Medical Nutrition 

Therapy Works 

for Seniors 

A Resource Guide for Registered Dietitian Nutritionists 

and Senior Nutrition Program Administrators 
Contents 

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 

Section I: Making the Case for Senior Nutrition Programs – Leveraging 

Emerging Opportunities for Future Readiness and Sustainability Through 

Health Care Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 

Section II: Medical Nutrition Therapy in the Changing Landscape of 

Medicare and Medicare Advantage . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

Medical Nutrition Therapy and RDNs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Medical Nutrition Therapy Works for Seniors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

MNTWorks for Seniors: The Value of Registered Dietitian Nutritionists . . . . . . . . . . . . . . . . . . 10 

MNTWorks for Seniors: Academy of Nutrition and Dietetics Evidence-Based Nutrition Practice Guidelines . . 11 

MNTWorks for Seniors: RDNs Provide Better Health Outcomes . . . . . . . . . . . . . . . . . . . . . . 12 

MNTWorks for Seniors: MNT Providing Return on Investment . . . . . . . . . . . . . . . . . . . . . . 14 

MNTWorks for Seniors: Testimonials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 

Section III: Promising Models for Providing Medicare MNT in 

Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 

Promising Practice Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 

Section IV: Tips and Resources for Getting Started . . . . . . . . . . . . . . . . . . 21 

Step 1. Obtaining a National Provider Identifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Step 2. Obtaining an Employee Identification Number . . . . . . . . . . . . . . . . . . . . . . . . . 22

Step 3. Enrolling as a Medicare Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Step 4. Understanding Medicare Requirements for Referral and Billing . . . . . . . . . . . . . . . . . . 23

Conclusion and Call to Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26 

Medical Nutrition Therapy Works for Seniors | 2 
Acknowledgments 

We are grateful to the Registered Dietitian Nutritionists, Community 

Administrators and Senior Nutrition Program staff who participated in surveys 

to inform the contents of this toolkit. 

About the Academy of Nutrition and Dietetics 

Founded in 1917 and representing more than 107,000 registered dietitian nutritionists, nutrition and dietetic 

technicians, and advanced-degree nutritionists, the Academy of Nutrition and Dietetics is the largest 

association of food and nutrition professionals in the United States working to accelerate improvements in 

global health and well-being through food and nutrition. 

About the National Resource Center on Nutrition and Aging 

The National Resource Center on Nutrition and Aging has been hosted since 2011 by Meals on Wheels America 

as part of a cooperative agreement with the Administration for Community Living. The vision of the NRCNA 

is to build the capacity of the aging services network to provide nutrition services for both current and future 

older adult populations integrated into a home- and community-based service system and provide training 

and technical assistance to the aging network regarding nutrition services. Additionally, the NRCNA works to 

enhance the aging service network’s knowledge regarding the role of nutrition services in health promotion 

and disease prevention, and the scientific and clinical evidence that support both healthy meals and other 

nutrition services. 

Prepared by Paula Ritter-Gooder, PhD, RDN, CSG, LMNT, FAND, commissioned by the National Resource 

Center on Nutrition and Aging, in collaboration with the Academy of Nutrition and Dietetics. 

We appreciate the feedback from the following on creating this resource: 

Ucheoma O. Akobundu, PhD, RD Courtney Doby 

Senior Director, Nutrition Strategy and Impact Manager, Policy and Advocacy Communications 

Director, National Resource Center on Nutrition and Aging Academy of Nutrition and Dietetics 

 Jeanne Blankenship, MS, RDN Marsha Schofield, MS, RD, LD, FAND 

Vice President, Policy Initiatives and Advocacy Senior Director, 

Academy of Nutrition and Dietetics Governance and Nutrition Services Coverage 

Academy of Nutrition and Dietetics 

Medical Nutrition Therapy Works for Seniors | 3 
Introduction 

Welcome to the Medical Nutrition Therapy Works for Seniors Toolkit. This 

toolkit is the result of a collaboration between the National Resource Center on 

Nutrition and Aging and the Academy of Nutrition and Dietetics. 

The NRCNA is hosted by Meals on Wheels America as part of a cooperative agreement with the Administration 

for Community Living. Both the NRCNA and the Academy identified the need to create a practice-informed 

compendium of targeted guidance, resources and case studies to assist registered dietitian nutritionists and 

senior nutrition program administrators in understanding emerging opportunities in the provision of medical 

nutrition therapy to support the nutrition and health needs of community-residing older adults. Registered 

dietitian nutritionists have had access to the Medical Nutrition Therapy MNTWorks Kit® through the Academy, 

which was specifically designed to detail the varied benefits of RDN services and serves as a premier resource 

guide to support these professionals in promoting coverage of MNT. Senior nutrition program providers are 

in need of similar tools. More and more, they have been encouraged to develop relationships with Medicare 

Advantage plans to provide needed nutrition services for community-residing older adults, covering nutrition 

care services provided by registered dietitian nutritionists. Before now, limited resources existed to assist these 

organizations in making the business case for offering reimbursable MNT services and for establishing working 

partnerships with the plans. 

The Medical Nutrition Therapy Works for Seniors Toolkit is a compilation of information, resources and tools 

that summarizes nutrition-focused health care integration opportunities for senior nutrition programs, 

highlights the role and impact of RDNs, and lays out the examples of promising practice and researchinformed evidence regarding the clinical and cost-effectiveness of nutrition interventions. This resource guide 

focuses on Medicare as a key payor of health care services for many seniors, the authors acknowledge that 

supplemental health plans and/or other secondary coverage are also used by older Americans to cover 

needed services like MNT. 

The goal of this toolkit is to provide resources for RDNs and senior nutrition programs to strengthen their 

ability to offer MNT services for coverage by Medicare and Medicare Advantage plans for older adults in 

community settings. 

