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Reimbursement Coach for Dietitians

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Is accepting insurance as a dietitian hard ?

January 10, 2023 by amyplano Leave a Comment

Is accepting insurance as a dietitian hard? This is perhaps one of the most asked questions I receive as a reimbursement coach for dietitians. 

 

And before I fully answer this question I want to chat a little about mindset. 

 

I am a firm believer your success in your insurance-based private practice is pretty much 10000000 percent related to your mindset. 

 

And to be crystal clear, success in private practice means SUPER different things to different dietitians. 

 

For some RDs success in their private practice looks like one or more of these …

 

… working when they want to work 

… working with who they want to work 

… not having to answer to anyone but themselves 

… leading a rockstar team 

… traveling frequently to cool places on their bucket list 

… contributing financially to their family in a way that feels good to them 

… making $50,0000 per year 

… making $50,000 per month 

… spending holidays at home with their family (not at their clinical job) 

… having sufficient time for self-care 

… having time to engage in their hobbies 

… being able to give back time (and/or) money to the organizations that matter most to them 

 

Being successful is NOT always about making x amount of dollars. If that is important to you. Awesome! If not. Also awesome. Because when you work for yourself YOU get to decide ultimately what success looks like for you. 

accepting insurance as a dietitian hard ?

 

However, in order for you to get to the next level (whatever that looks like for YOU!) you need to THINK and ACT wildly differently than you previously have. Your thoughts and action are the EXACT reason why you are where you are right now. And only you can change that. 

 

So I think this would be a great segway into the question I get asked oh-so-frequently is accepting insurance in private practice hard? 

 

So Amy P. is accepting insurance as a dietitian hard?

 

Hard is a relative term. 

 

And just like success the term hard means different things to different people. 

 

As an RD, you have already done some wicked hard shit. So I am always perplexed when RDs ask me this question. 

 

Like as if you are a stranger to hard work, hustle, grit, discipline, and tenacity. Said no dietitian ever. 

 

So Amy P. get back to the question is accepting insurance as a dietitian hard? 

 

My personal opinion is it all falls back on the mindset. 

 

When I first started accepting insurance in 2008, I knew it was going to be hard for lots of reasons. But I did it anyway. 

 

I really wanted to help the people who needed my services most. Not just the ones who could afford them. And while self-pay has its place, for me personally, it was just not a sustainable plan. Especially when people pay a lot of money for their insurance benefits. 

 

So I dove in HARD. 

 

For good or for bad at the time there was no one running an insurance-based model I could even ask for help. However, to be honest with you it was this ‘can-do attitude’ that has gotten me through time and time again. 

 

Trust me, I am no different than you. 

 

But I believe in myself more than I fear failure. 

 

Every single challenge I faced (and there were TONS!) I approach them as an opportunity to win. And while I know we tend to give trophies to everyone these days, I am not going to deny the fact that REALLY winning in life and in your practice is vital. 

 

It is not enough to open up shop as an insurance-based dietitian. Anyone can do that. But what is vital is that you learn to win at it. 

 

And guess what? 

 

You are probably going to fall down a bunch of times before you hit that grand slam. 

 

Treating success in your practice as an option is one of the many reasons why there are a lot of insurance-based dietitians but few who are killing it. 

 

I have a canvas in my office that says, “I have to be successful because I like expensive things.’ And that ain’t no lie. Being successful is my duty, obligation, and responsibility I have to myself. 

 

I am capable of it and you are too. 

 

But you need to embrace the suck. Do the hard things. Stop making excuses. And start living up to your potential. 

 

Quit lying to yourself that success is not important. Stop telling yourself your insurance-based practice is just a side hustle. 

 

Because if you keep telling yourself that bullshit. 

 

Guess what? It will continue to be just that. 

Is accepting insurance as a dietitian hard ?

 

So your homework for today is this: define what your definition of success looks like for you and don’t stop working towards that until you have achieved it. 

 

Success is not like playing the lottery, bingo, or cards. There can be many winners. There is no shortage of success. 

 

Your insurance-based practice can be wildly successful. But it will only be if you believe in yourself and put in the work. 

 

So stop whining and being a crybaby shedding tears and lamenting insurance sucks. Because whatever going on in your insurance-based practice good, bad, or nothing is caused by you. 

 

It’s time to assume responsibility, take massive action, change your mindset to ‘I got this shit,’ and let’s do this. 

