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DSMT Toolkit

Chapter 20. Working with a Medicare Provider Partner

In order to receive the Medicare reimbursement for DSMT and MNT services, the Medicare provider must submit a claim for reimbursement to the Medicare fiscal intermediary. One claim must be submitted for every qualified service provided to a Medicare beneficiary. The payment for services rendered will be submitted back to the Medicare provider. It is imperative that there be an agreement executed between the Medicare provider partner and the AAA, prior to the submission of claims for services. This agreement will govern the responsibilities of each organization and how to administer funds when received for services. In most cases, the two organizations should execute a memorandum of understanding or contract prior to providing billable services for Medicare beneficiaries.

Agreement elements

A key element of an agreement includes the governance of how money will be distributed. Prior to any share of money, both programs must first cover their costs of administering the program. The costs should be mutually agreed upon prior to deciding to participate in the program. Once both organizations mutually agree upon the final costs of delivering the program, this is the final program budget. All revenue earned over expenses will be considered the earned surplus. The surplus is what is shared after both organizations cover their mutually agreed upon program administration costs. In addition, the agreement should spell out the responsibilities of each organization. For example, the AAA will provide the Stanford DSMP course. It will be the responsibility of the AAA to maintain the program according to the Stanford licensing requirements. It will be the responsibility of the Medicare provider partner to maintain good standing with the Medicare program, submit timely claims, and report back to the AAA on the status of claims filed. If problems arise that will inhibit the filing of timely claims, then both organizations should discuss the barriers to submitting claims and develop a plan to address the barrier to billing.

Lastly, the agreement should have a termination clause. Both organizations should have the right to terminate the agreement at any time. The agreement to terminate should require written notification and an acceptable notification period, prior to the final termination date. Timely notification is a minimum of thirty (30) days notice.

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