Association of Diabetes Care & Education Specialists

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Barriers to Maintaining an Accredited Diabetes Education Program

May 26, 2015

Since becoming accredited in November 2011, our internal medicine practice has billed but has not received reimbursement for DSMT. It is difficult to maintain a program when revenue is not being generated and we have considered suspending our accreditation program. 

Our biller is not having much luck at finding the reason we are not being reimbursed. Possible reasons for lack of reimbursement include problems in the clearinghouse, deductibles not having been met, and one insurance company simply told us DSMT is not reimbursed. We definitely will continue to provide diabetes education but outcomes need to be collected to maintain accreditation.

As the nurse practitioner and diabetes educator, I can generate more revenue for the practice serving as the nurse practitioner treating patients instead of being in the CDE role providing DSMT. We have been conducting shared medical appointments but because no billing code exists for such visits, no outcomes are collected and reported. Accreditation was the means by which we want to show our outcomes to Medicare and insurance carriers. 

At this point, we have decreased our diabetes education sessions to a four-hour period once a week until we make a definite decision to continue or suspend the program. My understanding is that some programs charge a flat fee for DSMT and don’t even bother billing insurance; however, the majority of our patients are older adults who are on Medicare. They are already responsible for the yearly deductible and the 20 percent not covered by Medicare so paying for diabetes education is not a priority.

In Texas, there are ongoing reimbursement issues with Medicaid and many practices are having difficulty remaining open which compounds the problem of trying to keep our accredited program financially viable.

Is anyone else having reimbursement issues or if you have, how were you able to solve them?

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