Unlocking The Process: Billing Insurance For Nutrition Services

Billing insurance for nutrition services can be a complex process, but it is often worth the effort to increase access to nutritional care for clients. The first step is to determine whether the client's insurance covers nutrition services, as this varies depending on the insurance provider and the client's specific plan. Some insurance providers cover nutrition services for all clients, while others only cover services for clients with certain medical conditions or risk factors. It is also important to note that some insurance providers only cover services provided by registered dietitians, not nutritionists. Once coverage is confirmed, the next step is to become credentialed and contracted with the insurance company. This process can be time-consuming and may involve completing extensive paperwork. Alternatively, nutrition professionals can partner with Medicare-credentialed physicians and use incident to billing, where the physician bills for the nutrition services provided by the dietitian. This can streamline the billing process and result in higher reimbursement rates. Overall, billing insurance for nutrition services can be a challenging but rewarding endeavour that helps make nutritional care more accessible to clients.

Understanding the difference between a nutritionist and a dietitian

The terms "nutritionist" and "dietitian" are often used interchangeably, but they refer to two distinct professions with different qualifications, regulations, and services. Here are some key differences between nutritionists and dietitians:

• Education and Credentials: Dietitians typically have more education and credentials than nutritionists. In the US, dietitians must complete specific academic requirements, including a bachelor's or master's degree in nutrition or a related field, supervised practice hours, and passing a national exam. Nutritionists, on the other hand, may have varying levels of education, and in some states, anyone can call themselves a nutritionist without formal training or certification.
• Regulation: The title "dietitian" is highly regulated, and individuals must meet certain criteria and pass a credentialing exam to become a registered dietitian (RD) or registered dietitian nutritionist (RDN). In contrast, the title "nutritionist" is less regulated, and the requirements vary from state to state. While some states have specific certification requirements for nutritionists, others do not regulate the use of the title at all.
• Scope of Practice: Dietitians are qualified to treat clinical conditions and provide medical nutrition therapy, while nutritionists typically focus on general nutritional advice and education. Dietitians often work in collaboration with medical professionals to treat specific health conditions, such as diabetes, kidney disease, or eating disorders. Nutritionists may offer more general advice on healthy eating, weight loss, or improving overall health.
• Work Settings: Both dietitians and nutritionists can work in a variety of settings, including hospitals, clinics, schools, government agencies, and private practices. However, dietitians are more likely to be found in medical settings, working as part of a healthcare team, while nutritionists may be more commonly employed in schools, cafeterias, or athletic organizations.
• Insurance Coverage: Dietitians' services are often covered by insurance, including Medicare and private insurance plans. Medicare covers medical nutrition therapy services provided by dietitians for individuals with diabetes, kidney disease, or recent kidney transplants. Private insurance coverage for nutrition services varies, but some plans do cover registered dietitians. On the other hand, nutritionists' services are rarely covered by insurance, as they are not recognized as health professionals in the same way as dietitians.

In summary, while both nutritionists and dietitians play important roles in promoting healthy eating and improving health outcomes, they differ in their qualifications, scope of practice, and recognition within the healthcare system. It is essential to understand these differences when seeking professional advice or services related to nutrition and diet.

Knowing what insurance covers nutritionist services

The answer to this question varies depending on the reason for a client's visit to a nutritionist, and the type of insurance coverage they have.

Coverage for Nutritionists Under Medicaid

Medicaid is health coverage provided to certain groups of people who could not otherwise afford it. These groups include low-income adults, children, elderly adults, pregnant women, and people with disabilities. Coverage for Medical Nutrition Therapy varies from state to state, and some states do not recognize Registered Dietitian Nutritionists (RDN) as Medicaid providers. However, under the Affordable Care Act, nutrition services are available to all adults at risk for chronic diseases, in the form of nutritional counseling, with no copayment charged, regardless of whether the client is insured through Medicaid, Medicare, or private insurance.

