Nutrition, Diabetes Education, Health Promotion and Insurance Reimbursement for Professionals For the Healthcare and Food Industry




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MARY ANN HODOROWICZ CONSULTING, LLC

Nutrition, Diabetes Education, Health Promotion and Insurance Reimbursement for Professionals For the Healthcare and Food Industry

N e e d s and g o a l s A s s e s s m e n t


Date: Best day(s) to contact you (circle) M — Tu — W — Th — F — Sa -- Su
Best times to contact you: May I call you in the early evening? YES NO

May I call you on Sat. or Sunday? YES NO
Name: Credentials:
Position Title:

Business/Company/Association/Program Name:



Street Address :
City: State: Zip: Time Zone:
Work No.: Cell No.: Fax: Home No.:
E-mail: Web site address:

Place of Employment CATEGORY (check all that apply):

__Business/commercial company (for profit)

__Health food store

__Business/commercial (non-profit)

__Restaurant, cafeteria

__Hospital

__Private practice/self-employed

__Nursing home/long term care

__Skilled nursing facility

__Clinic/health center

__HMO/insurance/other health care

__Home health/hospice

__Pharmacy

__Public health department/rural health center

__Government (state, federal)

__University, collage, school

__Wellness center

__Professional membership association

__Television, radio station

__Physician’s office

__Grocery store

__Dietetic internship program

__Other (specify):

Major employment AREAS OR responsibilities (check all that apply):

__Business management or supervisor

__Medical Nutrition Therapy (MNT)

__Hospital food and nutrition services management

__Diabetes Self-Management Education (DSME)

__ Hospital inpatient clinical nutrition management

__Writing, editing, publishing, media work

__Program director or educator in academia

__Information technology/communications

__CDE

__Marketing and/or public relations

__Consultant

__Insurance billing or medical record claims coding

__Dietitian

__Community nutrition/nutrition education

__RN

__Advocacy/association membership work

__Account Rep

__Teaching

__Chef

__Health promotion, wellness

__Research

__Other (specify):

__Product development __Product distribution __Product sales __Product marketing/advertising for:

Food Nutritional supplements/tube feedings Package/labels Medical equipment/supplies

Food service supplies Glucose testing supplies Drugs, insulin Vitamin/mineral supplements

Health/food related magazines Other:


Which categories below are your needs in? (Check all that apply):



Third Party Reimbursement (Initiating, Maintaining, Increasing) for:

Medical Nutrition Therapy (MNT)

Diabetes Self-Management Training/Education (DSMT, DSME)

Medical Nutrition Therapy (MNT)

Enteral Nutrition Tube Feedings

  • Parenteral Nutrition Feedings

  • Diabetes/Blood Glucose Testing Supplies

  • Diabetes/Blood Glucose Testing Supplies via Pharmacy Benefit Management

  • Insulin Pump and Training

  • Continuous Blood Glucose Monitoring System

  • In-Office Hemoglobin A1c Test

  • Other (specify):__________________________________________________________________________


Specific needs are for: Consulting Training Presentation Article on:

___Medicare reimbursement coverage guidelines

___Private payer reimbursement coverage guidelines

___Claims coding

___Claims processing

___Completing CMS 1500 and/or UB04 claim form

___How to become Medicare MNT provider

___How to become credentialed provider with private insurance companies

___MNT/DSME superbill

___Physician referral/order form

___Other (specify):________________________________________________________________________
DEVELOPING and/or ENHANCING THESE PATIENT ProgramS IN YOUR PRACTICE SETTING

(HOSPITAL, CLINIC, PHYSICIAN OFFICE, ETC.):

MNT

DSME

Weight Loss

Diabetes Prevention

Nutrition Wellness
DEVELOPING YOUR OWN PRIVATE PRACTICE FOCUSED ON:

MNT

DSME

Weight Loss

Diabetes Prevention

Nutrition Wellness
Specific needs are for : Consulting Staff Training Presentation Article on

Program Development Mary Ann to Conduct Program on:
___Using “differentiation of nutrition services” model to maximize market share by gaining competitive edge

___Detailed business plan for program operations/structure to maximize physician and self-referrals and

patient attendance

___Outcomes tracking and management

___Curriculum for outpatient program

___Curriculum for inpatient diabetes survival skills training

___Deciding on which private practice reimbursement model to use (5 different models)

___Electronic (modifiable) forms for program and clinical operations: DSME MNT (patient attendance,

patient assessment, nutrition diagnosis, nutrition prescription, nutrient/calorie calculation per calorie level,

documentation, progress notes, flow sheets, outcome tracking, etc.)

