For last week’s practice question, we quizzed participants on reimbursement for group DSME classes through Medicare. 48% of respondents chose the best answer. We want to clarify and share this important information, so you can prepare for certification exams and pass it on to your colleagues.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Question:

JR is 73 years old and has Medicare Part A and B insurance.  JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s and tells you they want to repeat the group sessions since they have forgotten much of the information.

What is the most accurate response?

Answer Choices:

1. Sounds great. Let’s get you enrolled in our group classes.
2. Medicare only covers group sessions once in a lifetime.
3. Good thinking. Medicare covers annual group training.
4. Since your insurance won’t cover it again, you can attend for free.

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Getting to the Best Answer

If you are thinking about taking the certification exam, this practice test question will set you up for success since there are questions on Medicare Reimbursement. Test writers anticipate possible answers based on the details in the question. They will wave those “juicy answers” right under your nose. Your job is to weed through the particulars, pluck out the most important elements and choose the BEST answer.

Answer 1 is incorrect. 17.76% chose this answer. “Sounds great. Let’s get you enrolled in our group classes.” A very welcoming answer, but unfortunately, it’s not accurate. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

Answer 2 is correct. 47.74% of you chose this answer. “Medicare only covers group sessions once in a lifetime.” YES, this is the best answer. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

However, if the beneficiary has received initial DSMT paid by another health insurance company, he/she is still eligible to receive the 10 hours of initial DSMT as a Medicare benefit.

Answer 3 is incorrect. About 27.97% of respondents chose this. “Good thinking. Medicare covers annual group training.” Another tempting answer, but not accurate. According to Medicare Reimbursement Guidelines, Initial Diabetes Self Management Training (DSMT) is a “once-in-a-lifetime” Medicare benefit. Since JR completed a Diabetes Self-Management Program at a local hospital when they were in their late 60s, we assume that Medicare was billed for the service, since Medicare coverage starts at age 65. For this reason, it is important to verify that the beneficiary has not received any initial DSMT in the past prior to the delivery of the initial DSMT.

Finally, Answer 4 is incorrect. 6.53% chose this answer. “Since your insurance won’t cover it again, you can attend for free.” This answer is kind hearted, but not correct. For Medicare, initial DSMT group classes can only be provided once in a lifetime and should be billed to Medicare and not offered for free. Programs can create a self-pay/uninsured policy where services are discounted (must be consistent in charges and discounts etc.).

Here is a summary slide on Medicare Reimbursement Guidelines.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity! You can read through the Medicare Reimbursement Guidelines here or the ADCES Info Sheet on DSMT Reimbursement join our Setting Up a Successful Diabetes Program & Medicare Reimbursement Webinar for more information.

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Want to learn more about this practice question?
Join us LIVE in San Diego for our DiabetesEd Training Conference
October 11-13th, 2023

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Two Registration Options

Join Coach Beverly and Team for two and a half days of knowledge-sharing, fun, networking, games with prizes, and “aha” moments in beautiful San Diego. 

You don’t want to miss this one-of-a-kind learning opportunity. Get away from all those daily responsibilities and immerse yourself in a fun and intensive conference with plenty of networking opportunities.    

Attendees will leave this conference with new tools and a more complete understanding of the latest advances in diabetes care, from medications to technology to Medical Nutrition Therapy! 

Bring your colleagues and enjoy our friend discount.

Our team expertly translates the complex science of diabetes into understandable terms while keeping it real, practical, and fun. 

Team of expert faculty includes:

• Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES – Educator of the Year, 2020
• Coach Beverly Thomassian, RN, MPH, CDCES, BC-ADM
• Ashley LaBrier, MS, RD, CDCES, Diabetes Program Coordinator 

All hours earned count toward your CDCES Accreditation Information

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The use of DES products does not guarantee the successful passage of the diabetes certification exams. CBDCE & ADCES does not endorse any preparatory or review materials for the certification exams, except for those published by CBDCE & ADCES.