Dieticians

To be entitled to reimbursement from the National Health Fund or the relevant public sector fund, all dietary acts must be prescribed by a doctor and the prescription must be validated by the CNS. Prior validation allows me to have confirmation that the costs of the treatment will be covered by health and maternity insurance before starting a treatment lasting several sessions.

Request for validation by the insured person

If the insured person requests validation, they must send the original medical prescription by post to the CNS. The CNS will then send them a certificate of coverage or a reasoned refusal in paper form. In case of authorisation, they can come to me and give me the prescription and the certificate of coverage.

In this case, direct coverage by the CNS (third-party payer) is excluded.

Request for validation by the dietician

Making the request for validation directly by me, as a dietician, offers several advantages over the request made by the insured person. Electronic exchange between me and the CNS allows for faster and more reliable data transfer. In addition, to apply the third-party payment system, the request and issuance of the certificate of coverage must be done electronically.

After scanning the prescription provided by the insured and entering the necessary information with a suitable computer tool, I send the scanned request to the CNS. I will receive a response within one working day (barring exceptions). This response, which will also be sent electronically, will be either a reasoned refusal or an authorisation, including a certificate of coverage number, the period of validity of the certificate and details of the approved services.

Upfront payment by the insured party

At the end of the treatment, I will present the insured party with an invoice showing the total amount to be paid, i.e. the portion to be paid by the health insurance fund and the portion to be paid by the insured party.

After payment, the insured party will apply to their competent fund (CNS or public sector health insurance fund) for reimbursement of the portion to be paid by the health insurance fund.

Application of the third-party payment system

As a dietician, I cannot apply the third-party payment system if the insured person has himself requested a certificate of coverage from the CNS. In other cases, I must apply the third-party payment system if the insured person requests it and for services provided to persons within the competence of the Accident Insurance Association.

The portion of the costs that is not reimbursed by the health insurance must be invoiced directly to the insured person.

To obtain payment of the fees reimbursable by the health insurance as part of the third-party payment system, I send my invoices to the CNS electronically. I can include all the sessions carried out without having to wait for the end of a series of treatments (several sessions prescribed by a prescription).

The procedures for creating and sending the invoicing files to the CNS are defined in the specifications annexed to the agreement between the CNS and the ANDL, and are detailed under the ‘Electronic data exchange’ tab of the ‘My procedures for starting my activity’ section.

After processing, the CNS sends me an electronic file containing all the information and reasons concerning invoices that are not or not fully reimbursed, and proceeds to pay the amount due within a deadline of 30 days.

The practice of dietetics in a liberal association with fee pooling is linked to the creation of a common service provider code. All acts performed by members of the association can be invoiced under this association code.

Unlike other forms of common invoicing, the liberal association is characterised by greater stability and transparency among its members. In concrete terms, this translates into the following practical arrangements:

• Each member of the association must confirm the membership or departure of a member by signing it
• Each member of the association receives an annual statement of the amounts charged to the association for the period during which they were a member
  

To request an association code or to communicate a change in the composition of an existing association to the CNS, the form ‘Practice of dietetics in liberal association’ (Pratique de la diététique en association libérale) under the heading ‘Focus on forms’ should be used.

Private dieticians, dieticians' associations, care and assistance institutions, care and assistance networks and semi-residential centres have the right to invoice services provided by individual dieticians other than the invoicing dietician, provided that the relationship between the invoicing dietician and the performing dietician is first reported to the CNS. In this context, both an employment relationship and work under a business contract (also known as ‘freelance’) are permitted.

The CNS will only cover invoices for a practising dietitian who has been previously declared as a member of the invoicing firm or establishment using the form ‘Joining and/or leaving a group of dieticians with a common invoicing system (not grouped in a liberal association)’(Départ et/ou adhérence à un groupement de diététiciens à facturation commune (non regroupés en association libérale)) available under the heading ‘Focus on forms’.

To receive the latest information by e-mail, I would like to subscribe to the newsletter for service providers: CNS Update.

For any questions relating to day-to-day exchanges with the CNS, particularly regarding authorisation and invoicing procedures, I should contact: infodiet.cns@secu.lu