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Reimbursement Coach for Dietitians

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Can dietitians credential in a different state ?

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One of the most frequent questions I receive from dietitians and CNSs is: Can I get credentialed in a state other than the one I live in? The short answer is YES, but as with most insurance-related matters, the details are nuanced.

 

Understanding the intricacies of credentialing is crucial for dietitians looking to expand their practice across state lines. Some states, such as Florida, Michigan, and New York, pose unique challenges for dietitians and CNSs trying to secure insurance contracts, particularly with providers like BCBS. In certain areas, closed insurance markets can severely limit access.

 

So, what can dietitians do to get credentialed in another state? Let’s dive into the legal, ethical, and practical considerations.

 

Is Credentialing in Another State Legal?

 

Generally, dietitians can contract with national insurance products like Aetna, Cigna, and UnitedHealthcare. These companies operate in every state, as does Medicare, a federal program. However, state-specific plans, like Blue Cross Blue Shield, vary. Each state has its own BCBS entity, such as Horizon BCBS in New Jersey or Highmark BCBS in Pennsylvania.

 

Post-pandemic, dietitians could often secure a contract in one state and bill others via telehealth as long as licensure rules were followed. However, recent changes in insurance contracts now emphasize geographical restrictions. For example, a contract originating in New Hampshire may require patients receiving services—even via telehealth—to be located within that state. These changes can necessitate additional contracts and physical office addresses in your patients’ states.

 

Therefore, practicing in a different state may come down to ethics.

 

And please don’t ask me: How do they [the insurance company] know where the patient (or you!) is located? They don’t.

 

But by signing your contract, you AGREE to the terms.

 

Also, not to pour salt on the wound, but in your documentation, you should have the location of the patient and provider in each chart note.

 

Once again, NOT all contracts have geographical restrictions as described above.

 

Therefore, you will want to consult with a legal expert to make sure you are following the requirement outlined in your insurance contracts.

 

Physical Address Requirements for Credentialing

 

Insurance companies require a physical address for your office in the state where you are credentialing. Virtual-only practices are not permitted. This address must often comply with ADA standards, even if it’s a residential home. Be prepared to answer questions about zoning and accessibility if you use a non-commercial property.

 

If you choose to use someone’s home, the insurance companies will likely ask you if the home office is ADA-compliant. How do they know it is a home and not an office building? They can often see if the address is located within a residential zone. Therefore, if you choose someone’s home as your office, you may have to answer ADA-compliant questions to the best of your ability.

 

Suggestions for Credentialing in Another State

 

If you establish a physical office in another state, you are officially conducting business there. This comes with legal and tax obligations. Here’s a checklist of potential requirements:

 

  • Rent office space (required for credentialing)
  • Obtain an RD license (if applicable for that state)
  • Secure business and county licenses
  • Domesticate your business entity in the new state
  • Pay state and local taxes

 

This list is by no means all-inclusive. And you should ALWAYS consult with a tax professional. A CPA can streamline this process, helping you navigate interstate practice’ financial and legal implications. But please know even if you CAN (no geographical restrictions in your insurance contract) practice in another state there are ADDITIONAL things you likely need to do. 

 

 

Exceptions and Ethical Considerations

 

If you work as a 1099 contractor for a practice in another state, these rules typically don’t apply—you’re not required to establish a physical presence. However, compliance with state laws is essential for those renting office space or setting up an address for credentialing purposes. Additionally, ensure your documentation includes the patient and provider’s location for every telehealth session. This is not just for compliance but also an ethical best practice.

 

Final Thoughts

 

Credentialing in a different state is entirely possible but requires careful planning and attention to detail. Review your contracts closely, consult with attorneys and CPAs as needed, and always adhere to state licensure and tax regulations. Dietitians can successfully expand their reach by taking these steps while maintaining compliance and ethical standards.

 

Licensure for Dietitians : Resources

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Navigating licensure for dietitians can be daunting, especially if you’re new to the field or expanding your services across states. Last week, I promised to share the best licensure resources I’ve found to help guide you through this process.

 

Now, I’ll admit upfront—there’s no single perfect resource for dietitian licensure. Each requires a bit of effort to understand and apply, but together, they’ll give you a clearer path toward compliance. Let’s dive in!