Medical Nutrition Therapy Works for Seniors | 4 
Future Readiness: Healthcare Integration and 

Sustainable Senior Nutrition Programs

Section I: 

Making the Case 

for Senior Nutrition 

Programs 

Leveraging Emerging Opportunities 

for Future Readiness and Sustainability 

Through Health Care Integration 

Medical Nutrition Therapy Works for Seniors | 5 
Making the Case for Senior Nutrition Programs – Leveraging Emerging Opportunities 

for Future Readiness and Sustainability Through Health Care Integration 

The changes created by the Patient 

Protection and Affordable Care Act of 20101 

have created opportunities for providers of 

community nutrition services to have an 

impact on the social determinants of health2 

for older adults. 

The 2019 position paper on Food and Nutrition Programs for 

Community-Residing Older Adults, authored by the Academy 

of Nutrition and Dietetics and the Society for Nutrition 

Education and Behavior, recommends a person-centered 

approach that utilizes both health care systems and community 

based programs as equal partners to promote health and wellbeing of community residing older adults.3

 Senior nutrition 

programs have a service structure in place and as trusted and 

proven providers, they are positioned to be a valuable partner 

in the expanding health care market.4 Local senior nutrition 

program providers and Area Agencies on Aging are part of a 

national network of community-based organizations (called 

the Aging Network) that assist Americans to age successfully 

in their homes and communities. As reforms to the health 

care landscape continue and understanding of the impact of 

Social Determinants of Health, these aging services providers 

are increasingly sought after/seeking to partner with health 

care entities to further control health care costs.5 Much of 

the available published literature suggests that quality of life, 

health and well-being for older adults can be improved by 

better integration and coordination with health care systems. 

Medical nutrition therapy has been a Medicare benefit since 

2002 and is typically offered in health care settings. RDNs and 

 senior nutrition programs who provide nutritional support 

to older adults in the community should explore emerging 

opportunities and promising practices for offering Medicare 

MNT in their setting. Congregate and home-delivered meals 

programs funded through the Older Americans Act can be ideal 

settings to provide reimbursable MNT therapy for older adults 

who have diabetes or chronic kidney disease. Offering MNT in 

the community setting can slow the progression of and reduce 

symptoms of chronic diseases.3 Medicare MNT provided in 

senior nutrition programs can improve lives and delay or prevent 

adverse health conditions to curb health care costs associated 

with hospitalizations and admissions to long term care. 

Medicare reimbursement for MNT is a sustainable funding 

source beyond the traditional funding base for senior nutrition 

programs that employ RDNs. Contracting with RDNs to provide 

MNT in the community setting allows senior nutrition programs 

to partner with health care providers in their area. Interested 

nutrition programs can offset the startup costs of exploring 

reimbursable MNT service models through a number of 

options — including securing private grant funding to support 

future sustainability of nutrition programs.4 Also, the health care 

system is shifting its focus to value-based payments involving 

providers across the health care and community settings. 

Senior nutrition programs are well-positioned to pitch the value 

proposition of offering MNT services through such new health 

care partnerships and secure funding these services through 

these value-based payments. With such services in place, it is 

possible for older adults enrolled in community-based senior 

nutrition programs, particularly those with limited resources 

and access/transportation for health care visits, to receive MNT 

within a community setting or within their own home. In this 

aspect, offering Medicare MNT in the home is an opportunity 

to improve and increase access to quality services and can 

be a solution for those not able to access health care services 

routinely from their health care provider. An increasingly 

competitive environment for public and private funding 

requires senior nutrition programs to provide more quality, 

client-centered, effective and efficient products and services.4 

Conducting outreach and marketing MNT as a service may 

serve to attract and enroll new individuals in the senior nutrition 

programs, expand the reach of the agency into the community, 

create new health care partnerships and promote the role of the 

agency as a provider of other services already in place. 

To learn more about partnering with health care entities visit: 

https://www.aginganddisabilitybusinessinstitute.org/about. 

Medical Nutrition Therapy Works for Seniors | 6 
Future Readiness: Healthcare Integration and 

Sustainable Senior Nutrition Programs

Section II:

Medical Nutrition 

Therapy in 

the Changing 

Landscape 

of Medicare and 

Medicare 

Advantage 

Medical Nutrition Therapy Works for Seniors | 7 
Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

Medicare is the largest payer of health care 

in the United States. Since the 1970s, 

Medicare beneficiaries have had the option 

to receive benefits from private health plans 

instead of the federally administered Fee for 

Service program. 

Medicare Advantage is the private Medicare health plan 

option that is available to beneficiaries. These plans, also 

known as Medicare Part C, Medicare + Choice Plans, or MA 

Plans, are licensed by the state, certified by the Centers for 

Medicare & Medicaid Services and may offer additional 

benefits beyond original Medicare. In 2003, due to the 

Medicare Prescription Drug, Improvement, and Modernization 

Act, enrollment in the Medicare Advantage program has 

been increasing. Currently, more than one-third of Medicare 

beneficiaries, or around 22 million, are enrolled in Medicare 

Advantage with 42 percent expected to be enrolled in 

Medicare Advantage by 2028.6,7 The rapidly growing Medicare 

Advantage has the potential to improve the quality of life of 

beneficiaries while reducing Medicare spending. 

To learn more about Medicare Advantage and recent 

policy changes, visit: https://nutritionandaging.org/ 

toolkit-healthcare-policy-and-practice-opportunities-forsenior-nutrition-programs-part-1-the-evolving-healthcarelegislation-landscape. Enrollment in the Medicare Advantage 

market is uneven across the country. To learn where 

Medicare Advantage beneficiaries are enrolled, go to: 

https://www.bettermedicarealliance.org/about-medicareadvantage/medicare-advantage-enrollment-map. 

