August 15, 2008, Newsletter Issue #167: Medicare and Self-Management Training

Tip of the Week

Proper self-care for diabetes is the key in preventing complications, and obtaining prompt and appropriate treatment.

The Balanced Budget Act of 1997 provided for coverage of some diabetic-related supplies and self-management services, to decrease the risk factors associated with having diabetes.

In order to qualify for payment of self-management services, your physician must certify that the services are provided to you under a comprehensive plan of care.

The physician or other individuals that provide other Medicare and Medicare Part D services, can provide self-management training services. They can then bill Medicare for the services. If they accept the assignment, Medicare will reimburse the physician or individual for 80% of the cost of the training. This does not include the services of a Registered Dietitian, who is reimbursed at 85% of the costs of nutrition therapy.

If the provider does not accept the assignment, the individual is responsible to seek reimbursement and also to cover the 20% co-pay.

Note that if the individual is covered by an HMO (Health Maintenance Organization), the self-management services are a covered benefit, but a co-payment may apply.

Learning how to manage your disease is an important part of treatment, and Medicare is prepared to help you become skilled and knowledgeable in staying as healthy as possible with your diabetes.

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