What is Medicare and who is eligible for its benefits? Does Medicare cover an individual for nutrition services with a pre-diabetes diagnosis (Y/N)? There are three main parts to Medicare. Briefly describe what each part covers. Please include all parts: A. What does NPI stand for and what is a NPI number? B. Who needs to be assigned a NPI number? C. What is used for? True or False. RD’s can/should bill Medicare for services provided in inpatient hospital settings or skilled nursing facilities. Please briefly justify your answer. A RD has been inquired to provide diabetes MNT services to a client/patient. You (the RD) have opted out of being a Medicare provider, and the client/patient has Medicare. Should you provide services for this client/patient or refer to an enrolled RD? Please explain credentialing and contracting in regard to RD’s enrolling as an in-network pro. Medicare


Medicare is a national health insurance program that provides health care coverage for individuals who are 65 years or older, those with certain disabilities, and those with End-Stage Renal Disease (ESRD) (Centers for Medicare & Medicaid Services, 2020). There are three major parts to Medicare: Part A (hospital insurance) that covers inpatient stays at hospitals, skilled nursing facilities, hospice care and home care. Part B covers medical insurance that includes doctor visits, preventive care, durable medical equipment and some home healthcare. Medicare Advantage is also called Part C. It is an alternative to Original Medicare. Parts A, B and C include all of the same benefits as Parts A, but with additional benefits. Lastly, Part D is a prescription drug coverage plan (Centers for Medicare & Medicaid Services, 2020). Medicare doesn’t provide coverage for nutrition services that have a pre-diabetes diagnosis. The patient must be diagnosed with diabetes mellitus in order to qualify for coverage (American Diabetes Association 2018). NPI stands for National Provider Identifier, which is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare & Medicaid Services (CMS). All providers that bill Medicare or other insurance companies must have an NPI number. It is used to identify healthcare providers when submitting claims for services and supplies (Centers for Medicare & Medicaid Services, 2021). An NPI number is required for anyone who bills Medicare. It includes physicians, pharmacists, and other health care providers (Internal Revenue Service), 2021. False. True. Medicare will not pay for nutrition services in these facilities if the patient is diagnosed with malnutrition (American Dietetic Association 2017). Cont…

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