Senior nutrition programs have an opportunity to partner 

with Medicare Advantage plans due to recent trends in the 

evolving health care landscape. Plans may provide medical 

nutrition therapy benefits for more conditions than available 

through Medicare Fee for Service. The Bipartisan Budget Act 

of 2018 allows Medicare Advantage to cover a wider array 

of benefits, which have implications for senior nutrition 

programs. For example, negotiation for Medicare Advantage 

plans to cover supplemental benefits such as home delivered 

hot meals benefit for chronically ill enrollees are made 

possible by the new regulations.8 Nutrition and aging services 

organizations have embarked upon identifying partnership 

and training opportunities to aging services providers seeking 

to better integrate community-based senior nutrition program 

services with traditional health care delivery.9 

Medical Nutrition Therapy and RDNs 

Medical nutrition therapy is an evidence-based application 

of the Nutrition Care Process, which is a systematic approach 

used to provide high quality nutrition care. The NCP consists 

of four distinct, interrelated steps: Nutrition Assessment, 

Nutrition Diagnosis, Nutrition Intervention and Nutrition 

Monitoring and Evaluation. MNT utilizes all domains of 

nutrition intervention including food and/or nutrient delivery, 

nutrition education, nutrition counseling and coordination of 

nutrition care.10 

MNT is not identical to nutrition education commonly 

provided in The Older Americans Act congregate and homedelivered meal programs. Providing MNT to a patient/client 

typically results in the prevention, delay or management 

of diseases and/or conditions. To learn more about the 

distinction between MNT and nutrition education, visit: 

https://www.eatrightpro.org/payment/coding-and-billing/ 

mnt-vs-nutrition-education. 

Medical Nutrition Therapy Works for Seniors | 8 
Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

Medical Nutrition Therapy Works for Seniors | 9 

RDNs can bill Medicare Part B for MNT for physician referred 

individuals with diabetes and/or renal disease. Medicare 

informs beneficiaries of this benefit here: https://www. 

medicare.gov/coverage/nutrition-therapy-services. Seniors are 

advised that they pay nothing for MNT as their deductible and 

coinsurance do not apply. The Medicare benefit allows three 

hours of MNT in the first referral year and two hours in each 

subsequent calendar year. Additional visits may be covered 

when there is a documented change in medical condition. 

Medicare Advantage plans must cover MNT services because 

MNT is a Part B benefit. RDNs or any organization that plans 

to provide MNT within a Medicare Advantage plan must first 

contract with that plan to be an MNT provider. The Centers 

for Medicare & Medicaid Services regulations require providers 

to obtain a National Provider Identifier number and use 

current procedural terminology codes when billing for MNT. 

To learn more about RDNs and MNT, please visit: 

https://www.eatright.org/food/resources/learn-more-aboutrdns/rdns-and-medical-nutrition-therapy-services, and 

https://www.ncoa.org/wp-content/uploads/Tip-SheetMedical-Nutrition-Therapy-10.23.15.pdf. 

Medical Nutrition Therapy Works 

for Seniors 

The following resources may be used to market and educate 

the use and benefits of MNT to community nutrition 

program administrators, health professionals, consumers 

and managed care.
 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

MNTWorks for Seniors 

The Value of Registered Dietitians Nutritionists 

RDNs are NUTRITION EXPERTS 

RDNs provide vital food and nutrition services, while promoting health and well-being to the public. RDNs 

use their expertise to help individuals make unique, positive lifestyle changes. They work throughout the 

community in hospitals, private practice, physician offices, public health clinics, nursing homes, fitness centers, 

worksite wellness programs, schools and other locations. 

RDNs provide MEDICAL NUTRITION THERAPY 

RDNs are the best qualified health care professionals to deliver nutrition education and medical nutrition 

therapy services for prevention, wellness and disease management. Nutrition services provided by RDNs can 

improve a consumer’s health and increase productivity and satisfaction levels through decreased doctor visits, 

hospitalizations and reduced prescription drug coverage. 

RDNs apply EVIDENCED-BASED PRACTICE 

RDNs provide care by applying the Academy of Nutrition and Dietetics’ Evidence-Based Nutrition Practice 

Guidelines. The guidelines illustrate best practice for MNT related to specific diseases or conditions to achieve 

positive outcomes. 

RDNs are HIGHLY TRAINED PROFESSIONALS 

RDNs receive extensive training that combines academic preparation with hands-on, practical patient 

experience. RDNs must complete a minimum of a bachelor’s degree, participate in a practice program 

involving direct patient interaction and pass a national registration exam. Approximately 50 percent of RDNs 

hold advanced degrees. RDNs are also required to complete continuing professional education to maintain 

their credential. 

RDN Services are integral to the PATIENT-CENTERED MEDICAL HOME 

RDNs work hand-in-hand with referring providers and multidisciplinary health care team members to deliver 

care that is coordinated and cost-effective. In addition to providing MNT, RDNs address areas such as glucose 

monitoring and body composition analysis. 

Adapted and printed by permission of the Academy of Nutrition and Dietetics from the Medical Nutrition Therapy MNTWorks Kit®. 

Medical Nutrition Therapy Works for Seniors | 10 
 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage

MNTWorks for Seniors 

Academy of Nutrition and Dietetics Evidence-Based Nutrition 

Practice Guidelines 

Registered Dietitians Nutritionists implement evidence-based practice, along with professional judgment, in 

order to achieve optimum care and positive nutrition and health outcomes. Utilizing the Academy of Nutrition 

and Dietetics Evidence-based Nutrition Practice Guidelines, RDNs make decisions about appropriate medical 

MNT interventions for specific disease states or conditions. 

Several guidelines indicate the length and frequency of MNT visits for a particular disease or condition. For 

example, in adults with Diabetes Mellitus, the RDN should implement three to six medical nutrition therapy 

encounters during the first six months and determine if additional MNT encounters are needed. In studies 

reporting on the implementation of an initial series of RDN encounters (three to 11; total of two to 16 hours), 

MNT significantly lowered HbA1c by 0.3 percent to 2.0 percent in adults with type 2 diabetes and by 1.0 percent 

to 1.9 percent in adults with type 1 diabetes during the first six months, as well as optimization of medication 

therapy and improved quality of life.1 

The following Academy nutrition practice guidelines include recommendations that are supported by evidence 

and describe RDN interventions that achieve best outcomes: 

• Adult Weight Management

• Celiac Disease

• Chronic Kidney Disease

• Chronic Obstructive Pulmonary Disease

• Critical Illness

• Diabetes Type 1 and 2

• Diabetes Type 2 Prevention

• Disorders of Lipid Metabolism

• Heart Failure

• HIV/AIDS

• Hypertension

• Oncology

• Unintended Weight Loss in Older Adults

1 Academy of Nutrition and Dietetics Evidence Analysis Library. “In adults with type 1 and type 2 diabetes, how effective is MNT provided 

by an RD/RDN on glycemia (A1c or glucose), medication usage and quality of life?” Accessed August 17, 2019. https://andeal.org/topic. 

cfm?menu=5161&cat=5596. 

