state and enroll to become Medicare providers, they will need proof of licensure in all states where they practice. Individuals who complete an accredited dietetics program after completion of a bachelor's degree would meet the legislative intent to qualify as a provider. CMS’ final rule clarifies that Medicare will pay dietitians who enroll to obtain provider status in the Medicare program regardless of whether they provide the MNT services in an independent practice setting, hospital outpatient department or any other setting, except for services provided to patients in an inpatient stay in a hospital or skilled nursing facility. Current rules regarding reassignment of benefits apply to MNT. Reassignment applies to RDs who choose to enroll for Medicare provider status and who are employed by hospitals or physician clinics. for the Medical Nutrition Therapy (MNT) benefit for diabetes and kidney disease comes a higher level of exposure and accountability for dietetics professionals. Dietetics professionals have been able to operate independently, setting their own rates, administrative functions, billing practices, etc. As of January 2002, however, all this changed. Medicare MNT providers are now exposed to potential civil and monetary penalties if they fail to meet specific civil and administrative regulatory statutes related to fraud and abuse of the Medicare program. The federal government suggests Medicare MNT providers establish a compliance program. ADA assists practitioners in meeting compliance guidelines by providing key resources: the Code of Ethics, the Standards of Professional Practice, the Professional Development Portfolio and publication of MNT Medicare provider resources and MNT Medicare workshops.