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Spring Issue

Your ERP Team is happy to bring you the 2011 1st quarter issue of Recognition News. We would like to remind you about the American Diabetes Association Alert Day


which falls on March 22, 2011. The goal of this event is to reach out to the undiagnosed population with life-

saving information about type 2 diabetes risk and prevention. You should have received an email from us providing you with access to materials you can use for planning your own Diabetes Alert Day programs. More information about Diabetes Alert Day can be found at In this issue, we highlight reimbursement with 2011 updates, the essential components of a diabetes education curriculum, provide a wealth of resources to enhance your DSME activities and showcase one of our outstanding programs. Feel free to always email us ([email protected]) or call (1-888-232-0822) with any recognition questions. Regular updates can be found at

Diabetes Education

Reimbursement for Diabetes Self Management Training (DSMT)

Recognition Tips

Essential components of a curriculum: The curriculum seems to be one of the most problematic of all the paper audits required with applications. Many programs submit content only, thinking that this meets criteria. Read More...


Information on upcoming conferences, updates on ERP Connect, new patient materials and references for healthcare providers. Read More...

Program Spotlight

We are proud to showcase one of our outstanding recognized programs that recently got audited and passed with flying colors. Read More...

Diabetes Education

Reimbursement for Diabetes Self Management Training (DSMT)

Reimbursement for DSMT continues to pose challenges for our Recognized programs. While diabetes care in general accounts for 32% of all Medicare expenditures, the DSMT benefit is chronically underutilized. This is due to multiple issues: barriers prevent DSMT providers from continuing to provide and bill for the service. Some of the barriers include inconsistencies in payment policies that lead some Medicare contractors to inappropriately deny DSMT claims. Others include low payments for the service that ultimately does not sustain some programs. DSMT providers sometimes do not submit appropriate claims for the services they provide, leading to claims denial. Below are some essential requirements for the Centers for Medicare and Medicaid Services (CMS) to reimburse programs or entities for diabetes education services: 1. 2. 3. 4. 5. 6. The program (providing DSMT) must be Recognized or Accredited by a National Accrediting Organization deemed so by CMS. The two accrediting bodies are currently the American Diabetes Association and the American Association of Diabetes Educators. Services must be provided to eligible Medicare beneficiaries with diagnoses of diabetes. The certificate of recognition must be submitted to the local Medicare Contractor's provider enrollment office. A person or entity cannot enroll in Medicare for the sole purpose of providing DSMT. The Program (and it's Sponsoring Organization) must be eligible to bill Medicare for other services before they can be eligible to apply for Recognition or accreditation. A referral for DSMT services is required for Medicare reimbursement. This referral must be from the provider responsible for managing the beneficiary's diabetes. Medicare reimburses for 10 hours of initial DSMT in a 12 month period for the beneficiary who has never received DSMT as a Medicare beneficiary. Medicare reimburses for additional 2 hours of group or individual DSMT each calendar year following initial training, as prescribed for the beneficiary's healthcare provider. In calendar year 2011, payments for DSMT services are expected to increase based on a calculation that assigns physician work relative value unit and additional practice expense to DSMT provision. In essence, the complexity of what currently goes into DSMT provision, e.g. CGMS monitoring, downloading of meters, pump training, insulin to carbohydrate ratios, etc. have increased compared to when DSMT payments were initially permitted back in 1997. These complexities are being accounted for in the new payments for both individual and group DSMT sessions. Also in 2011, DSMT group and individual services, qualify for Telehealth billing. For additional information on DSMT Services, go to:

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Recognition Tips

Essential components of a curriculum: The curriculum seems to be one of the most problematic of all the paper audits required with applications. Many programs submit content only, thinking that this meets criteria.

Your curriculum defines your program. Your curriculum defines your program. Although the 9 content areas are specified by the National Standards, the curriculum establishes what you hope your participants will accomplish, how you will teach the content, to what extent you

cover the content and how you will evaluate if your participants have grasped the information and are able to use it in their everyday lives. You may purchase commercially prepared curricula and tailor them to your population or you might chose to prepare your own. In either case, in order to meet criteria: A complete curriculum must include, at minimum:

· · · ·

Learning Objectives Methods of Delivery (teaching) Content Outline Methods of Evaluation of Learning

Every content area of your curriculum should be set up this way. Learning Objectives: These are what you expect the participant to be able to do after the content has been covered. They should be stated in action terms so that they can be evaluated. Some examples are: The participant will be able to:

· · · · · ·

Name the foods they eat that are highest in carbohydrates. Define hypoglycemia and list the symptoms. Demonstrate how to give themselves an insulin injection. State that diabetes is a chronic condition. Develop an exercise plan. Perform a blood glucose test.