Adapted and printed by permission of the Academy of Nutrition and Dietetics from the Medical Nutrition Therapy MNTWorks Kit®. 

Medical Nutrition Therapy Works for Seniors | 11 
 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

MNTWorks for Seniors 

RDNs Provide Better Health Outcomes 

The inclusion of nutrition interventions and counseling, when provided by a registered dietitian nutritionist 

as part of a health care team, results in significant improvements in weight and BMI, A1C, blood pressure and 

serum lipids. The following systematic reviews1 and other studies2 demonstrate the benefits of RDN-provided 

nutrition services. 

Overweight/Obesity 

Studies show medical nutrition therapy provided by a registered dietitian nutritionist to overweight and 

obese adults for less than six months yields significant weight losses of approximately one to two pounds per 

week. MNT provided from six to twelve months yields significant mean weight losses of up to 10 percent of 

body weight with maintenance of this weight loss beyond one year.1 MNT provided by an RDN results in both 

statistically and clinically significant weight loss in older adults with overweight and obesity.2 

Hypertension 

MNT provided by an RDN lowers blood pressure in adults with hypertension. Studies show MNT provided for less 

than six months leads to significant reductions in blood pressure of approximately five mm Hg for both systolic 

and diastolic blood pressure. MNT provided from six to twelve months reported similar significant reductions in 

blood pressure with sustained reductions in blood pressure beyond one year.1In older adults with hypertension, 

MNT provided by an RDN significantly reduces dietary sodium and lowers blood pressure.2 

Diabetes 

In studies reporting on the implementation of an initial series of RDN encounters (three to 11; total of two to 

16 hours), MNT significantly lowered HbA1c by 0.3 percent to 2.0 percent in adults with type 2 diabetes and by 

1.0 percent to 1.9 percent in adults with type 1 diabetes during the first six months, as well as optimization of 

medication therapy and improved quality of life.1 

Metabolic Syndrome/Prediabetes 

MNT provided to older adults by RDNs resulted in significantly greater weight loss, improvements in serum lipid 

profile and reduction in prevalence of the disease.2 

(continued on next page) 

Medical Nutrition Therapy Works for Seniors | 12 
 

 

 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

Disorders of Lipid Metabolism 

Patients who attend multiple RDN visits for MNT lasting an average of 45 minutes (30-60 minutes per session) 

over six to twelve weeks can reduce daily dietary fat (five percent to 8 percent), saturated fat (two percent to 

four percent) and energy intake (232-710kcal per day). This can result in a reduction in serum total cholesterol 

(TC) (down 7 percent to 21 percent), LDL-C (down 7 percent to 22 percent) and triglycerides (down 11 percent to 

31 percent).1 MNT provided by RDNs promote changes in dietary intake of fat and saturated fat and positively 

affects changes in serum lipid levels in older adults age ≥ 60 years who have disorders of lipid metabolism.2 

HIV Infection 

Studies regarding MNT report improved outcomes related to energy intake and/or symptoms (with or without 

oral nutritional supplementation) and cardiovascular risk indices especially with increased frequency of visits. 

Two studies regarding nutritional counseling (non-MNT) also report improved outcomes related to weight gain, 

CD4 count and quality of life.1 

Unintended Weight Loss in Older Adults 

Studies report that individualized nutrition care, directed by an RDN on the health care team, results in improved 

outcomes related to increased energy, protein and nutrient intakes, improved nutritional status, improved 

quality of life and/or weight gain.1 

Chronic Kidney Disease 

Research related to the time requirements for MNT provided by an RDN indicate that approximately two hours 

per month for up to one year may be required to provide an effective intervention for adults with chronic 

kidney disease. MNT should be initiated at least twelve months prior to the anticipation of renal replacement 

therapy (dialysis or transplant). Studies regarding effectiveness of MNT report significant improvements in 

anthropometric and biochemical measurements sustained greater than or equal to one year.1 

Heart Failure 

Research reports that MNT provided by RDNs resulted in a significant decrease in sodium intake and 

maintenance of body weight.1 The impact of MNT provided by an RDN for older adults with heart failure resulted 

in significant reductions in sodium and fluid intake.2 

Cancer 

In older adults with cancer, MNT provided by an RDN resulted in significant improvements in energy and 

protein intake, quality of life, and improved outcomes of prevention of nutrition deterioration, decreased weight 

loss, fewer unplanned hospital admissions during treatment, and shorter length of stay during unplanned 

hospital admissions.2 

1 Academy of Nutrition and Dietetics Evidence Analysis Library, https://www.andeal.org/default.cfm. Accessed August 19, 2019. 

2 The Academy of Nutrition and Dietetics National Coverage Determination Formal Request. J. Acad Nutr and Diet. 2012;112(1):149-176. 

Adapted and printed by permission of the Academy of Nutrition and Dietetics from the Medical Nutrition Therapy MNTWorks Kit®. 

Medical Nutrition Therapy Works for Seniors | 13 
 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

MNTWorks for Seniors 

MNT Providing Return on Investment 

Data shows that medical nutrition therapy involving in-depth individualized nutrition assessment and a duration 

and frequency of care using the Nutrition Care Process to manage disease, yields positive results. MNT is linked to 

improved clinical outcomes and reduced costs related to physician time, medication use and hospital admissions 

for people with obesity, diabetes and disorders of lipid metabolism, as well as other chronic diseases.1 

University of Virginia School of Medicine2reported that an RDN case management approach to lifestyle care can 

improve diverse indicators of health, including weight, waist circumference, health-related quality of life and use 

of prescription medications, among obese persons with type 2 diabetes. These results were seen with a minimal 

cost of $350 per year per patient. 

