Diabetes patient education programs. Quality and reimbursement

To inform health-care providers and third-party carriers of the national quality assurance systems in place for diabetes education programs and the health professionals who provide education services and to indicate the need for consistent reimbursement of essential outpatient diabetes education services. The components of an independent quality assurance mechanism were examined and a survey was conducted to determine reimbursement coverage of ADA recognized programs. A national program to evaluate whether programs meet national standards is in place. Many ADA approved programs were reimbursed and official recognition helped in the process of attaining reimbursement. Insurance coverage decisions made by third-party carriers, however, were inconsistent and largely unpredictable. Outpatient education and follow-up for diabetes is an integral component of care. These services need to be more clearly defined to enable appropriate coding and coverage decisions to be made by third-party payors.