___Physician referral/order form

___Staffing

___Writing program proposal for administration

___Program performa and budget

___Marketing, advertising plan

___Increasing physician referrals

___Increasing self-referrals and/or program attendees

___Decreasing patient appointment “no show” rates

___Other (specify):________________________________________________________________________
Obtaining Recognition for DSME Program (Required for Medicare Billing)


Specific needs are for : Consulting Training Presentation Article on:
National Standards for Diabetes Self-Management Education

American Association of Diabetes Educators’ new 7 behaviors for diabetes self-management
PRESENTATIONS TO PROFESSIONALS
Topic(s) can be selected from list below* or can specify own topic.
Name of event:____________________________________________________________________________

Sponsoring organization:_____________________________________________________________________

Date of event:____________________________ Date of presentation:________________________________

Location of event:__________________________________________________________________________

Is presentation planned as pre-conference workshop? __YES __NO __MAYBE

Will presentation have outside sponsorship? __YES __NO __MAYBE

Are CEUs desired? __YES __NO __MAYBE

Time frame for presentation (minutes/hours):_____________________________________________________

Attendees level of understanding of topic is assumed to be: __minimal __moderate __advanced



  • Specific topics (Mary Ann’s signature presentations):




  • Money Matters in MNT and DSME: Increasing Reimbursement Success in All Practice Settings




  • How to Implement a Successful Hospital-Based or Private Practice MNT Program




  • Diabetes Encounters of the Senior Kind: Unique Self-Management Challenges of the Older Person with Diabetes and Practical Ways to Minimize Them!




  • Zest for Life: Nutrition and Lifestyle for Healthy Aging



  • Update on the Nine Newest Medicare Provisions Impacting MNT Coverage and Utilization and New CPT Codes for RDs Use




  • T.A.P. into Personal and Professional Potential: A 15 Point Make-Over of Traits, Attitudes and Practices Leading to Extraordinary Success!




  • Patient Empowerment: Proven Model for Enhancing Behavior Change in Patients with Chronic Disease




  • FINALLY! A Super Easy, Step-by-Step Guide for Making a Nutrition Diagnosis




  • Critical Connections to Advance Your Career and Your Profession: Performance, Advocacy, Competency and Expertise Sharing




  • Improving the Quality and Effectiveness of Chronic Care Teams (Based on: Institute of Medicine’s Quality Chasm Report; Better Diabetes Care by National Diabetes Education Program; Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement, ‘04 by Institute of Health Care Improvement)




  • Business Matters: How to Create a Dynamic Business Plan for Building, Maintaining and Growing a Dietitian’s Private Practice




  • How to Successfully Market Your Medical Nutrition Therapy Program and Your Private Practice: Don’t Just Survive, Thrive!




  • C” How to Increase Referrals and Patient Attendance in Hospital-Based MNT and DSME Programs: Proven Marketing Strategies Guaranteed to Keep Your Program Thriving!




  • If a ‘Best Practice’ Nutrition Department is Your Dream, Then Implementing a “5 Star Quality Management Plan” Should Be Your Passion!




  • Be a ‘Best Practice’: A Comprehensive Quality Management Plan for MNT and DSME Programs




  • Simplifying and Summarizing the American Dietetic Association’s Medical Nutrition Therapy Evidence-Based Guides for Practice




  • Developing a MNT and DSME Outcomes Management System: It’s Easier and More Essential Than You Think!




  • A Dietitian’s Business Plan for Implementing a Successful Hospital-Based and/or Private Practice MNT Program




  • Defining Good Business: The Dietitian’s Step-by-Step Guide for Developing a Comprehensive Business Plan for a Private Practice




  • Step-by-Step Guide for Obtaining American Diabetes Association Education Recognition Program Certification for Your Diabetes Education Program




  • How to Establish a Successful Hospital-Based Outpatient MNT Clinic




  • Everything the RD Needs and Wants to Know to Successfully Provide the Medicare MNT Benefit…And Then Some!