Diabetes and obesity are associated with elevated rates of lost productivity and disability. In 2007, people with 

diabetes lost 15 million days of work due to diabetes, costing the U.S. economy approximately $2.6 billion.3 

A modest-cost, RDN-led lifestyle intervention provided to people with diabetes and obesity reduced the risk of 

having lost work days by 64.3 percent and disability days by 87.2 percent, compared with those receiving usual 

medical care. For every dollar an employer invests in the lifestyle modification program for employees with 

diabetes, the employer would see a return of $2.67 in productivity.4 

Massachusetts General Hospital5reported that participants receiving group MNT in a six-month randomized 

trial had a six percent decrease in total and LDL-cholesterol levels, compared with the group not receiving MNT. 

The non-MNT group had no reduction in total cholesterol or LDL levels. The study revealed a savings of $4.28 for 

each dollar spent on MNT, much less than the cost of statin therapy. 

The Lewin Group documented an 8.6 percent reduction in hospital utilization and 16.9 percent reduction 

in physician visits associated with MNT for patients with cardiovascular disease. The group additionally 

documented a 9.5 percent reduction in hospital utilization and 23.5 percent reduction in physician visits when 

MNT was provided to persons with diabetes mellitus.6 

Prenatal nutrition programs that target high-risk pregnant women have been shown to improve long-term 

health outcomes in children, saving at least $8 for each dollar invested in the program.7 

1 Academy of Nutrition and Dietetics Evidence Analysis Library. Medical Nutrition Therapy Effectiveness (MNT) Systematic Review 

(2013-2015). https://www.andeal.org/default.cfm. Accessed August 19, 2019. 

2 Wolf AM, Conaway MR, Crowther JQ, et al. Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving 

Control with Activity and Nutrition (ICAN) study. Diabetes Care. 2004;27:1570–6. 

3 American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2007. Diabetes Care. 2008;31:596–615. [PubMed: 18308683]. 

4 Wolf AM, Siadaty MS, Crowther JQ, et al. Translating Lifestyle Intervention on Lost Productivity and Disability: Improving Control with 

Activity and Nutrition (ICAN). J Occup Environ Med. 2009 February;51(2):139–145. 

5 Delahanty LM, Sonnenberg LM, Hayden D, Nathan DM. Clinical and cost outcomes of medical nutrition therapy for hypercholesterolemia: 

A controlled trial. J Am Diet Assoc. 2001;101:1012–1016. 

6 Johnson, Rachel. The Lewin Group — What does it tell us, and why does it matter? J Am Diet Assoc. 1999;99:426–427. 

7 Duquette MP, Payette H, Moutquin JM, Demmers T, Desrosiers-Choquette J. Validation of a screening tool to identify the nutritionally atrisk pregnancy. J Obstet Gynaecol Can. 2008 Jan;30(1):29–37. 

Adapted and printed by permission of the Academy of Nutrition and Dietetics from the Medical Nutrition Therapy MNTWorks Kit®. 

Medical Nutrition Therapy Works for Seniors | 14 
 

Medical Nutrition Therapy in the Changing Landscape 

of Medicare and Medicare Advantage 

MNTWorks for Seniors 

Testimonials 

The benefits of providing Medicare MNT within senior nutrition programs and in community settings include 

positive client and community program outcomes. The case for offering Medicare MNT in community-based 

organizations is demonstrated by these testimonials. 

Our perception is that Accountable Care Organizations and physicians previously viewed us as Home Care folks, they 

now see us as part of managed care. 

— Area Agency on Aging Administrator 

We received very positive feedback from a physician during the referral process and feel that is building an important 

bridge. We feel delivering MNT will help us align with the health care community. 

— RDN Senior Nutrition Program Administrator 

Health care partners are very excited to hear that we offer this service and over time we get more and more referrals to 

help them reach clients they are not able to help. We have made some dramatic impacts on clients. We have helped 

one individual control his diabetes to the point that he lost weight and got his BG/A1C in control. He was placed on the 

kidney transplant list again (had been removed due to poor health management). Other clients have reported that 

with the new knowledge we have given them, they are now empowered to know how to manage their diabetes and 

their health. They feel supported and that they have someone who can help navigate their health issues. 

— Administrator of a Non-Profit Organization 

Providing MNT has been a huge impact on engagement with health care partners. It has opened up conversations 

with other health plans as we are a licensed Medicare provider. 

— Administrator of a Meals on Wheels Program 

Adapted and printed by permission of the Academy of Nutrition and Dietetics from the Medical Nutrition Therapy MNTWorks Kit®. 

Medical Nutrition Therapy Works for Seniors | 15 
Future Readiness: Healthcare Integration and 

Sustainable Senior Nutrition Programs

 

Section III:

Promising Models 

for Providing 

Medicare MNT in 

Community 

Settings 

Medical Nutrition Therapy Works for Seniors | 16 
Promising Models for Providing Medicare MNT 

in Community Settings 

Recognizing that all community-based 

nutrition programs are unique to their 

communities, the following case studies offer 

insights into how a selection of programs 

have established Medicare MNT services. 

Gleaned from information interviews with key 

staff at each organization, the case studies 

provide an overview of their service models, 

challenges encountered, and success realized 

to guide you in implementing MNT services 

within your community. 

Promising Practice Case Studies 

Case Study 1 

A not-for-profit organization that provides a comprehensive array 

of health and nutrition services to older adults and individuals 

living with a medical challenge and/or disability. 

1. What led you to provide Medicare MNT services?

Initiated in February 2018, our original focus was to provide 

services to home bound individuals. We started with the 

goal to reduce frequent hospital readmissions, but referrals 

were not occurring. We had to develop multiple revenue 

streams to provide economy of scale. Primary focus is on MNT 

for diabetes. 

2. What is your business model and how long have you

provided Medicare MNT?

We offer MNT for Medicare beneficiaries who have diabetes, 

and other individuals in the community who have private 

insurance plans, as well as corporate wellness programs. 

We employ 3.5 FTE’s RDNs. We offer MNT in the home and 

at other locations to be creative (libraries, etc.) We limit the 

service to in-county residents due to drive time and mileage. 