Coverage for Nutritionists Under Medicare

Medicare is a federal program that provides medical insurance coverage for older adults, usually starting at age 65 but sometimes as young as 62. Medicare Part B provides coverage for medical nutrition therapy under certain circumstances and by qualified health care professionals. Clients with diabetes, kidney disease, or kidney transplants that have occurred within the past 36 months qualify for Medicare coverage for Medical Nutrition Therapy (MNT). Additionally, all older adults covered by Medicare qualify for nutritional counseling if they are at risk, under the provisions of the Affordable Care Act. A client must be referred by a primary care physician to a nutritionist for Medicare coverage to occur.

Coverage for Nutritionists Under Private Health Care Insurance

Coverage for nutritionists varies under private health care insurance. Some policies may cover the services of a nutritionist regardless of the client's condition. Others may only cover their services under certain conditions, such as a diabetes diagnosis. Some insurance plans only cover preventive services offered by a nutritionist, like nutrition counseling. All must cover nutritional services to those at risk for chronic diseases, in the form of nutritional counseling, with no copayment charged, under the Affordable Care Act. Additionally, there may be a limit to the number of visits a client may have with a nutritionist under their private health insurance plan, and a copay is usually required. Most private insurers will also require that a nutritionist be registered through the CDR or state-licensed/certified for their services to be covered or reimbursed.

Federal Insurance Programs

Some federal insurance programs offer limited coverage, which varies across states.

Most major health insurance companies like Aetna, Cigna, BlueCross BlueShield, and United Healthcare offer coverage for nutrition counseling. However, it is important to note that coverage can vary by provider and by plan.

Knowing what insurance covers dietitian services

Private insurance

Private healthcare insurance policies may cover the services of a dietitian, but not a nutritionist (an unregulated title). Some policies may cover dietitian services no matter what, while others may only cover them under certain conditions, such as the client having diabetes. All private insurance policies must cover nutritional services for those at risk of chronic diseases, in the form of nutritional counselling, with no copayment charged, under the Affordable Care Act.

Medicare

Medicare is a federal health insurance program that covers older adults, usually starting at age 65 but sometimes as young as 62. Medicare Part B provides coverage for medical nutrition therapy under certain circumstances and by qualified health care professionals. Clients with diabetes, kidney disease, or a kidney transplant in the last 36 months qualify for Medicare coverage for medical nutrition therapy. Medicare covers three hours of medical nutrition therapy with a dietitian and two hours every year after.

Medicaid

Medicaid is a state-run health insurance program offered to low-income individuals. Coverage for medical nutrition therapy varies from state to state, and some states do not recognise registered dietitians as Medicaid providers. However, under the Affordable Care Act, Medicaid must recognise nutrition therapy as optional preventive care services amounting to obesity prevention and treatment.

Tricare

Tricare is the healthcare program for uniformed service members, their families, and retirees from service. It provides health coverage similar to private pay or Medicare plans, including medical treatments and prescriptions. Tricare may cover visits with a registered dietitian, but a referral from a primary provider is likely needed.

Insurance coverage for dietitian services

Most major insurance providers cover nutrition counselling, but only with registered dietitians who are licensed through the Commission on Dietetic Registration. To find out if your insurance covers dietitian services, you can contact your insurance provider, determine your covered nutrition services, and find out how many visits you are allowed each year.

How to bill insurance for nutrition in a hospital setting

Billing insurance for nutrition services in a hospital setting can be a complex process. Here is a step-by-step guide to help you navigate the process:

Step 1: Understand the Billing Landscape

Before you begin billing, it is important to understand the billing landscape in a hospital setting. Inpatient nutrition services are typically not billed directly to insurance companies. However, there may be opportunities to bill insurance for nutrition services provided in certain specialty units within the hospital, such as mental health or substance abuse units, as these may operate as separate entities with their own billing policies. It is important to check with your hospital's billing department to understand the specific billing procedures for these units.

Step 2: Determine Billing Eligibility

To bill insurance for nutrition services, you need to determine if the patient is eligible for reimbursement. Ask the following questions:

• Is the patient an inpatient or outpatient?
• Is the patient covered by insurance for nutrition services?
• What are the specific insurance plan and policy details?
• Are there any diagnosis restrictions or specific procedure codes that need to be followed?
• Are there any deductibles, copayments, or coinsurance requirements?
• Is a referral from a primary care provider or specialist needed?
• Is there a maximum number of visits or restrictions on how often these visits can be billed?

