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.
While giving nutrition and health advice to people, a dietitian faces high liability. 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 nutritionists should accept insurance. A registered dietitian (RD) helps patients manage and prevent nutrition-related deficiencies or diseases.
It can alternatively expose huge risks. There could be escalated legal costs or a patient injury, and more. Thus, accepting insurance is the best option for the dietitian.
The Affordable Care Act (ACA) provided the general public with improved access to preventive services.
The emphasis on these services made it possible to obtain reimbursement, making it available for clients who otherwise are unable to afford it.
Dietitians accepting insurance see growth in their practices as being a provider increases the number of their 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?
Obesity became a medically recognized disease under ACA. Since then, full or partial coverage for bariatric surgery or nutritional counseling has been provided.
Besides, other effective treatment trends like nutritional therapy, behavioral therapy, and weight loss counseling 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 are used to describe conditions and inform insurance companies regarding the services and procedures provided by the RDs.
For Medical Nutrition Therapy (MNT), the following CPT codes are applicable for 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
Besides self-pay and private insurance, public or government insurance is also accepted by the RDs in the form of Medicare and Medicaid.
Medicare, a federal health insurance program, provides insurance for US citizens aged 65 and older, including those younger than 65 with certain disabilities. Nutrition services are reimbursed with good 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 offers similar benefits as Medicare Part B, however, through private insurance companies that include Health Maintenance Organization plans or Preferred Provider Organization plans.
Medicaid provides health coverage to low-income Americans, including eligible children, adults, the elderly, pregnant women, and people with disabilities.
Medicaid coverage is administered by states 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.
Fortunately, most Cigna plans cover the full cost of counseling sessions. For more information, visit https://static.cigna.com/assets/chcp/
Dietitian Insurance Coverage – Getting Started
After deciding to accept insurance, there are two main parts to getting set up with insurance, that is, credentialing and contracting.
To become a credentialed or in-network provider, the following is required:
1. Employer Identification Number;
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 serves as 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 be authorized to access the information for credentialing. Insurance companies then review CAQH and send further information.
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
Once credentialed and contracted with one or more insurance companies in the specific state, a claim can be filed. 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 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.
Dietitians accepting insurance can set their billable rate, and the insurance company will set the reimbursement rate.
The dietitians should research for a competitive rate according to the geographic location, and negotiate for a high. They can also negotiate for a higher reimbursement level.
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.