We expanded into wellness programs for younger clients to 

sustain a strong funding stream. In this venue, we partnered 

with other primary care providers for referrals to be able to bill 

insurance plans for reimbursement for MNT. 

3. Describe what steps were involved in getting this model

operative, what were the inputs or resources needed?

The RDN obtains the NPI and insurance billing staff assists 

the RDN to become credentialed with insurance plans and 

Medicare. It took about two-three months to accomplish 

these steps. Clerical support is needed to bill and process 

referrals and obtain all the necessary information for billing 

to be successful. We employ a case manager to help set up all 

needed requirements before the RDN calls the client to set 

the appointment. We need a referral and diagnosis of diabetes 

to bill insurance. The clinicians also want medical information 

and medications the client is taking. 

4. How are referrals generated?

First, we used the typical approach to get referrals from 

primary care providers using fax and email and obtained an 

estimated 137 referrals in the last calendar year. Transitioning 

to our online secure referral portal that is encrypted for 

necessary HIPAA regulations accelerated referrals and broke 

down many barriers. We received 200 referrals from January 

to May 2019, by the end of July we hit 300, with 500+ referrals 

anticipated by end of calendar year. Referrals are building 

as we develop relationships within the community. Using 

the online portal, health care professionals can refer at any 

time. Additionally, we accept self-referrals through this same 

portal. Administrative staff obtains needed information for 

all referrals, the physician offices are beginning to provide 

all necessary information including insurance information, 

so the referrals are ready to go. We find it important to get 

back to the referral source if client denied service and report 

any outcomes. This was vital to demonstrate that we are 

responsive and a partner in providing professional services. 

5. Explain your billing process.

We decided to bill the claims ourselves so we could actively 

and timely pursue any claims that are denied. Our billing is 

processed directly through the electronic health record that 

we use. The referral is taken with the diabetes ICD10 code, 

case manager assigns a client to the RDN, the RDN calls the 

client and sets the appointment, appointment is conducted, 

RDNs chart and then send billing through the EHR, the billing 

specialist sends the billing to the insurance companies. 

Medical Nutrition Therapy Works for Seniors | 17 
 

6. What is your system for documenting care?

We use an electronic health record to document care and 

process billing (Meditouch®). 

7. How have you marketed the service?

MNT is marketed on our website, word of mouth/networking. 

8. Are you profitable? If yes, how? If not, why?

We are not profitable yet, and I expect that this will only be 

one source of revenue for our department. Going into homes 

has much higher costs vs. having a client come to the office. 

There is travel time and mileage that adds to the RDN’s time. 

The max visits per day is estimated at three, since there is still 

charting that happens after the visit. We also use permanent 

employees for this model. Using contingent RDNs would be 

somewhat risky, as they would be paid an hourly rate and 

most of what is paid by insurance reimbursements would go 

to their wages and mileage. There are administrative costs that 

still need to be covered. Having this program as one of several 

lines of income seems to be the best way to offer it. 

9. What were the struggles or challenges?

Know what the infrastructure expenses will be. Investigate the 

startup costs as revenue will not come in immediately. Getting 

the back-end structure in place, clients understanding the 

service and desiring it, determining that the client is eligible, 

estimating the costs of the service and compensation to the 

RDN to account for drive time and chart time as these are not 

billable expenses. 

10. What factors contribute to making you successful in

this endeavor?

We continue to work on evolving the model and the RDNs 

work in other areas that bring in income. We use grants to 

support those who cannot pay the deductible for other 

chronic conditions not currently covered. 

11. What has been the impact of this service on:

a. The organization’s bottom line? 

It has added one new revenue stream to our department.

We also do corporate work (no insurance billing needed) and

receive grants for community work.

b. Engagement with health care partners?

Health care partners are very excited to hear that we offer this

service and over time we get more and more referrals to help

them reach clients they are not able to help.

c. Client health care outcome?

We have made some dramatic impacts on clients. We have

helped one individual control his diabetes to the point that he

lost weight and has improved glycemic control. He was placed

on the kidney transplant list again (had been removed due to

poor health management). Other clients have reported that

with the new knowledge we have given them, they are now

empowered to know how to manage their diabetes and their

health. They feel supported and that they have someone who

can help navigate their health issues.

Medical Nutrition Therapy Works for Seniors | 18 
 

Promising Models for Providing Medicare 

MNT in Community Settings

Case Study 2 

An Area Agency on Aging, a non-profit agency serving elders, 

and addressing needs for food, mental assistance, necessities and 

financial management. 

1. What led you to provide Medicare MNT services?

For health promotion, use of evidence-based practices, 

numerous questions for RDNs at senior centers, flexibility in 

funding sources. 

2. What is your business model and how long have you

provided Medicare MNT?

The RDN is employed on staff, and per diem RDNs are 

contracted for languages other than English. We have 

provided Medicare MNT for six years. MNT is provided 

primarily in the home and at community centers, public 

housing developments, and senior centers. We have started a 

pilot program with Medicare Advantage Plan. 

3. Describe what steps were involved in getting this model

operative, what were the inputs or resources needed?

The key is to use administrative staff for appointments and 

obtaining needed referrals and use the RDN time for MNT. 

4. How are referrals generated?

A letter describing who is eligible, description of the 

service, how to refer and an overview of our agency is sent 

to health care providers. A screening and referral form is 

used to obtain beneficiary information in congregate 

settings and other programs offered by the agency. Referral 

requests are submitted to the primary care provider for the 

needed authorization. 

5. Explain your billing process.

Claims are submitted directly by our agency to National 

Government Connex Services 

6. What is your system for documenting care?

Paper records are maintained, we are researching 

electronic software. 

7. Are you measuring patient care outcomes or

other outcomes?

Quality of Life Surveys and Food Frequencies are obtained for 

individual clients, but not enough data is available for health 

care utilization studies. 

8. How have you marketed the service?

MNT is marketed as a solution, secondary resource, 

and complementary to the health care provider services. 

Case managers screen initial intakes for diabetes and 

kidney diagnosis. 