 

Need help?!? I got you boo. Check out my EPIC reimbursement coaching program that helps you start, manage and scale your insurance-based practice.

 

Cool? 

 

Thanks for listening to my Ted Talk. 

 

Let’s go! 

 

is accepting insurance hard as a dietitian?

Filed Under: mindset for dietitians, Reimbursement Dietitian Basics Tagged With: insurance, mindset for dietitians

The pros and cons of accepting insurance if you are a dietitian

September 30, 2022 by amyplano Leave a Comment

I have no idea why I have not written a blog on the pros and cons of accepting insurance if you are a dietitian SOONER. But here it is. Obviously, as an insurance-based dietitian since 2007, I am a wee bit biased when it comes to insurance. However, as a hard-core realist, and a huge advocate for dietitians making smart business moves it is equally as important to talk about both sides of the coin as they relate to accepting insurance.

 

Ultimately, if you decide to accept insurance in your practice, I really want it to be a ‘Hell, yes,’ moment. If you are on the fence, then my suggestion is to read through the following words carefully and see where your heart lands.

The pros and cons of accepting insurance if you are a dietitian

Accepting insurance is no doubt a commitment. It is a commitment first and foremost to yourself. There is a learning curve and several steps you must take to create a successfully insurance-based practice. There will be many moments you want to give up. And yes, you will want to throw large objects across the room (while you scream REPRESENTATIVE!!! at the top of your lungs). But you won’t. Because at the end of the day you are a moutha-f*cking dietitian and have certainly been through harder shit.

 

Aside from it being an investment in yourself, accepting insurance serves as a commitment to the people you serve in your community. It identifies you as someone who strives for inclusivity in your practice. When you accept insurance for your services you are sending the message that awesome nutrition services delivered by an expert should not be a privilege but a right.

 

However, with that being said you owe to yourself, your clients, and our field to DO it RIGHT. Under no circumstances should you go blindly into accepting insurance and haphazardly bill.

 

It’s not cool to get credentialed, not know what the heck you are doing, bill inappropriately, and then blame insurance.

 

I get it! Trust me. This shit can be confusing. Not to mention overwhelming.

 

But nowadays, there are SO many resources on accepting insurance. Whether it be my epic reimbursement programs, other rad reimbursement coaches, The Academy’s payment resources, or the oodles of public Facebook pages you can join there are options for educating yourself before you start accepting and billing insurance.

 

And don’t get me wrong. I DO want YOU on #teamreimbursement.  In fact, I have no shame in saying I want all private practice dietitians on my team. But I want us to do it right, with integrity, dignity, and confidence.

 

Accepting insurance has been a game-changer for my patients and my practice. And I know it can be for you and your practice.

 

So, without further ado, let’s tackle the top pros and cons of accepting insurance if you are a dietitian.

 

More people with your services 

 

There is no denying the fact, when you are a Registered Dietitian in private practice who accepts insurance, you are able to help MORE people with your services. When you are only cash-pay, you can only help the people who can afford your services. This greatly limits the number of people you can help and ultimately impact with your services.

 

Therefore, if you are looking to increase your reach, magnify your impact and expand your practice’s growth potential you may want to consider accepting insurance in your practice.

 

ALL commercial plans are required to have preventative MNT benefits at no cost-share to your patients

 

Given the introduction of the Affordable Care Act in 2015, the important concept (which is NOT a new one – duh!) of preventative services emerged in the reimbursement space for dietitians. Whereas before this time period we only saw solid MNT coverage for marked disease states like diabetes, kidney disease, eating disorders, and some food allergies. It was also limited at best with some insurance carriers only covering a handful of MNT visits per year.

 

The ACA changed the reimbursement game for dietitians. Following its inception, all commercial insurance plans were required to offer some form of preventative MNT coverage for their patients who qualify. While the actual policies define the actual frequency of visits many plans cover unlimited visits as long as they are medically necessary.

 

pros and cons of accepting insurance if you are a dietitian

And note: the majority of the time, YOU, the dietitian is the expert in determining medical necessity. All the power lies in your hands, girl. You earned it. Now use it.

 

The patient may not even require a formal diagnosis on many of these plans. When dietitians correctly follow the preventative guidelines for each insurance company their patients don’t have a cost-share (deductible, co-pay, co-insurance) for the visit. This means the patient can often see you as much as you deem necessary given their current health status and long-term medical goals.