The participant "will know the effects of protein on blood glucose" is an example of a poorly written learning objective, because it does not tell you how you will determine knowledge. A better way to phrase this could be: "Can verbalize what the effects of protein are on blood glucose." Methods of Delivery: How will the content be taught? Methods can include lecture, PowerPoint presentations, demonstrations, videos, role playing, discussion, games, etc. The trend in education is to move away from strictly didactic presentation of information and towards a more patient centered, empowerment model of teaching that helps patients to make informed decisions about the care of their diabetes. Content: The amount of detail your content section contains is at the discretion of the program. At minimum a content outline is required. Some curricula are so detailed that they resemble a script. This might be helpful for less experienced instructors, but is not required. Having talking points or instructor's notes may serve as triggers to keep the discussion going and the instructor on point. Evaluation of Learning: How will you determine if participants have understood what was presented to them? Pre and post tests used to be popular, but they have their limitations. They can be intimidating to those with literacy issues and some people are just not good test takers.

Some better methods might include:

· · · ·

The instructor's observation of questions asked or answered. Participation in discussions or group activities Return demonstrations Completed assignments: food records, blood glucose logs, exercise plans

Optional Components of the Curriculum: Purpose: Summary of important points in the content Time Frames: Amount of time spent on each sub-topic; total time for content area. May be helpful for the flow of the session. Materials: Audio visual equipment, whiteboards, handouts, demonstration items. May help instructors with organization. Documentation Plan: This area describes how, what and where you describe the educational experience for individual participants. Your curriculum is the framework for your program. It should be detailed enough so that a new/PRN instructor could pick it up and know what to teach, how to teach it and how to evaluate learning. It should be reviewed at least annually and updated as necessary, to reflect new information and ideally, new concepts in education. You may refer to an example of a section of a curriculum at

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ERPConnect: Our online community for ADA Recognized program coordinators has a new feature: "Discussions." This new feature allows our community members to start a "discussion" on a particular topic and have others respond directly to it, creating continuity in conversations in a logical, easy to follow format. These discussion links can be found on the main page and on group pages. The 26th Annual Clinical Conference on Diabetes (Southern Regional Conference) will be held from May 26-29, 2001 at the Hyatt Regency Grand Cypress Resort in Orlando, Florida. A maximum of 20.3 hours of continuing education is being offered. You can register at The 71st Scientific Sessions will be held from June 24-28, 2011 at the San Diego Convention Center, San Diego, CA. Healthcare professionals can learn about cutting-edge clinical research, hear from world renowned diabetes experts and experience over 2,000 oral and poster presentations. And, of course, there is our exciting exhibit hall and the ADA Booth. ERP will be presenting a session on "Trends in Diabetes Education, Education Recognition and Access to Diabetes Care," Saturday June 25, from 8-10 am. Up to 33 CE hours can be earned for this conference. For more information, please go to "Living Well With Diabetes" The second installment of this well received workbook has been sent to all of our Recognized programs. The

Spanish edition is currently in the works and will be available in the near future. Enjoy! ADA's "Living with Type 2 Diabetes" program has been launched with the introduction of the "Where Do I Begin" booklet. This program is targeted toward the person newly diagnosed with Type 2 diabetes as part of the organization's New Patient Initiative. It includes the booklet with information as to how to join the program and receive 3 free issues of Diabetes Forecast, more information about taking care of Type 2 diabetes and delicious and healthy recipes for participants and their families. Free copies of the brochure can be obtained at NEW!! DiabetesPro SmartBrief brings you the diabetes treatment news that really matters every day. Knowledgeable editors handpick key articles from hundreds of publications, summarize them and provide direct links to the original sources. This is a free service that brings this material directly to your email. To sign up please go to

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Program Spotlight

We are proud to showcase one of our outstanding recognized programs that recently got audited and passed with flying colors.

Hurley Diabetes Center at Hurley Medical Center in Flint Michigan has been recognized by ADA since 2000. This program serves an urban population with diverse needs. It has an adult component, a pediatric component as well as a pregnancy affected by diabetes component. The population's special needs range from participants with physical disabilities to those with English as a second language. Special allowances made for participants include transportation services, use of interpreters and special low literacy education tools compiled by program staff. It is the largest diabetes education program in Genesee County, Michigan. Our onsite auditors were impressed by the care coordination the program staff provide to the participants of the program. For example, the pediatric patients typically start on the inpatient where they are seen by the same educators who make sure they get the proper care and survival skills education they need to prevent unnecessarily prolonged inpatients stays. They make sure that outpatient appointments are then available for the participants and their family members, within a week of discharge and then every 3 months after that. There are monthly support groups for this population as well as well as an online blog for those interested. "The program staff demonstrates superb documentation skills that make it easy to trace the experience of each program participant", commented one of the onsite auditors. "We really didn't find any weakness in this program," commented the other. We are pleased to acknowledge that the program coordinator is one of our own, Micki Juip, who has been a volunteer auditor for the Association's ERP onsite audit program since it was started in 2003. Congratulations to Micki and the highly qualified staff at Hurley Diabetes Center who, over the last 10 years, have consistently improved the quality of life, health and health status of the communities it serves.

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