Medicare MNT Systems Evaluation

Use this form to review components and steps to implementing the Medicare MNT benefit, and as an audit tool for the benefit.

*If "needs improvement" of "not in use" then record your measurable follow-up plan which includes anticipated follow-up date and responsible person. Utilize QI process (PDSA).  Identify root cause.

 I. Access Actions (pre MNT encounter)  In Use  Needs Improvement* Not in use*
 a. Eligibility Verified (Medicare card copied)                
 b. MSP screen complete      
 c. Communicate information to beneficiary  about co-pay and deductible, ABN as indicated      
 d. Referral Documentation Complete- Diagnosis and medical necessity for MNT      

 II. MNT Protocol Implementation

      
 a. Assessment complete       
 b. Progress notes complete      
 c. Medicare MNT log complete      
 d. Outcomes Management Tracking Forms complete      
 III. Claims Processing      
 a. HCFA 1500 complete      
 b. Signature on file for file beneficiary      
 c. Initial Claims submitted timely      

 d. No claims are returned or rejected (an incompleted claim with missing information, invalid claim is any claim that contains complete and necessary information however, the information is illogical or incorrect.)

      
 e. Appeals submitted timely for all denials      
 IV. Compliance      
 a. Policies and procedures reflect actual practice (including HIPAA)      
 b. Medical Record Documentation Self Audit Forms completed quarterly      
 c. Medicare education/training attended/provided as per business/compliance plan      
 d. Data trended over time is used to detemine need for further changes to Medicare MNT Service      

 

Signature: Date:

American Dietetic Association; March 2002


 

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