 

PT want to use their benefits 

 

This is an easy point to illustrate. We all have some form of health insurance. And whether you are self-employed, not employed, or employed and insured by a group-funded plan the majority of us are no strangers to high insurance premiums. In addition, deductibles and out-of-pocket costs for health care services appear to be at an all-time high. As a nation, this means we are paying more than ever for our health care needs.  And while I am certainly grateful for modern medicine, I like everyone else want to be able to use these health insurance benefits we pay so much for. And it is not shocking our patients are no different.

 

Given the fact so many insurance plans cover MNT, coupled with the high cost we all pay to utilize these services, there is no denying the fact your patients want to squeeze as much is humanly possible from their health insurance benefits.

 

Therefore, if you are a cash-based dietitian it is likely not a surprise that many of your patients are asking the same EXACT question: Do you accept insurance?

 

As I mentioned, the ‘cost’ for many of your patients to see an RD is waived as long as you correctly code the visit as preventative. And even if you have to bill it as a medical visit the patient will generally just need to pay their cost-share towards your services.

 

Doctors love referring their patients to in-network RDs

 

I have no shame in saying the majority of my practice’s referrals come directly from local doctors within a 25-mile radius of my practice.

 

When you are an in-network insurance provider getting doctor referrals is easy-peasy! When you participate with insurance, the ‘hand-off’ from the doctor to the patient is often seamless. It can be as easy as the MD directing the potential client to your office phone, website, or online schedule to set up a discovery call or book their first visit.

 

Trust me when I tell you these doctors are looking for your services to direct their clients to, just as much as you are looking to land their referrals. The last thing they want to do is educate their patients on something they know little to nothing about. They want to stay in their zone of genius just like we do. So, think about creating this referral network as the ultimate definition of #winning.

 

In my reimbursement coaching programs, I not only teach you how to effectively market to physicians and health care providers. But I also teach you how to make the process literally seamless. When you have a step-by-step process to connect with the people who serve your clients getting a steady flux of ideal clients has never been easier.

 

Pay is solid

 

This is not my first rodeo when it comes to insurance. When I started accepting insurance the rates were double what I was making at my clinical job. Which truth be told, when I got my first insurance check I felt like a millionaire. And while I will NEVER forget those awesome feelings now, I can easily say, my insurance rates are leaps and bounds relative to what I used to make as a clinical RD. In many cases, the rates exceed 4-7 times the rate of most clinical jobs.

 

Your reimbursement rates as an RD will vary by state. As well as by insurance plan. So, what I receive in CT for certain plans, is different than a dietitian in a neighboring state like NY may receive. However, what I can conclude as a reimbursement coach who works with dietitians in pretty much every single state including both Alaska and Hawaii is the rates are solid. Yes, some rates are MUCH better than others! But as a whole, I would say most dietitians accepting insurance are making well above $100/hour and in some states DOUBLE that. I shit you not. Martha.

 

Curious about what the average rates are for your state?

 

Google Medicare + dietitian + MNT + rates. If you are an AND member these rates are located under the ‘payment’ tab on the Medicare section on their website. Medicare is a federal health insurance plan and these are the ONLY insurance rates that are public knowledge.

 

So, if you googling what Aetna’s MNT rates are or United MNT’s rates you are going to be looking for a long time. They are not public knowledge. Insurance reimbursement rates are proprietary to your contract and are never supposed to be shared.

 

Please note that the Medicare rates are noted in 15 minutes increments. So, if you are seeing a patient for an hour you need to multiply those values by 4. This will give you a sense of the middle-of-the-road rates some RDs are receiving for reimbursement.

 

Don’t need to ‘sell’ yo’self on social media 

 

As I noted above it is very possible to do the majority of your ‘marketing’ by creating a strong referral network with local providers. In addition, when you become in-network the insurance companies will list your practice in their directory. So, when patients are searching for a dietitian near them, your smiling face will pop right up.

 

Also, the fact you accept insurance will often travel through your current clients rather quickly. In my practice, the relationship would often start off with one family member, and then the existing family member would refer other family members, friends, and coworkers (all of which had the same insurance benefits as them) to me as well. I was so grateful for the ‘easy’ referrals and knew while my skillset as a badass RD was awesome – it had more to do with the fact I accepted their insurance and the visits were covered.

