Registered dietitians play an integral part in managing chronic diseases from counseling after radiation therapy to coaching patients with diabetes. In this webinar hosted by the South Central Telehealth Resource Center and the National Telehealth Resource Center consortium, Dee Pratt, RDN, LDN, shares her lessons learned in developing her Tele-Nutrition specialty as well as how she continues to offer nutrition therapy via telemedicine technology.

Follow-up Participant Questions:

Q: You reference originating site and state that the patient must be in rural area and at qualifying location, and this is a known medicare requirement; however, do 3rd party payers actually enforce these same guidelines? Most 3rd party payers promote telemedicine platforms (Teledoc, Doctor on Demand, etc…) to their patients and these platforms allow the patient to be at home and the patient does not have to be in a rural area to receive this care. How would the requirements be any different for tele-nutrition?

A: Just as insurance can vary from state to state or insurance company to different company, you will find that tele-nutrition rules vary widely. Medicare is federal and is the same throughout the country but 3rd party payers can vary greatly. As I mentioned on the webinar that many of the rules will vary based on the “parity laws”. They differ state to state. In my state (TN), I cannot see anyone in their homes or in areas that don’t meet the guidelines for rural health if I wish to be reimbursed by 3 party payers. NOTE: I can see these folks anywhere if they are paying out of pocket. The rules can be different for physicians and there are some places where there is a grant and the dietitian may be working under their guidelines and being paid by the grant money and not 3 party payers directly.  Third party payers can set their own rules so you will need to check with your state third party payers and your parity laws which are of great importance to your coverage outside of Medicare. Also there are some states that have approved Medicaid reimbursement via Tele-nutrition but not in TN

Q: Is video a requirement? Can you talk about other forms of virtual nutrition services that seem to be popping up?

A: Video is a requirement unless you live in Alaska or Hawaii where “store and forward” is allowed for dietitians.  This can be done for physicians in several states but is not approved as widely for dietitians.

Q: Did you piece the technical things together, or do you use a particular vendor?

A: No I handle the components myself which is not that involved once you agree on a telecommunications company.

Q: What telecommunications services have you used or others used that you have found to be successful?

A: I have used V-See and Zoom and both are great.

Q: Are there only certain disease states/conditions you can provide tele-nutrition for?

A: We provide for all disease states with Tele-nutrition just as we do in our offices and because  of our State parity law, we can be reimbursed by the same companies that we receive payment from in our offices for regular outpatients.

Q: What telemed IT system do you use?

A: We use Zoom but we have used V-See. Be sure to get the BAA agreement whichever you chose.

Q: How do you handle the appointments?  Is it through the appointment software or EMR or just in your own calendar?

A: Scheduled through Office Ally

Q: Would you please clarify the necessity of licensure for reimbursement? Michigan does not have licensure at this time.

A: Medicare along with most insurance companies require licensure for reimbursement when you apply to become a provider but if there is not licensure in the state, they require your CDR card for credentialing in most cases.

Q: From a process perspective…do you send the education materials to the patient BEFORE your tele-nutritional visit and before you do the education.

A: No the education materials are shown on the screen through your “share screen” during the session. We then email or mail the patient the materials they were shown on screen.

Q: Can the DSMT code G0108 be reimbursed for dietitians using telehealth?

A: Yes, DSMT is reimbursable under that code (in Tennessee).

Q: Will the slides be available on the webiste as well?

A: Yes, view slides (Tele-Nutrition slides 2016).

Q: Where/How do you get your patient referrals?

A: Physicians and Nurse Practitioners in the clinics refer the patients.

Q: Do you have to go out and sell/market your services to referral sources?

A: Yes, we have marketed our services to many physician offices in our area.