Dietitian Insurance Coverage – Why Matters
Dietitian insurance coverage is one of the most challenging tasks faced by dietitians in establishing their businesses.
However, getting credentialed and contracted with insurance companies doesn’t have to be daunting when there is a roadmap to help.
A dietitian is highly liable when giving nutrition and health advice to people. Getting dietitian insurance ensures that the business, property, and employees are protected.
It also covers legal expenses that stem from patient injuries.
Why is Dietitian Insurance Coverage Needed?
There are many reasons why dietitians should accept insurance. A registered dietitian (RD) helps patients manage and prevent nutrition-related deficiencies or diseases.
It can also expose the dietitian to huge risks. These could include escalated legal costs, patient injury, and more. Thus, accepting insurance is the best option for the dietitian.
The Affordable Care Act (ACA) includes provisions that improve access to preventive services for the general public.
The emphasis on these services made reimbursement possible, making them available for clients who otherwise could not afford them.
Dietitians accepting insurance see growth in their practices as being a provider increases the number of clients.
It makes nutrition health care accessible and affordable for people while, at the same time, allowing the provider to be reimbursed well.
Dietitian Insurance Coverage – What Services Are Covered?
The American Medical Association recognized obesity as a disease in 2013, independent of the ACA. Influenced by this recognition and ACA guidelines, many insurance plans may offer full or partial coverage for bariatric surgery and nutritional counseling.
Besides, other effective treatment trends like nutritional therapy, behavioral therapy, and weight loss counseling have developed.
However, coverage depends on an individual’s health insurance plan and preexisting conditions, qualifying a person for coverage.
The clients with the same insurance beneficiary may also see variances in the benefits, depending on the membership plan.
Dietitians Approved Treatment Codes
Coverage is determined based on the diagnosis code (ICD-10-CM) and the Current Procedural Terminology (CPT – treatment code) code used.
Diagnosis codes describe conditions and inform insurance companies about the services and procedures provided by RDs.
The following CPT codes are applicable for medical nutrition therapy (MNT) in Medicare, Medicaid, and private insurance.
1. 97802 – Initial assessment and intervention, face-to-face with individual, every 15 minutes;
2. 97803 – Follow up visit or reassessment, face-to-face with the individual, every 15 minutes; and
3. 97804 – Group (two or more individuals) visit every 30 minutes.
4. G0270 – Reassessment and subsequent interventions following a second referral in the same year for a change in the treatment regimen, diagnosis, or medical condition, 15-minute individual session; and
5. G0271 – Reassessment and subsequent interventions following a second referral in the same year for a change in the treatment regimen, diagnosis, or medical condition, 30-minute group session.
While other codes exist, these are most typically used in nutritional care.
Dietitian Insurance Coverage – Public Insurance
RDs also accept public or government insurance, such as Medicare and Medicaid, in addition to self-pay and private insurance.
Medicare
Medicare, a federal health insurance program, provides coverage for Americans aged 65 and older and those under 65 with certain disabilities. Nutrition services are covered under specific conditions with varying reimbursement rates.
Medicare provides reimbursement to dietitians. It covers individuals with diabetes, chronic kidney disease (except inpatient dialysis), or a kidney transplant within the past 36 months.
Dieticians can become Medicare Part B providers that cover outpatient medical care and can seek referrals from physicians.
Medicare Part C, administered by private insurance companies, offers similar but not identical benefits to Medicare Part B and may include options like Health Maintenance Organization or Preferred Provider Organization plans.
Visit cms.gov and enroll with the state’s Medicare carriers by completing the CMS-855I form.
Medicaid
Medicaid provides health coverage to eligible low-income Americans, including children, adults, seniors, pregnant women, and people with disabilities.
States administer Medicaid coverage and hence varies from state to state.
Dietitians are required to consult their Academy reimbursement representative for their state by visiting the Academy’s Leadership Directory.
Other Major Insurance Payers
Other major insurance payers include Cigna, which covers nutritional counseling. However, the extent of coverage and sessions varies by plan.
Many Cigna plans provide coverage for counseling sessions, but the extent and conditions of coverage can vary. For more information, visit https://static.cigna.com/assets/chcp/
The typical credentialing for dietitians and reimbursement for nutrition services are offered by Anthem, Blue Cross Blue Shield, and United Healthcare.
Dietitian Insurance Coverage – Getting Started
After deciding to accept insurance, there are two main parts to getting set up with insurance: credentialing and contracting.
Credentialing
To become a credentialed or in-network provider, the following is required:
1. Employer Identification Number;
2. License;
3. Provider Identifier (NPI); and
4. Liability insurance.
Additionally, it is important to set up as a healthcare provider through the Council for Affordable Quality Healthcare ProView (CAQH).
It is a digital filing cabinet where basic personal information, education and training, and specialties and certifications can be securely stored in the CAQH portal.
The specific health plans can authorize access to the information for credentialing. Insurance companies then review CAQH and send further information.
Contracting
Contracting involves the process of becoming an in-network provider with insurance companies. It establishes the policies and guidelines for filing claims.
Filing Claims 101
A claim can be filed once credentialed and contracted with one or more insurance companies in the specific state. It involves:
Conducting an Eligibility and Benefits Check
It is used to verify the services that the patient’s health insurance covers. It includes checking for the patient’s plan, which covers nutrition counseling services and additional diagnosis codes.
Filing a Claim
It means managing claims reimbursements. Dieticians need to become familiar with the Health Insurance Claim Form, which can be found at the https://www.cms.gov/
RDs must collect the necessary information from the clients to complete the form.
Getting Paid
Dietitians accepting insurance can set their billable rate, and the insurance company will set the reimbursement rate.
Dietitians should research competitive rates according to their geographic location and negotiate for higher reimbursement levels. They can also negotiate for a higher reimbursement level.
Conclusion
When determining dietitian insurance coverage options, it is vital to do some market research.
Consider which insurance plans accept the major medical facilities and find which plans other dietitians in the area are in-network with. The larger insurance providers can provide the most client referrals.
See Also
How to Get Insurance Without a Job
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