 

Therefore, while you do need to put effort into marketing your practice as an insurance-based dietitian it’s very different from traditional marketing. When you are a cash-based RD, you need to hang out where your ideal clients hang out. Which for many RDs is on social media.

 

So many of us have love/hate relationships with social media. We like engaging in it as a medium for our personal life. But the thought of being on there non-stop because we ‘have’ to make a sale is rather daunting! And unfortunately, as we all know you can’t just show up once on social media. You need to show up consistently with a crystal-clear marketing message targeted at your ideal client. Because if you are talking to everyone, you are talking to no one!

 

The pros and cons of accepting insurance if you are a dietitian

 

While many insurance-based RDs choose to utilize social media as one of their elected marketing channels, it’s generally more because they want to and less because they have to. There are SO many more effective marketing strategies than relying on social media if you are an insurance-based RD. And most require far less effort as well.

 

So, if the thought of pimping yourself on social media 25-7 doesn’t appeal to you, then you might want to consider accepting insurance as your bulletproof marketing strategy.

 

You stand out 

 

Not that your shit doesn’t already sparkle!

 

But as RDs we are constantly pointing the finger at non-credentialed people doing our jobs. Even if they do our jobs better than us (let’s be honest – some do!) For some reason, we just love to cast shade on people who don’t have R.D. after their names.

 

But guess what, yo?

 

Only credentialed professionals with legitimate degrees can accept insurance. Take that health coaches. Even if you are good. WE are better.

 

Want to stand out – start by accepting insurance. That automatically separates the sheep from the goats and the rockstars from the wannabes.

 

You can incorporate packages 

 

Did you know if you accept insurance in your practice, you can still seemingly do it on most of your own terms?

 

You can …

 

…selectively choose which insurance companies you participate with …

 

… sell high ticket packages …

 

… deliver killer a la carte services that serve your ideal client.

 

It’s not insurance or the highway.  People think they need to ‘ride or die’ with insurance only.

In fact, it is quite the opposite.

 

The sky is the limit when you accept insurance in your practice. It makes your patient’s life easier (as well as yours). But it doesn’t necessarily change the way in which you practice.

 

This is especially beneficial if you are a functional practitioner and offering a la carte services that insurance doesn’t cover in the first place (such as GI mapping, DUTCH testing, MRT testing, etc.) By accepting insurance, you can ‘lighten the financial load’ on your patients. Their insurance can potentially cover the MNT aspect of their treatment regime with you while helping defray the overall amount of money they need to lay out long term. This way everyone benefits from this scenario.

 

The pros and cons of accepting insurance if you are a dietitian would not be complete without talking about some of the drawbacks. As much as I want to position accepting insurance in your nutrition practice in a positive light, it is only fair to address some of the apparent downsides as well. So, let’s get to it!

 

Not all policies are universal 

 

While there are certain insurance plans that behave similarly from an MNT coverage standpoint to other plans, a patient’s benefits are determined on a policy level NOT a plan level. For example, while the majority of Anthem Blue Cross Blue Shield plans in CT provide unlimited MNT visits as long as they are medically necessary, there may be a handful of policies that don’t cover any visits. While this is certainly the exception and not the rule in CT, it all comes down to a patient’s particular policy.

 

In my EPIC reimbursement coaching program, I teach dietitians exactly how to navigate these nuances. And while I do my best to provide specific step-by-step instructions I am not going to lie; this process can be frustrating. However, what I can sincerely tell you is the more you bill, the more comfortable you will become with each individual plan. Just like anything in life, you will start to see trends and become more confident with each claim you submit and get paid for. And what starts off daunting, will seem seamless the more you practice.

 

Not taught this in skool

 

I know we all feel this at our core. We are not taught anything about accepting insurance OR private practice in skool or during our internships. In fact, if I remember correctly, I was told to run as fast as possible away from starting an insurance-based practice.

 

Therefore, not only is our robust, million-dollar curriculum lacking in education surrounding these important, career-altering concepts it’s also missing any sort of advocacy for any alternative RD path.

 

More so, people in positions of authority who we look up to (who don’t know anything about accepting insurance or opening a private practice because they have been working in the basement of the same hospital, they did their internship 40 years ago!) discourage our dreams of becoming independent insurance-based RDs who not only make a massive impact with their services they also generate a killer salary.

 

And I know those words just formed the world’s biggest run-on sentence. But the shit that I just said was important. So, it is okay to violate proper grammar, yo!