Step 3: Obtain Necessary Credentials and Contracts

To become an in-network provider and bill insurance for nutrition services, you will need to obtain the necessary credentials and contracts. This typically includes the following:

• Employer Identification Number
• License (if required by your state)
• National Provider Identifier (NPI)
• Liability Insurance
• Completion of the Council for Affordable Quality Healthcare ProView (CAQH) application, which serves as a digital filing cabinet for your provider information
• Contracting with insurance companies, which involves becoming an in-network provider and establishing the policies and guidelines for filing claims

Step 4: Conduct an Eligibility and Benefits Check

Before providing nutrition services, conduct an eligibility and benefits check with the patient's insurance company. This will help you verify the specific coverage details for nutrition counseling services and any additional diagnosis codes. Ask the questions listed in Step 2 to gather all the necessary information. Be sure to document the name of the representative you speak with, along with the date, time, and a reference number for future reference.

Step 5: Provide Nutrition Services and Document Patient Encounters

After confirming patient eligibility and benefits, proceed to provide the necessary nutrition services. Ensure that you document all patient encounters, including the date of service, reason for the visit, diagnosis codes, and any relevant procedure codes. This documentation will be crucial for filing insurance claims.

Step 6: Submit Insurance Claims

Once you have provided the nutrition services and have the necessary documentation, you can proceed to submit insurance claims. Use the Health Insurance Claim Form (CMS-1500 form) for both private and public insurance claims. Submit the completed form electronically through a clearinghouse or use a nutrition reimbursement company for assistance.

Step 7: Follow Up on Denied Claims

In some cases, insurance claims may be denied. If this occurs, contact the insurance company immediately and provide relevant information, including your NPI number, tax ID number, patient's information, and claim details. Inquire about the reason for the denial and follow any necessary procedures to correct or resubmit the claim.

How to bill insurance for nutrition as a private practice

Setting up a private nutrition practice to accept insurance is time-consuming and can take months to complete. Here is a step-by-step guide to help you get started:

Step 1: Weigh the pros and cons

Accepting insurance can help your practice grow and give you access to a large set of potential clients. It also makes your services more accessible to clients who may not be able to afford your care otherwise. However, getting set up to accept insurance is time-consuming and complex, and insurance companies set how much they're willing to reimburse, which may limit how much you can charge for your services.

Step 2: Get licensed

Licensure requirements vary from state to state. Some states don't require any specific education or credentials to practice as a nutritionist, while others require a license to perform nutrition counselling. Check the laws of your state.

Step 3: File as an LLC or S-corp

Filing as a business communicates your practice's stability and ability to consistently provide quality care. It also creates legal boundaries between you and your business, which has an impact on lawsuits and taxes.

Step 4: Get liability insurance

Liability insurance protects you from potentially devastating legal costs and is required by most insurance companies. It limits the financial sanctions you have to pay personally if your advice is associated with negative outcomes.

Step 5: Get your National Provider Identity (NPI) number

You need a unique identifier when filing insurance claims. The Health Insurance Portability and Accountability Act (HIPAA) requires that you have an NPI, which is a 10-digit identification code. The application is free and straightforward, with a turnaround time of between one and 20 days.

Step 6: Decide which insurance companies to work with

Consider reaching out to clients, nutrition professional peers, and referral partners to see which insurance companies they work with. You can also search the internet for the most popular insurance companies in your area.

Step 7: Apply to become an in-network provider

Each insurance company has a different application process, but generally, there are two main phases: credentialing and contracting. Credentialing is the process of getting enrolled in an insurance company's preferred provider network, while contracting is when you set your reimbursement rates and policies for filing claims.

Step 8: Learn how to file claims

Once you're credentialed and contracted with an insurance company, you're ready to file your first claim. Each claim filed will involve conducting an eligibility and benefits check, filing a claim, and getting paid. You can use a CMS 1500 form for claims filing.

Frequently asked questions