Diet and nutrition providers that are looking to leap into billing with insurance may not know the best place to start. After all, today’s insurance landscape is extremely complicated and can feel daunting if you are not familiar with the process. Many specialists who previously did not accept insurance are beginning to and more and more insurance plans are bringing dietician services under their umbrella of coverage. The realization has been that accepting insurance is a quicker way to get paid for services, it helps make services affordable for patients, and brings in a higher number of patients than without.
Ultimately understanding what medical billing codes to use, and who is eligible to use them, will help providers improve their overall claims process by achieving more approvals and earning more payments.
Billing Differences for Dieticians and Nutritionists
Though they work with their clients in similar ways, like chiropractors and physical therapists, there are major differences between how dieticians and nutritionists bill for their services. Boiled down, the main difference between the two is Registered Dieticians (RDs) and Registered Dietician Nutritionists (RDNs) undergo a rigorous qualification process set for the by and Academy of Nutrition and Dietetics. Because dietician training is federally mandated, all dieticians can bill insurance.
Certified Nutrition Specialists (CNSs) also undergo training and certification, but the requirements are not nearly as stringent as for dieticians. The ability for nutritionists to bill insurance companies varies from state to state. Even if a nutritionist is eligible to bill to insurance, they are less like to be covered as thoroughly as their RDN counterpart.
It is also important to note that, especially with the rise of social media influencers, there are dozens of titles like personal trainers and life coaches and the like who may offer nutritional advice and diet plans, but who do not meet the qualifications in order to be covered by or to bill insurance companies.
5 Billing Tips for Dietitians and Nutritionists:
For providers that are eligible for insurance billing, it’s important that they are doing so correctly and efficiently. Though dietitians and nutritionists may gather a large portion of their revenue from self-pay clients, the ability to leverage insurance billing can boost their bottom line. Insurance billing, however, is a complicated landscape. Here’s a breakdown of billing basics.
1) Determine What Insurance Companies are Used Most in Your Area
The first step to billing for dietician services is to first determine which insurance companies you would like to partner with. What companies you choose to work with should be influenced by a few key factors.
Providers should first look at the major insurance providers in their area. This would include the insurance companies that the most potential patients would carry depending on where you practice. While some big names might pop up in your brain for who is considered a major insurance group, that does not necessarily mean they are popular in your area.
Providers should also consider which payers are known to offer coverage when billing for dietician services. This will make going through the credentialing process much more rewarding.
Each payer will have different requirements for what is necessary to be a part of their provider panel. While it would be nice if there was one standardized process for each provider, there is not. This is why it is so important that you make sure you work with the right companies. Doing so will prevent you from having to adhere to too many unnecessary payer requirements and take up too much of your time.
2) Prepare for the Application and Credentialing Processes
To join an insurance company’s provider panel, you must go through the credentialing process. This is an extremely involved means for getting enrolled in an insurance company’s preferred provider network. This is not necessary to bill to the insurance, but you will need to be credentialed if you wish to be paid by them directly rather than having to work through your patients. The credentialing process is part of what makes billing for dietician services so complicated.
The credentialing component of billing for dietician services can take anywhere from 90 days up to 6 months depending on how smooth the process runs. If you are looking to accept insurance, you need to start the credentialing process much sooner than later.
Thankfully partners like Apex EDI can support you through the enrollment process.
3) Familiarize Yourself with Common CPT Codes
There are two types of codes that providers might use in their medical careers. These codes include ICD-10 codes and Current Procedural Terminology (CPT) codes. When billing for dietician services, providers will need to be familiar with CPT codes. It is less likely that the job of a dietician would involve the utilization of ICD-10 codes, which are used for describing medical diagnosis on claims.
In order to bill effectively and maximize how much a dietician earns from each claim, knowing these codes and coding each claim accurately is extremely important.
Some of the most used codes used when billing for dietician services include:
- 97802: MNT; Initial assessment and intervention, individual face-to-face with the patient, 15-minute units.
- 97803: Reassessment and intervention, individual face-to-face with the patient, 15-minute units.
- 97804: Group intervention (2 or more individuals), face-to-face, 30-minute units.
It is important to note that when billing for dietician services with health insurance companies, providers will always use form CMS 1500. The easiest, most effective, and most rewarding way to file claims is through the use of an electronic clearinghouse. It will always verify that you are coding your claims with the correct CPT codes and optimize each one for approval.
4) Understand Superbills
For providers that want to accept insurance without going through the credentialing process, they will need to use superbills. A superbill is an itemized list of all services that a provider rendered to a client. Clients then take this itemized list to their insurance company, where they are reimbursed for all, or a percentage, of what was paid to the provider out of the patient’s pocket.
This will allow patients with insurance to continue to utilize dietician services even if their provider is not credentialed with their payer. While billing for dietician services is more convenient for the patient when their provider is credentialed with their payer, superbills allow a provider to visit with more patients than just those who have the insurance they accept.
With the right software, providers can automatically generate superbills to give to their patients who need them.
5) Streamline Patient Statements
As a dietician or nutritionist, you know your services are less likely to be covered by insurance plans than other practitioners – like pediatricians or outpatient surgeons. Patients may have deductibles, and appointments with you may not be covered in full. Plus, if insurance billing seems complicated to you, imagine how complex it seems to your patients. The best way to help patients stay on top of their cost-sharing responsibilities is to send patient statements which clearly delineate what they owe, what was covered, and how much and by when they need to pay.
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Tracy Karle, Billing Manager
Find the Right Technology to Simplify the Entire Process
The most important part of billing for dietician services is finding the right tools that will help you along the way. Billing for dietician services can be time-consuming when you do not have the right software and technology to streamline the process. Apex EDI is here to help simplify your claim processing and help you get paid faster. Schedule a demo today to learn more.