 

Key Resources for Dietitian Licensure

 

Resource 1: Academy Licensure Office Hours

The Academy of Nutrition and Dietetics (AND) offers licensure office hours for members every Wednesday from 2:00 pm to 3:00 pm EST. If you have specific questions on licensure rules in your state, this is an excellent opportunity to get direct answers. For those unable to attend, AND also provides a link where you can submit questions, though responses may take 7-10 days.

 

Click HERE to join The Academy’s office hours on dietitian licensure. 

 

Resource 2: Academy Licensure Affinity Group

Another AND perk is the Licensure Initiatives Affinity Group, a community that meets monthly to discuss dietitian licensure topics and advocacy. These discussions, held on the second Tuesday of each month, provide insights into licensure priorities and how you can stay informed on legal changes impacting your practice. As telehealth and virtual practices grow, staying up-to-date with dietitian licensure regulations is essential.

 

Click HERE to join the Licensure Affinity Group.

 

 

Resource 3: AND’s Licensure Map

AND’s licensure map allows members to click on each state to view licensure requirements. While this map isn’t the easiest to navigate, it’s a good starting point if you’re unfamiliar with state-specific licensure rules. Just remember—you must be logged in as an AND member to access it.

 

Click HERE to access the Academy’s map on dietitian licensure.

 

Resource 4: CDR Licensure Map

For non-members, the Commission on Dietetic Registration (CDR) offers a similar licensure map, accessible to the public. This map is a valuable resource for dietitians needing a quick look at licensure laws without an AND membership.

 

Click HERE to access CDR’s map on dietitian licensure.

 

Resource 5: Dietitian Licensure Compact

With state-by-state regulations, practicing across state lines has been challenging for dietitians. However, initiatives like the Dietitian Licensure Compact aim to standardize these requirements. Through collaborations with organizations like the Council for State Governments and the Department of Defense, AND is pushing for more flexibility to support multistate licensure. This compact could allow dietitians to expand their services across member states with fewer barriers.

 

Click HERE to access information the Dietitian Licensure Compact

 

Resource 6: State Laws for Certified Nutrition Specialist 

I think of all the resources ‘out there’ many of the CNS resources are the most helpful. 

HERE is a link to a CNS resource from American Nutrition Association.

 

 

Clarifying Key Licensure Rules for Registered Dietitians

 

Licensure rules can be complex, but here are two essential points to remember. First, your service type—not your payment method—determines whether you need a license in a particular state. For instance, if you’re providing Medical Nutrition Therapy (MNT) in a state requiring licensure, you must be licensed, regardless of whether you bill insurance or operate a cash-based practice.

 

Secondly, calling yourself a “coach” instead of a dietitian doesn’t exempt you from licensure requirements if you hold the Registered Dietitian credential. While CPT codes for coaching exist, they’re not widely accepted by insurance, meaning licensure rules for MNT apply to all credentialed dietitians.

 

I hope these resources and insights give you a helpful starting point in understanding licensure for dietitians.

 

If you want a deeper dive, check out the replay of my webinar on telehealth billing and licensure considerations. When it was presented live, we had over 200 + RDs and CNSs attend. So it was juicy indeed.

 

As always, I’m here to support your growth in our evolving profession!

 

licensure for dietitians

Unlocking the Ultimate Dietitian Hack for AI Charting: Revolutionize Your Workflow

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Obviously, as a dietitian, your ability to document your patient visits is crucial. However, the process of charting can often feel tedious and time-consuming, detracting from the time you could be spending with your clients. What if there was a way to streamline this process, making it faster and more effective? Enter the ultimate dietitian hack for AI charting—a game-changing approach designed to revolutionize your workflow.

 

The Challenges of Traditional Charting

 

Traditional charting methods can be cumbersome and inefficient. Manual data entry, inconsistent documentation, and scattered information can slow you down, leaving you with less time to focus on what truly matters: your clients. As dietitians, managing multiple clients with diverse needs requires a system that is not only efficient but also adaptable to your unique practice.

 

Meanwhile, if you need help with knowing exactly what needs to be in your documentation you can purchase my master class How to Correctly Document as an Insurance-Based Dietitian HERE.

