Medical Billing - Enteral Nutrition Billing

By: Michael Russell
Submitted: 2007-01-17 15:35:54
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In the world of medical billing, there is a sub domain all to itself. It is called enteral nutrition. Once upon a time, this was something that would have never been considered to be billable, which is part of the reason that this particular sub domain has its very own CMN. To understand how the CMN works, we first have to know a little something about enteral nutrition itself and what it is.

In modern times, it has been determined that there are people who are ill because they don't get the right kind of nutrition. Years ago, we weren't so health conscious. The 60s saw the days of white bread and preservatives and nobody even knew what the word fiber stood for. Health food stores were the exception rather than the norm. Then, suddenly and without much warning, people started getting very sick and coming down with diseases that we were able to determine were directly related to nutrition. Over time, we began to take nutrition more seriously and started to pay more attention to what we were eating.

In the early days of medical billing, it was almost impossible for a doctor to prescribe nutrition supplements for a patient and expect to be able to bill for them. It was just unheard of. You have to understand that in the early days of modern medicine, it was just that. Medicine. The thought of treating anything with food was not even a consideration. Those days are long gone. Today, enteral nutrition is not only billable, but it is also very big business for the medical profession. This serves a multitude of purposes.

For starters, it gives the physicians another source of income. Being able to bill a patient for something that years ago didn't exist is certainly a welcome addition. Aside from that, there is the revenue for the enteral nutrition manufacturers themselves. Products like Enfomil and Similac are big business. Of course there is the additional revenue for the billers and the companies who make forms for the enteral products.

Are their problems with enteral nutrition and enteral billing? As with anything else in the medical billing industry, of course there are problems. For one thing, we are dealing with products which, though they are not drugs, can interact with drugs that the patient may be taking or just flat out not agree with the patient at all and make the patient ill. Some patients have very violent reactions to many enteral nutrition products. Nausea and even vomiting are not uncommon. Sometimes it takes a while to find a product that the patient can tolerate.

On the billing end, there is always all the red tape involved with determining if the patient is eligible to get enteral nutrition and if so, how much are they supposed to get per day and how much the carrier will allow to be billed per day. Yes, they dish this stuff out by the spoonful, literally, which makes billing enteral products a real pain.

In our next installment on medical billing, we're going to cover the GE0 record CMN, which is specifically designed for enteral billing

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