Isabelle F. Hunt

Strategies for increasing third-party reimbursement for nutrition counseling

OBJECTIVE AND SETTING The purpose of this two-phase project was to determine whether specific interventions would affect third-party reimbursement for outpatient nutrition services at the Nutrition Clinic of the Los Robles Regional Medical Center. DESIGN, SUBJECTS, AND INTERVENTION In phase 1, the baseline reimbursement rate was determined by a questionnaire mailed to 191 clients seen in the clinic from January 1 to September 30, 1989. The survey was completed by 115 clients (60%). In phase 2, two strategies were used to increase reimbursement: instructing clients about how to file claims and providing clients with form letters of medical necessity to submit with their claims. The strategies were applied to 76 new clients from March 15 to July 31, 1991. Five weeks later, 67 of the 76 clients (88%) were interviewed by telephone. OUTCOME MEASURES The primary outcome measures were submission rates and reimbursement rates. RESULTS The results showed that in phase 1 (before intervention), 75 of the 115 clients surveyed (65%) submitted claims to their insurance carriers, and 12 of the 74 clients (15%) whose claims were acted on received reimbursement. In phase 2, 47 of the 67 clients (70%) submitted claims, and 15 of the 36 clients (42%) whose claims were acted on received reimbursement. Of the 20 clients who did not submit claims, 8 did not apply because of time constraints, and 5 did not apply because of low expectations of reimbursement. APPLICATIONS/CONCLUSIONS Form letters of medical necessity increased the reimbursement rate, but client instruction did not increase the submission rate. Most of the clients who did not submit a claim said they did not have time to do so. Therefore, the Nutrition Clinic is attempting to submit insurance forms for the clients after clients have paid for the consultation. Other providers of outpatient nutrition counseling who follow this strategy may increase the reimbursement rate.

Iron, thiamin, riboflavin, and niacin content of corn tortillas made in Los Angeles, California

Corn tortillas are a common food in the diet of people of Mexican descent who live in the Los Angeles area. Corn tortillas are not enriched, and on a weight basis contain less iron, thiamin, ribofl...

Bone Mineral Content in Postmenopausal Vegetarians and Omnivores

There is evidence that the consumption of diets containing large amounts of animal protein is associated with low bone mineral content (BMC). Mazess and Mather (1974, 1975) observed that in Eskimos, whose diets consisted chiefly of meat and provided about 200 g of animal protein per day, bone loss occurred earlier in life and was of greater magnitude than in Caucasians in the U.S.A. An explanation for these observations is based on findings that the higher content of sulfur-containing amino acids in animal as compared to plant proteins results in a greater production of metabolic acid (Halperin and Jungas, 1983; Breslau et al.,1988) and higher net excretion of urinary acid. This increased acid load is buffered by calcium which in individuals with marginal or negative calcium balance is made available by the dissolution of bone (Allen et al., 1979; Schuette et al., 1980; Bushinsky, 1989). Because foods that have a high protein content also tend to be high in phosphorus, the calciuretic effect of a diet high in protein may be ameliorated by the concomitant presence of phosphorus. There is evidence that increased phosporus intake depresses serum calcium levels and stimulates the synthesis of parathyroid hormone which leads to increased reabsorption of calcium by the renal tubules (Yuen et al., 1984).

Protective foods recall as a tool for dietary assessment in the evaluation of public health programs for pregnant Hispanics

The Protective Foods Recall (PFR), a new tool that includes a dietary demerit scoring system, was developed for evaluating nutrition programs for pregnant women of Mexican descent with low incomes. The tool costs less to administer than the 24‐hr, dietary recall because it takes about half the time and does not require calculation of nutrient content. The kinds and amounts of protective foods (foods with high nutrient densities) that the client recalled eating the previous day are recorded on the PFR and scored by the nutritionist during the first interview with the client. Dietary counselling based on the score can be given immediately without further calculation. When compared with the 24‐hr, dietary recall, the PFR was sensitive and specific. The study suggests that the PFR is an effective tool for evaluating nutrition programs for pregnant Hispanics with low incomes.