 

While AI Charting can in fact provide dietitians with Super Hero like powers it is only as helpful as the content you put into it. Therefore, you still need to know exactly what is expected. So don’t sleep on that fact.

 

The Ultimate Dietitian Hack: Leveraging Technology and Templates

 

One of the most effective ways to enhance your charting process is by integrating technology and utilizing customizable templates.

 

On Saturday, September 14, 2024 two of the ROCK star RDs from my advanced coaching program presented to our group of 200 + RDs on AI charting using the platform HEIDI Health. While there are other AI platforms on the market, our awesome presenters discuss why they chose HEIDI long-term over the others.

 

It was such a good presentation. Therefore, I wanted to share with you all.

 

The webinar was presented by Kim Riley, RD, LDN, CDCES, and Maya Nahra, RD, LDN, DAIS

 

By the end of this presentation, dietitians and CNSs will be able to the following: 

 

  • Describe the key features of AI charting 
  • Define the three main benefits of AI charting 
  • Assess the key factors to consider when choosing AI software 
  • Summarize the associated risks with using AI software 
  • Evaluate the technical and operational challenges of AI software 

 

Plus, we even hook up with the exact templates you need to get you started with using AI charting. Note these are ‘just’ templates. They do require ‘massaging’ relative to the needs of your practice. But it is better than starting from scratch. Thanks, Kim and Maya!

 

The Benefits of the Dietitian Hack for AI Charting

 

Implementing these strategies offers numerous benefits.

 

  • Increased Efficiency: By automating and streamlining your charting process, you can significantly reduce the time spent on documentation, allowing you to focus more on client interactions.
  • Enhanced Accuracy: Customizable templates and integrated data reduce the likelihood of errors, ensuring that your records are accurate and up-to-date.
  • Improved Client Experience: With more time available for personalized client interactions and a more organized system, you can provide a better overall experience for your clients.

 

Embrace the Future of AI Charting

 

The ultimate dietitian hack for charting is all about embracing technology and optimizing your workflow. By adopting specialized software, creating effective templates, automating tasks, and leveraging data analytics, you can transform your charting process from a time-consuming chore into a streamlined, efficient system. Say goodbye to the old, inefficient methods and ‘Hello!” to a new era of productivity and client care.

 

Ready to revolutionize your charting process? Explore the latest charting tools and start implementing these hacks today. Your clients—and your practice—will thank you for it!

 

 

 

By integrating these strategies into your practice, you’ll not only enhance your efficiency but also elevate the level of care you provide. Embrace the ultimate dietitian hack for charting and watch as your workflow becomes more seamless and effective.

 

Once again, if you are freaking out about what needs to be in your documentation you can purchase my Master Class How to Correctly Document as an Insurance-Based DietitianHERE. The Master Class was juicy! We sold it out live. So you know it was awesome.

Why Dietitians Don’t Have to Choose Between Accepting Insurance or Cash

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Why Dietitians Don’t Have to Choose Between Accepting Insurance or Cash

 

Most dietitians and CNSs think you have to choose.

 

But I am a girl who loves options.

 

So trust me when I tell you I would never rope myself into something I needed to commit to without wiggle room.

 

Hi, I am Amy Plano, The Reimbursement Dietitian. I help dietitians and CNSs scale their insurance practices to six figures. In today’s blog, I will explain why dietitians don’t need to choose between accepting insurance or cash in their private nutrition practices.

 

Accepting Insurance or Accepting Cash?

 

The cool thing is you can choose to do one or the other.

 

Or you can choose to do both.

 

As an insurance-based dietitian, you can bill insurance for the face-to-face time you spend (in person or virtual) providing Medical Nutrition Therapy (MNT). For the ‘other’ stuff, you can directly charge the patient. Therefore, if a service you offer is NOT MNT, you can totally 100 percent offer it to the patient. You can charge them (NOT insurance!) directly for the service(s) if they want it. This means the age-old fallacy that you have to choose between accepting insurance or accepting cash is false.

 

If you prefer the video version of this blog please feel free to watch below.

 

 

So Many Options for Dietitians

 

The sky is endless relative to the a la carte services and programs you can offer your patients. It depends on who your ideal client is and what services you think they would benefit from as the subject matter expert.