 

This leaves us feeling frustrated and full of animosity towards the very institutions that made us who we are. But a smart person once told me, “Fuck that noise!” and blaze your own path. Spending time harping on what our educations didn’t teach us, gives far too much power to an antiquated system collecting dust.

 

Take control of your own career.

 

Find yourself a mentor or coach.

 

Follow other insurance-based dietitians on social media. Take them out for lunch (Not just coffee. These Queens deserve a proper meal). Listen carefully to their stories of growing their empires.

 

And get inspired by the thousands of other insurance-based dietitians who are out there kicking butt, taking names, and making an impact in their communities.

 

Not all networks are open

 

Insurance companies credential you based on the zip code you provide for your physical office address. Yes. You do NEED a physical address to credential with the insurance companies. And depending upon how many other dietitians are already ‘supposedly’ already participating as in-network providers with the insurance company in that zip code they may inform you that the network is closed to new providers.

 

I say supposedly because often when you review the directory there are often not ANY RDs within a 25 miles radius of your office zip. And if there are none of them work with the types of patients you do. In fact, more often than not, many of the RDs listed in the directory no longer practice at the address they are listed at (or practice at all!) Yet, they are still taking up a ‘spot’ in a limited provider base.

 

This happened to me twice in my career. Once with Aetna. And the other time with United Health Care. Just like I teach the dietitians enrolled in my coaching programs how to successfully appeal closed insurance panels, I did the same for my practice. It took me a hot second (and many letters) to get ‘in’. But I am grateful I put in the work as both insurance companies are awesome to work with in CT.

 

So, while it’s not uncommon for a network to be closed, don’t let that stop you from appealing. And if this is something you are struggling with, I literally hand you the actual appeal letters I used to get in. No reinventing the wheel when you work with me.

 

Poor communication

 

The level of insanity as it relates to the poor communication occurring before, during, and even after you have been credentialed/contracted with the insurance companies is maddening. Never have I worked in an area of my practice, where the level of communication is as poor as dealing with various insurance companies.

 

I am not going to sugarcoat it. It is horrible. And to be honest I don’t know how they get away with it.

 

My favorite is when you request your fee schedule (something you are entitled to!) and they tell you they can’t give you that information until AFTER your sign your contract. All of which is bananas. Or you get an automated email reply that says they will get back to you within 30 days.

 

Thanks. Super helpful.

 

The pros and cons of accepting insurance if you are a dietitian

 

 

If that’s not completely cracker-jacks then I am not sure what is.

 

My team and I experience this just like everybody else. However, often given our tenure in this world we tend to be plugged into back-end people who allow us sometimes to bypass these individuals who for lack of a better word ‘suck.’

 

Words of wisdom – roll up your sleeves, crank the hip-hop (Biggy, Biggy can’t you see sometimes these insurance companies hypnotize me!), tighten your ponytail and know you will get through it (eventually). And hopefully, if you are working with a coach, they can help expedite the process or steer you in the right direction.

 

Better coverage for certain conditions 

 

I work in weight management. In addition, I work with many of the conditions that go hand-in-hand with weight management like pre-diabetes, diabetes, PCOS, hypertension, and high cholesterol. Due to the policies enforced by the ACA, billing insurance for my patients is a piece of cake.

 

Why you ask?

 

Because the majority of my patient’s insurance plans have to cover preventative services. And the conditions noted above are part of the criteria for services covered under the ACA. When patients are seen and properly billed for preventative services, they pay nothing for these services.

 

Does this mean that other diet-related conditions are not covered?

 

No. Believe it or not, we live in a time and place where the majority of diseases and disorders we as dietitians treat from a dietary standpoint are in fact covered. However, many of these conditions are covered on the medical side of a patient’s insurance policy.

 

Is that a bad thing?

 

No. It just means just like with any medical service the patient receives there is often a cost-share to utilize the services. This might come in the form of a deductible, co-pay, or co-insurance. A cost-share is simply put in place to discourage a patient from using a service they don’t necessarily need. It puts some of their skin in the game as they say!

 

In many states, there are even laws in place where certain conditions MUST be covered. Two of the most common ones are eating disorders and diabetes. While these conditions may not fall under the patient’s preventative side of the policy, they have covered services and you will be reimbursed your normal rate minus any applicable cost shares your patient has.