9. Are you profitable? If yes, how? If not, why?

The last six months have been the breakeven point for us 

since we started the service over six years ago. The increase in 

referrals made this possible. 

10. What were the struggles or challenges?

Working on denied claims. 

11. What has been the impact of this service on:

a. The organization’s bottom line?

The last six months have been the breakeven point.

b. Engagement with health care partners?

Our perception is that Accountable Care Organizations and

physicians previously viewed us as home care folks, they now

see us as part of managed care.

Medical Nutrition Therapy Works for Seniors | 19 
Case Study 3 

A meals-on-wheels and nutrition education program for senior 

citizens and other individuals with chronic diseases. 

1. What led you to provide Medicare MNT services?

We needed a way to sustain funding for our nutrition 

education and nutrition counseling services. Continued

funding sources were also needed to employ the professional 

registered dietitian nutritionist. We wanted to be more 

involved in the health care arena by providing a professional 

service and to have a marketing niche to offer hospital systems 

and insurance companies. 

2. What is your business model and how long have you

provided Medicare MNT?

We have been providing MNT for about seven years with RDNs 

on staff. Our agency is a Medicare Provider for MNT. Most 

Medicare MNT clients have transportation problems, so we 

provide in-home service using a code to bill for in-home. The 

RDNs also work in multiple projects in addition to Medicare 

MNT. For example, we have a Ryan White grant (federally 

funded program for HIV clients) and the RDNs see many clients 

in our four clinics. 

3. How are referrals generated?

Referral forms are sent by providers using fax or email. We 

get referrals from the Medicaid manager, hospitals, and other 

business clients who receive our education programming

or meals. 

4. Explain your billing process.

We bill Medicare directly as we have a biller who was already 

on staff to bill Medicaid Waiver meals. 

5. What is the system for documenting care?

We use both electronic health records, (Epic©) and paper 

charts depending on what the clinic uses. 

6. How have you marketed the service?

The biggest challenge has been no funds for marketing. We 

use presentations and conversations to get the message out. 

7. Are you profitable? If yes, how? If not, why?

The Ryan White grant is helpful in supporting the cost of the 

overall MNT program. Our startup cost was high as we had a 

Promising Models for Providing Medicare 

MNT in Community Settings 

biller on staff who could address denials. The biller has helped 

with our intake process to ensure all required information is on 

the form prior to submitting the claim. 

8. What were the struggles or challenges?

Marketing the service and getting the referral form completed 

has been a challenge. Getting a physician signature has been 

difficult in many situations. We are now reviewing telehealth 

opportunities as travel time is not billable. We have identified 

a platform that the patient and provider can both access, with 

a goal to have in place prior to the end of this year. 

9. What has been the impact of this service on:

a. The organization’s bottom line:

We do not itemize costs out for different services to determine 

if the revenue for providing MNT covers the cost. Our RDNs 

work in multiple program areas. 

b. Engagement with health care partners:

This has been a huge impact as we are a licensed Medicare 

provider. It has opened conversations with other health plans. 

c. Client health care outcomes:

We are starting the process and have applied for funding 

to do research on MNT outcomes. For previously related 

projects we have collected A1c, knowledge assessment and 

behavior change. 

Medical Nutrition Therapy Works for Seniors | 20 
Future Readiness: Healthcare Integration and 

Sustainable Senior Nutrition Programs

 

Section IV: 

Tips and 

Resources for 

Getting Started 

Medical Nutrition Therapy Works for Seniors | 21 
 

Tips and Resources for Getting Started 

Positioning your organization or yourself 

to provide Medicare MNT takes multiple 

steps. The Academy has resources to assist 

with getting a Medicare MNT service 

initiated that are available at no cost to 

Academy members and available for 

purchase by nonmembers. To learn more, 

visit: https://www.eatrightpro.org/payment/ 

getting-started/becoming-a-provider. 

Step 1. Obtaining a National 

Provider Identifier 

The NPI is a unique 10-digit number issued by CMS to health 

care providers in the United States. Obtaining an NPI must 

be done prior to enrollment as a Medicare provider. The 

NPI identifies the RDN as a health care provider in standard 

transactions, including billing for services. To read more about 

the value of the NPI, go to: https://jandonline.org/article/ 

S2212-2672(18)30746-9/fulltext. 

The NPI number is good for life and the RDN may have 

received one while at another place of employment. Before 

applying for an NPI number you can search the NPI registry 

to learn if you already have a number. For more information, 

please visit: https://npiregistry.cms.hhs.gov. 

If your organization has employed the RDN and will receive 

payment for MNT, your organization must also obtain an NPI 

number. Directions and application for applying for an NPI are 

located at https://nppes.cms.hhs.gov/#. 

Step 2. Obtaining an Employee 

Identification Number 

If you are an RDN, a sole proprietor, and will be billing 

Medicare directly for MNT services, obtaining an EIN will 

protect your Social Security Number from being disclosed 

on numerous documents and claims sent to health plans. For 

more information, visit: https://www.irs.gov/businesses/smallbusinesses-self-employed/how-to-apply-for-an-ein. 

Step 3. Enrolling as a Medicare Provider 

The RDN as the Medicare Provider 

The RDN must be an approved Medicare Provider to provide 

Medicare MNT and directly receive payment or assign 

benefits to the employing agency. CMS uses an Internet Based 

Provider Enrollment, Chain and Ownership System to accept 

applications and changes in provider status. To apply directly 

on the CMS website to become a Medicare provider go to: 

https://pecos.cms.hhs.gov/pecos/login.do#headingLv1. 

Find more information about the benefits of becoming a 

Medicare provider and how to enroll in Medicare, visit: 

https://www.eatrightpro.org/payment/medicare/medicareprovider-enrollment. 

Senior Nutrition Program as a Medicare Provider 

If your organization employs RDNs to provide MNT, your 

organization must also apply as a Medicare Provider for billing 

purposes. Specific directions for senior nutrition programs 

(i.e. local service providers and Area Agencies on Aging) to 

complete an application for billing Medicare for MNT can 

be found here: https://www.ncoa.org/wp-content/uploads/ 

Instructions-for-Obtaining-a-Medicare-Provider-Number.pdf. 