 

Some services RDs offer include DUTCH Testing, GI Mapping, meal plans, metabolism testing, DEXA scans, online courses, email check-ins, etc. I could go on and on about these types of services because there are so many things many dietitians can do in addition to MNT that support their patients in getting incredible outcomes.

 

However, it boils down to what services help deliver the best results for your clients.

 

Choose Between Accepting Insurance or Cash

 

 

Is This Sh*t Even Legal?

 

Of course, it is silly. I have personally been utilizing this model since 2009 with my PCOS patients.

 

Dietitians can ONLY bill insurance for the time spent counseling the patient. Therefore, for anything else they do (aside from charting, which is part of the billable portion for MNT), the patient can be billed for the services.

 

But securing patient consent is necessary, and patients can’t be forced to purchase these extra services.

 

If you participate with their insurance and they have diagnoses covered on their plan, you must allow them to receive only the MNT portion.

 

However, if you create these services well, their hand should shoot right up, and they will say, “I need [insert your AMAZING services] in my life. Here is my credit card.”

 

Join My Master Class all about those options:  so you don’t have to choose between accepting insurance or cash

 

If you struggle with creating this TYPE of demand, I can help. I will be presenting live on Thursday, August 22, 2024, at 6:00 pm, on How to Integrate High Ticket Programs & Packages into Your Practice.

 

HERE is a link to enroll in this EPIC Master Class.

 

By the end of this Master Class, you will be able to describe the four critical aspects of reimbursement necessary to packages, identify my 6-phase process for seamlessly integrating insurance with packages, create a package of your own using insurance, define which types of services can be billed to the patient, define what services MUST be billed to insurance, explain what paperwork must be used when selling a la carte items in your insurance-based practice, identify at least ten potential revenue channels insurance-based dietitians can create in their practices, and formulate a pricing structure that gets you paid your worth.

 

As you guys know my Master Class always sell out. So jump on this opportunity today.

 

Why Dietitians Don’t Have to Choose Between Accepting Insurance or Cash

What Every Dietitian Billing Medicare Advantage Plans Needs to Know

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What Every Dietitian Billing Medicare Advantage Plans Needs to Know

 

Navigating the complexities of Medicare Advantage plans can be daunting for dietitians. Understanding what every dietitian billing Medicare Advantage plans needs to know is essential for ensuring proper reimbursement and compliance. These plans, also known as Medicare Part C, offer an alternative to traditional Medicare and often have the SAME coverage rules and requirements for MNT. This article will provide key insights for dietitians on billing Medicare Advantage plans effectively.

 

What Diagnoses do Medicare Advantage Plans Cover?

 

Medicare Advantage plans are Medicare plans offered by private insurance companies approved by Medicare. These plans provide at least the same level of coverage as traditional Medicare Part A and Part B but may (although NOT often) include additional MNT benefits. It’s crucial for dietitians to verify the specific benefits and coverage details of each Medicare Advantage plan their patients are enrolled in. Additionally, this verification process helps avoid surprises and ensures that services provided are covered.

 

Every Dietitian Billing Medicare Advantage Plans

 

I have been billing Medicare Advantage plans for the last two decades. I know that is a LONG a** time. With that being said,  they seem to cover the same diagnoses as Medicare for MNT. Therefore, they cover diabetes, CKD stages 3a, 3b, 4 and 5 non-dialysis. In addition they cover 3 years status post kidney transplant. Furthermore, I have also seen a small handful of plans cover additional diagnoses. However, I would confidently state most Medicare Advantage plans cover the same MNT ICD 10 codes as a traditional Medicare plan does

 

What type of limits on MNT do Medicare Advantage Plans Have?

 

In my personal experience Medicare Advantage plans follow the same limits as straight Medicare plans. They also utilize the same CPT codes and follow the EXACT same rules as traditional Medicare plans.

 

 

Do Medicare Advantage Plans cover Obesity?

 

One of the biggest mistakes I see dietitian make is assuming obesity is a covered ICD 10 code in a private practice setting. And while it actually is RDs in private practice are not eligible providers. To learn more about this mistake click HERE to read a recent blog on IBT.