  • Getting Paid What You’re Worth in a Physician’s Medical Practice: How the RD Can Determine and Negotiate the Best Business Plan




  • Using and Understanding the Nutrition Care Process and Model




  • Should a Private Practice Dietitian use a Medical Biller? Crunching the Numbers and Examining the Pros and Cons So You Can Decide!




  • Train the Trainer Workshop on MNT and DSMT Programs: Obtaining Medicare and Private Payer Reimbursement, Increasing Referrals and Attendance and Enhancing Program Efficiency, Viability and Quality




  • Insider Secrets of Successfully Providing Reimbursable Medicare MNT and Therapeutic Diet Meals to Homebound Seniors in an Elderly Nutrition Program: The Time Has Come…Are You Ready?




  • Business Matters: How to Create a Dynamic Business Plan for Building, Maintaining and Growing Your Facility-Based, Reimbursable MNT Program




  • Six Super Star Metrics” for Evaluating the Performance and Value of Your MNT and DSME Programs…or Why Revenue is only 1/6 of the Programs’ True Value!


Any of these PowerPoint® presentations can be customized to fit your needs like a hand in a glove! They can

also be formatted to fit the time frame allotted. Just ask! As I self-publish a manual on MNT and DSME

reimbursement, another on establishing a MNT program and also sell electronic MNT and DSME forms, I offer a

big discount to conference attendees upon purchasing these resources in the month following my talk. I also

donate several copies of the manuals and the electronic forms for a raffle or door prizes for your meeting!  This is

my way of saying thanks for the honor of speaking to your group!
PRESENTATIONS TO CONSUMERS



  • Nutrition in Pre-Dialysis Renal Disease

  • Nutrition in Renal Failure

  • Diabetes: S.W.E.E.T.S. Control

  • Diabetes Prevention

  • Nutrition in Primary Biliary Cirrhosis

  • Weight Loss / Weight Control

  • 5 Star Healthy Eating Plan

  • The Skinny on Fad Diets

  • Health Heart Nutrition

  • Vitamins, Minerals, Supplements: Right for You?

  • Dietary Fats: The Good, The Bad and the Ugly!

  • The Newest Dietary Guidelines for Healthy Americans

  • Healthy Restaurant Eating

  • Controlling Eating Triggers: Trigger Foods, Moods and Situations

  • My other interest is: ____________________________________________________________________




  • HAVING NUTRITIONALLY BALANCED MENUS WRITTEN FOR (SPECIFY):


HAVING AN INSTRUCTIONAL MANUAL WRITTEN ON (SPECIFY TOPIC):


  • HAVING MY PRODUCT OR SERVICE EXPERTLY REPRESENTED AND PROMOTED AT:


Consumer trade show Professional trade show

Specify product or service:



  • TEACHING DIETETIC STUDENTS “REAL-WORLD” PRACTICAL SKILLS (Using ADA’s MNT evidence-based practice guidelines, MNT outcomes management, MNT and diabetes education reimbursement from Medicare and commercial payers, developing a private practice, developing a recognized diabetes self-management education program, constructing a business plan, writing a business proposal, patient empowerment, effective nutrition counseling skills, etc.)




  • OTHER CONSULTING AND/OR TRAINING NEEDS (SPECIFY):


Which of these parameters meets your needs best? The Consulting/training is:

On site Off site Telephone conferences Other (specify):

  • In half-day increments In whole day increments Other (specify):

What is your desired time frame for having your needs met?
What is your firm deadline?

If your need is for employee TRAINING, approximately about how many will be in attendance?

Other NEEDS, concerns, comments:

OPTIONAL: How did you learn about MARY ANN HODOROWICZ CONSULTING, LLC?

__web search __referral __heard Mary Ann speak __ADA practice group __networking

__classified ad in magazine __Internet listserv __I’m a former patient of Mary Ann’s

__I’m a former or current client of Mary Ann’s __other (specify):



anything else?




Thank you for taking the time to complete this form! Please submit to Mary Ann (see bottom of page). I will contact you as soon as possible so we can talk further about meeting your needs.
12921 SYCAMORE PALOS HEIGHTS, IL 60463

Office: 708. 359.3864 hodorowicz@comcast.net www.maryannhodorowicz.com
Fax: 866.869.6279







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