Group program reimbursement

Author: 

Micaela Karlsen, MSPH

Question: 

Is it possible for physicians to be reimbursed for group medical appointments? I would like to incorporate more nutrition education into my practice but the reimbursement issue makes it tricky.

Answer: 

Incorporating group appointments or group nutrition counseling programs into your practice is a terrific way to make delivery of nutrition education financially feasible. Brief, individual appointments with patients will not provide the time for the practitioner to educate the patient, or opportunity for the patients to ask questions and get feedback about all their concerns. In addition, many new skills to support a plant-based lifestyle are needed, such as cooking, shopping, eating out, eating while traveling, and navigating social dynamics. If an intervention program can address as many of these areas as possible, the chances for the patient's long-term success and adherence increase. For the patient or client, just being involved in a group with a shared goal of more plant-based food can be an important factor in their success. For a summary of factors influencing patient adherence to new behaviors/diet, read this excellent review by L.E. Shay: A Concept Analysis: Adherence and Weight Loss.

If you are considering developing or increasing a group component to your practice - with either an structured intervention plan or simple group medical or counseling appointments, you may find this article by the American Academy of Family Physicians (AAFP) on Group Visit Coding useful. While many successful practices that use programs or group interventions rely on out-of-pocket payments by patients, the opportunity for insurance reimbursement broadens the reach of any service.

The AAFP article lists the medical reimbursement codes mentioned in the Current Procedural Terminology (CPT) manual, the universally accepted standard for reimbursement codes. While all codes listed in the CPT are recognized by all insurance payers, not all payers reimburse for all the codes. For both physicians and dietitians, the best practice is to consult the CPT manual to understand which codes refer to which services (consult the Group Visit Coding article for ideas on which codes may apply for nutrition education), and then check with the actual insurance payers you work with to check if those codes are reimbursed by them.

Physicians may wish to partner with a dietitian or other nutrition educator to more cost-effectively deliver group training. In addition, many insurance payers may require certain criteria be met for reimbursement, and sometimes for medical nutrition therapy or education a dietitian may be required to take advantage of those codes. Overall, the more group appointments or programs, the more patients you may reach and the more contact with they will have with someone around plant-based nutrition, which will help their chances of continuing the diet.