Ask the Reimbursement Expert & More
Increase DSMES program reach and impact by maximizing insurance reimbursement and helping people with diabetes find affordable care.
Get Answers to Your Most Pressing Questions with Ask the Reimbursement Expert
Our Ask the Reimbursement Expert service has helped thousands of ADCES members who provide DSMES navigate their diabetes reimbursement challenges, allowing them to be successful and continue to serve people with diabetes in their communities. Our expert answers both general and very specific questions related to DSMES/DSMT billing and insurance coverage. We also have an extensive list of FAQs for you to peruse. To give you a sense, some of the more common questions include:
- What needs to be in place in order to bill and get reimbursement from Medicare for DSMT services?
- How does an eligible individual or entity apply to bill Medicare for Part B Services?
- Can nurses, pharmacists, and CDCESs bill Medicare?
Insurance Reimbursement Requires a Referral and Often Accreditation
Studies show DSMES reduces diabetes-related complications and encourages better management, but it doesn’t happen without a DSMES referral from a prescriber. We’ve created a sample referral order form that can be downloaded and adapted for your use. Included on this form is also an order for Medical Nutrition Therapy (MNT), which is often used in conjunction with DSMES, referred to as DSMT when billing. If using an electronic medical record (EMR), it's particularly helpful to have the referral order built in and easily accessible.
Download the DSMT/MNT Referral Form
In addition, insurance reimbursement by Medicare and often commercial insurers doesn’t happen if the DSMES program isn’t accredited.
Learn how to become an ADCES-accredited DSMES program
DSMT Billing
Billing Codes: Understanding What's Covered
Healthcare systems, clinics and primary care offices can maximize their DSMT billing potential by better understanding the DSMES reimbursement process, using the appropriate billing codes and submitting them correctly.
But what about the other codes? There are many more you can likely use when providing diabetes-related services, so we’ve created a chart of all relevant billing codes, allowing you to maximize your billing potential. It covers the code and who can bill as well as increments, frequency and limits. It prominently highlights technology-related codes but covers more!
View Our Coding Resource
Become a DSMES Reimbursement Expert With Continuing Education
From an annual reimbursement update webinar to a program and business management certificate and many courses in between, we have the continuing education (CE) you need to understand Medicare changes, coding and coverage, and successful program management.
Affordable Care
Working With People Who Are Underinsured
We’ve pulled together resources to help you address issues related to the cost of care.
Starting Conversations About Cost
As a healthcare professional, you may not always be familiar with cost-of-care limitations that present significant barriers to your patients. By initiating conversations about out-of-pocket healthcare costs, you can take a vital step toward providing equitable and actionable care that meets the individual’s needs. We partnered with Beyond Type 1 to create guidance to help you navigate this discussion.
Go to: A Practical Guide to Having Healthcare Cost Conversations - English and Spanish
Patient Assistance & Insulin Assistance Programs
If you have a client or patient struggling to pay for supplies because they have no insurance or inadequate insurance, consider our guides that include patient assistance programs by medication/device, discount card programs, organizational resources, and consideration depending on whether the patient is on Medicare, Medicaid, private insurance or is uninsured.
- Insulin Cost Savings Resource Guide (In the process of being updated)
- Non-insulin Diabetes Medications Cost Savings Resource (In the process of being updated)
Diabetes Technology Affordability Tool
We've created a tool that lets you search by product (CGMs, connected pens, biosensors, pumps, AID systems and patches), brand and insurance type to find financial support options, coupons and other discount programs.
Go to the Diabetes Technology Affordability Tool, on danatech