 

How do Medicare Advantage Plans Work Relative to Network Status

 

Every dietitian billing Medicare Advantage plans needs to know is the importance of understanding the plan’s network requirements. To successfully bill a Medicare Advantage plan for MNT there are specific requirements. The dietitian needs to be in network with BOTH Medicare AND have a contract with the Medicare Advantage. If  you are just a Medicare provider and not in network with the commercial side of the plan you can’t bill this plan. If the patient has a qualifying diagnosis you can’t see them. You need to refer them to an RD provider who is in network with the patient’s Advantage plan.

 

Want this content in video format? Click below to watch my YouTube Video on What Every Dietitian Billing Medicare Advantage Plans Needs to Know

 

 

WHICH plan do we bill for Medicare Advantage Plans?

 

The dietitian must submit the claim to the commercial payer. For example if it is an Aetna Medicare Advantage Plan the we submit the claim to Aetna. Or for example if it is an United Health Care Medicare Advantage Plan the claim we submit the claim directly to United Health Care. We never submit an Advantage Medicare plan directly to Medicare. No reimbursement is made to the dietitian when they submit to the incorrect payer.

 

Summary

 

In conclusion, for dietitians looking to optimize their billing practices with Medicare Advantage plans, understanding these key points is essential. Staying informed about the specific plan requirements, knowing who to bill, and when are all critical components of successful Medicare Advantage plan billing.

 

Does the Medicare process feeling SUPER duper overwhelming?

 

My Reimbursement Coaching Program walks you step by step through EVERY single aspect of Medicare reimbursement.

 

Click HERE to put in an application and go from a scared, frightened Medicare Newbie to a confident, rock star Medicare billing Ninja.

 

For more tips and resources on billing and reimbursement, dietitians can follow my Instagram @reimbursement_dietitian

 

By mastering these aspects, dietitians can enhance their practice and provide better care for their patients.

 

Dietitian Billing Medicare Advantage Plans

What Dietitians Billing Medicare Need to Know about Obesity Coverage

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What Dietitians Billing Medicare Need to Know about Obesity Coverage

 

 

Dietitians often face the challenge of navigating the complexities of billing and insurance, especially when it comes to Medicare. One frequently asked question is what dietitians billing Medicare need to know about obesity treatment. Understanding the specifics of Medicare’s coverage for obesity counseling is essential for dietitians. The good news is  Medicare provides coverage, the bad news is dietitians in private practice are NOT eligible to provide these services.

 

Who can Bill for Obesity

 

Medicare Part B covers intensive behavioral therapy (IBT) for obesity, which includes dietary counseling. This benefit is available for beneficiaries with a BMI of 30 or higher. However, to bill Medicare for obesity counseling, dietitians must ensure that their services are provided in a primary care setting and are consistent with the U.S. Preventive Services Task Force recommendations. This coverage includes one face-to-face visit every week for the first month, one visit every other week for months 2-6, and one visit a month for months 7-12, contingent on the patient achieving a weight loss of at least 3kg (6.6 lbs) during the first six months. Understanding these details is crucial for dietitians billing Medicare.

 

To learn more about the IBT benefit click HERE.

 

Dietitians billing Medicare need to be aware that they can’t provide this service in their private practices. Often, the RD calls to verify the Medicare beneficiary’s MNT benefit. It’s unfortunately common for the Medicare rep to tell the RD that Medicare covers obesity.  YES, it is covered, but only when billed under the IBT benefit, within a primary care setting, and billed incident to the PCP.

 

For all dietitians who do better with retaining information in video format, check out my YouTube video highlighting: What Dietitians Billing Medicare Need to Know about Obesity Coverage.

 

 

 

What dietitians billing Medicare need to know about obesity coverage is this: YES. It exists. But NO we can’t currently bill it.  Therefore, I encourage dietitians to make a mental note of this key criteria. The Academy of Nutrition and Dietetics is working hard to pass the  Medical Nutrition Therapy Act. This bill expands the diagnoses Medicare allows RDs to to bill for.

 

What can you do?

 

I encourage you to complete this Action Alert for The Medical Nutrition Therapy Act. It will take you under 1 minute to complete and you can do so HERE.

 

Also, if you are struggling with Medicare and need more support, then I got YOU!

 

Click HERE to learn about my Medicare Course which teaches dietitians like you everything you need to know about the Medicare credentialing and billing process.

 

What Dietitians Billing Medicare Need to Know about Obesity Coverage

 

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