Article I



POLICY

An important aspect of diabetes management is the patient’s ability to self-manage their disease. [Clinic Name] supports patient self-management by providing access to Diabetic Education through referrals to local resources. This policy outlines our commitment to ensure that referrals for Diabetes Self-Management Education Services (DSMES) and Medical Nutrition Therapy (MNT) are identified and referred promptly (within 2 weeks of visit).

PROCEDURE

Referral Procedure

1. Provider verifies that the patient qualifies for the service ordered.

a. If MNT is ordered, the referral must be signed by an MD, not a PA or NP.

2. Scan the referral into the Electronic Health Record (EHR) using the patient’s medical record number.

a. Verify with the patient’s insurance to determine whether the service ordered is covered.

i. Medicare or Medicaid (all 5 plans under Healthy Louisiana) both MNT & DSMT is covered for newly diagnosed diabetes, poorly controlled diabetes, and chronic renal failure.

ii. Private Insurance, verify coverage with the insurance company.

iii. Private Pay (no insurance), inform the patient there will be a charge. If they would like to meet with the Financial Aid Consultant provide them with his/her contact information. The patient is then responsible for providing the proper financial documentation to the Consultant to determine their uncompensated care coverage for the service(s) ordered.

3. Send order for DSME referral.

a. If MNT is ordered, schedule an MNT Initial visit on any day after the DSMT Initial and not on the same day. The patient cannot be billed for DSMT and MNT on the same day.

4. Referrals for Medical Nutrition Therapy

a. Referrals for MNT cover 3 hours of MNT in the initial calendar year.

b. No initial hours can be carried over to the next calendar year.

c. The calendar year ends in December; therefore, a new referral is needed to provide MNT in the next calendar year.

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