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Cleaner claims help reduce the risk of Medicare payment denials and delays. The following tools provide coverage information for Medicare and Medicaid nutrition policies. Medicare billing resources are provided to help support the claim process.

Medical Necessity Letters

Template Letters for Medical Necessity
Selection of letters for Nestlé products with proposed payer language to document product use

Payer Overview

Medicare Part B Guidelines For Enteral Nutrition
Basic information pertaining to Medicare Part B enteral nutrition coverage

Medicare Policy Changes on Payment for Hospital Acquired Conditions
Overview to Medicare limits on paying for select conditions acquired during hospitalization

General Reimbursement Information by Payer
Basic policy information for Medicare, Medicaid, private payers, and WIC

Medicare

Number of 100 Kcal Units per Case
Nestlé Health Science products by code, NDC-Format Numbers, and HCPCS codes; kcal/mL; package size; pack factor, calories; and billing units/case

Sample Documentation Checklist for Enteral Reimbursement
Provides an overview of documents and information required for Medicare enteral nutrition reimbursement submission

Medicare Part B Nestlé HealthCare Nutrition Products
HCPCS codes for Nestlé enteral products

Nestlé Health Science Product Code Cross Reference
UPCs, NDC-Format, Product Codes, and HCPCS for Nestlé institutional and retail products

Medicaid

Enteral nutrition policies regarding tube feeding and oral supplements for adults and children vary from state to state. When a Managed Medicaid program is being utilized, the payer responsible for the program may provide additional benefits. When there is a benefit policy in place, most policies require that there is a documented medical need for the therapy. 

For further information on your state specific enteral nutrition policy go to www.medicaid.gov.  For information on a Managed Medicaid program, contact the commercial payer’s benefit manager for specific coverage and payment information.

Reimbursement information provided by Nestlé Health Science, Inc. (NHSc) is gathered from third party sources and is presented for illustrative purposes only. Information comes from a variety of sources including verbal communication and electronic records. This information does not constitute reimbursement or legal advice and does not constitute a recommendation related to medical necessity or the documentation that should be provided in connection with a given patient or claim. All medical necessity determinations must be made by the responsible clinician. NHSc makes no representation or warranty regarding this information or its completeness, accuracy, timeliness, or applicability to a particular patient. NHSc specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information in this document. Suppliers are responsible for submitting accurate and appropriate claims for services. Laws, regulations, and payer policies concerning reimbursement are complex and change frequently. Accordingly, NHSc recommends that you consult with your payers, reimbursement specialist, and/or legal counsel regarding coding, coverage, and reimbursement matters. ©2016 Nestlé.