Medical Nutrition Therapy Works for Seniors | 22 
Tips and Resources for Getting Started 

Step 4. Understanding Medicare 

Requirements for Referral and Billing 

The following information is intended to support RDNs and 

community agencies in their understanding of complying 

with Medicare delivery and payment requirements. Basic 

information is available at: https://www.cms.gov/Medicare/ 

Medicare.html. Dedicated administrative support is 

necessary to ensure Medicare MNT provided by the RDN 

is reimbursable and claims processing goes smoothly. 

Submitting accurate claims when requesting payment for 

Medicare-covered health care services requires a good 

understanding of the Medicare program. Detailed information 

on the ins and outs of billing and practice management 

resources containing sample referral forms, privacy practice 

for HIPAA, and other forms can be found in toolkits that 

are available to Academy of Nutrition and Dietetic members 

at no cost and for purchase for a nominal fee by nonmembers 

11-13

at: https://www.eatrightstore.org/product-subject/mntreferences/mnt-business-practice-tools. 

The following toolkit is available to learn more about 

launching an in-home medical nutrition therapy program: 

https://nutritionandaging.org/toolkit-healthcare-policy-andpractice-opportunities-for-senior-nutrition-programs-part-2-

launching-an-in-home-medical-nutrition-therapy-program. 

Medical Nutrition Therapy Works for Seniors | 23 
 

Conclusion and 

Call to Action 

Ongoing changes in health care policy have provided opportunities for 

senior nutrition programs and RDNs to become health care partners in the 

community setting. 

This toolkit can be used by senior nutrition programs and RDNs to understand the framework for providing 

MNT within community programs. Due to increasing enrollment in Medicare Advantage, the toolkit can 

also serve to advocate for inclusion and expansion of nutrition services within Medicare Advantage plans. 

Innovative models and programs are emerging which demonstrate promising practices of providing 

community-based MNT. These opportunities illustrate how programs are integrating into health care delivery. 

By tapping into the payment stream of Medicare and Medicare Advantage, senior nutrition programs are 

securing additional funding streams to support their nutrition programs that serve seniors. For future 

sustainable programming that enhances the health of seniors, senior nutrition programs and RDNs are 

encouraged to be innovative and establish similar programs within their community. 

Medical Nutrition Therapy Works for Seniors | 24 
References

 1 U.S. Department of Health and Human Services. The Affordable Care Act. Available at: https://www.hhs.gov/ 

healthcare/about-the-aca/index.html.

 2 Centers for Disease Control and Prevention. Social Determinants of Health: Know what affects health. Available 

at: https://www.cdc.gov/socialdeterminants/index.htm.

 3 Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: 

Food and Nutrition Programs for Community-Residing Older Adults. J Acad Nutr Diet. 2019;119(7):1188-1204. 

Available at: https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/ 

position-papers/pp_foodnutritionprogramsolderadults.pdf.

 4 Netterville, LL. Sustainability and Revenue Generation in an Evolving Senior Nutrition Business Environment. 

Available at: https://nutritionandaging.org/wp-content/uploads/2019/04/Sustainability_Brief.pdf.

 5 National Association of Area Agencies on Aging. Measuring the Value of AAA Services. Making the Case to 

Health Care Partners. A ROI survey of Area Agencies on Aging. Available at: https://www.n4a.org/files/n4a_ 

ROI_Report_July2018_Final.pdf.

 6 Kaiser Family Foundation. Available at: https://www.kff.org/medicare/issue-brief/a-dozen-facts-aboutmedicare-advantage.

 7 Congressional Budget Office (2018). Medicare – Congressional Budget Office’s April 2018 Baseline. Available at: 

https://www.cbo.gov/sites/default/files/recurringdata/51302-2018-04-medicare.pdf.

 8 Sung, J, Noel-Miller, C. AARP Public Policy Institute. Supplemental Benefits in Medicare Advantage: Recent 

Public Policy Changes and What they Mean for Consumers. July 2019. Available at: http://www.nasuad.org/ 

sites/nasuad/files/medicare-supplement-series-two.doi.10.26419-2Fppi.00075.002.pdf.

 9 Meals on Wheels America. Effective Partnerships Between Community-Based Organizations and Healthcare: 

A Possible Path to Sustainability. Available at: https://www.mealsonwheelsamerica.org/docs/default-source/ 

research/effective-partnerships-between-cbos-and-healthcare_full-report_final.pdf?sfvrsn=8e5fbf3b_2. 

10 Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for 

Nutrition Care 2017. Available at http://ncpt.webauthor.com. 

11 RDN’s Complete Guide to Credentialing and Billing: The Private Payer Market 2016. Available at: 

https://www.eatrightstore.org/product-type/toolkits/rdns-complete-guide-to-credentialing-and-billing. 

12 Coding and Billing Handbook. A Guide for Program Directors and Preceptors. Second Edition, 2017. Available 

at: https://www.eatrightstore.org/product-subject/mnt-references/coding-and-billing-handbook-a-guide-forprogram-directors-and-preceptors. 

13 MNT Business Practice Tools: A Set of All Handouts. Available at: https://www.eatrightstore.org/productsubject/mnt-references/mnt-business-practice-tools. 

Medical Nutrition Therapy Works for Seniors | 25 
 

Resources 

1. Getting started with internet Based PECOS. https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/MedicareProviderSupEnroll/downloads/GettingStarted.pdf 

2. National Coverage Determination (NCD) for Medical Nutrition Therapy. https://www.cms.gov/medicarecoverage-database/details/ncd-details.aspx?NCDId=252&ncdver=1&bc=AAAAQAAAAAAA& 

3. Malpractice insurance rationale and process for obtaining malpractice insurance. https://www.proliability. 

com/professional-liability-insurance/dietetic-practitioners?prof=DieteticNutritionists_professionlist 

4. MNT Provider Monthly Newsletter. https://www.eatrightpro.org/news-center/in-practice/mnt-provider/2019-

mnt-provider 

Medical Nutrition Therapy Works for Seniors | 26 
The National 

Resource Center on 

Nutrition & Aging