We recently hosted a webinar on Medicare Billing for Diabetes Self-Management Education and Support (DSME/S) and Medical Nutrition Therapy (MNT) with Jo Ellen Condon, Director of Education Recognition at the American Diabetes Association. Below is a Q&A with Jo Ellen that reflects some of the questions answered on the webinar as well as some received as follow-up questions via email.

In case you missed it, you can listen to a recording of the webinar HERE. You can also download a copy of the slides HERE.

Q: What are the biggest hurdles to becoming a recognized education program?

A: The first hurdle is getting a program up and running with a qualified educator that is trained to deliver quality DSME. Even this step can be a challenge in some areas. Once the program gets up and running, the next hurdle is establishing a process to drive referrals that will financially sustain the program.

Q: What are some resources that the American Diabetes Association provides at no cost to recognized education programs?  

A: The Education Recognition Program (ERP) website at www.diabetes.org/erp offers all of the templates and sample forms that a program needs to document education, track outcomes, and perform annual recognition requirements. The website also includes the advisory group template, population and program assessment template, program CQI project forms, and more. We offer all of these forms and templates for free.

In addition to the downloadable resources, the ERP also hosts four free monthly conference calls. The topics of these calls are:

1. The New Program Coordinator call: We walk new coordinators through the National Standards and our ERP website, templates, and resources.
2. The Application call: We review the most common reasons why an application may get a “more information is required” response when submitted.
3. The Annual Status Report call: We walk through how to complete the annual status report.
4. The Chronicle Diabetes (CD) call: We recently added this call to walk through the use of CD, which is an electronic charting system for diabetes education.

These calls are very well-attended and many join us for more than one call.

Registration for these calls is located on the ERP landing page (login required). There is a button at the top of the page called: Monthly Q&A Conference Calls.

Q: Aside from the ability to bill Medicare for DSME, what are the other benefits to being an ERP?

A: Many state Medicaid insurance and private insurance plans also require that the DSME program be recognized or accredited. Recognition demonstrates that a program delivers quality education based on the National Standards for Diabetes Self-Management Education. These standards are reviewed and revised every five years to ensure they are relevant per current research.

Q: Who can write the referral for DSME and what does the referral need to include in order to meet Medicare standards?

A: The provider managing the individual’s diabetes mellitus condition must write the referral. Please see slides 32-34 (download above) for the exact referral requirements.

Q: Do you have to be a CDE in order to be a part of an ERP?

A: No the minimal educator requirement is RD, RN, RPh, or CDE. If the RD, RN, or RPh is not a CDE or BC-ADM, then they must get 15 hours of CEUs annually in diabetes mellitus or diabetes mellitus related topics.

Q: Prior to joining the American Diabetes Association, you were providing MNT and had been part of an ERP. This puts you in a unique position as you’ve seen both sides of this process. How is your current position at the American Diabetes Association an extension of your mission to maximize the best in diabetes care?

A: My experience with a DSME program afforded me a clear understanding of the daily tasks associated with the role, as well as the importance of a well-orchestrated referral process. It also allowed me to fully understand the value of a DSME program and how the outcomes impact both the income and cost savings for a hospital.

Being in a private practice provided me with the experience of applying to both in-network and with insurance companies. This allowed for better interpretation of reimbursement language. I have leaned on this experience to review policy change requests. It has also given me a better understanding of the struggles that a diabetes educator often faces with reimbursement and has allowed me to represent them more authentically. Since I have joined, we have increased the free ERP resources and monthly conference calls because we know that diabetes educators need these tools and we are focused on supporting them.

Thank you to Jo Ellen for taking the time to answer our questions. Please leave any additional comments or questions in the comments section below and we will respond to them.