 

So, while the ‘easiest’ billing is in the preventative arena (and some plans have ZERO requirements to qualify!) don’t fret. TONS of other nutrition diagnoses are covered under our scope of practice as well on MANY policies.

 

SO I hope this blog helps if you are on the fence about accepting insurance in your nutrition private practice. I feel like I could talk for days about the pros and cons of accepting insurance if you are a dietitian. However, for so many of us, the decision is a no-brainer. We want to make killer money, help a boatload of people with our services, and live life on our own terms as business owners. Accepting insurance in your practice can give you that and then some.

 

Trust me. I got you, boo!

dietitian podcasts

 

 

 

Filed Under: Insurance, Policies, Reimbursement Dietitian Basics Tagged With: pros and cons accepting insurance

Dietitian Podcasts, oh my!

August 30, 2022 by amyplano Leave a Comment

The pleasure was literally ALL mine: 5 dietitian podcasts to check out

 

First off, I love a good podcast. Don’t you?

 

There is something so satisfying about collecting little ‘gems’ and golden nuggets of knowledge in seemingly unknown places. Plus, (like a typical dietitian!) I am a world-class note-taker.

 

Don’t believe me?

 

Check out the ‘notes’ section on my iPhone or the hundreds of spiral-bound (color-coded) notebooks in my office.

 

Do you know what I love even more than just a good old personal growth podcast? A podcast hosted by a fellow dietitian colleague.

 

Want to know what I love even more than THAT? Being a guest on a fellow dietitian colleague’s podcast.

 

To me, dietitian podcasts are the BOMB dot com.

 

Over the years I have had so much stinking fun on so many different dietitian podcasts. And my brilliant husband (none other than THE Marc Plano) had a great idea of compiling a list of all the recent episodes. He sent them to me in an email last night with the title ‘Amy’s Podcast Episodes.’ So I thought I would follow his excellent lead and drop the episodes below.

dietitian podcasts

 

On these dietitian podcasts,  you will easily see (and hear!) I am super passionate about helpings dietitians create, maintain, and grow their insurance-based practices. Working with RDs in my coaching programs lights me up like nothing else. Whether you be a newbie RD (Welcome!), someone who is just refining their skillset and scaling, or a veteran I have a program designed specifically to meet your needs.

 

But before you sign up to work with me you may want to feel me out. And I ain’t mad at you. My programs are an investment. And one I want you to feel incredibly comfortable making. Therefore. check out these podcasts below. First and foremost will see, the real Amy P. comes out … full force.

 

I hope you enjoy these dietitian podcasts as much as I enjoyed doing them.

 

5 banging dietitian podcasts

 

Make More Money as a Dietitian with Christine Dyan Thomson.

I love, love, love Christine. If you don’t know Christine – you better. She is literally one of my favorite RDs on the planet. Check her out HERE.

Title: Amy Plano, The Reimbursement Dietitian

Episode summary from the host:

Amy Plano is a Connecticut-based Dietitian, author, foodie, wife, professor, and self-declared fashionista, and is widely known as The Reimbursement Dietitian. She is passionate about empowering dietitians to have profitable insurance-based nutrition private practices. Her journey includes completing a traditional pre-med undergrad, 2 years of med school, and some time spent in Costa Rica.

In this episode of the Make More Money as a Dietitian Podcast, Christine and Amy have a candid discussion about her journey. And they dig into Amy’s experience working with insurance reimbursement and she shares “all the things” you need to know about getting reimbursements and growing your dietitian business.

Click HERE to listen to the episode.

 

Pursuing Private Practice Podcast with Jennifer McGurk.

This RD is on fire. Every time I think of Jenn I can’t help but smile. She is one of those RDs who is just incredible in every sense of the word. Check her out HERE.

Title: Insurance Challenges with Amy Plano, RD

Episode summary from the host:

This conversation has been a long time coming! I’ve been a huge fan of Amy Plano’s for a long time. It is such an honor to have her on the podcast.

Amy is so passionate about helping dietitians figure out how insurance works within their private practices. We talk a lot about the challenges of accepting insurance in your private practice. We often hear about the positives of accepting insurance, but I wanted to have a very honest conversation with Amy about the challenges too, and she delivers! Amy gives so much great advice in this episode.

Some of the topics discussed include:

Creating systems to streamline the insurance process, setting boundaries in your business, money mindset issues, and reimbursement rates

Click HERE to listen to the episode.

 

The Dietitian Success Podcast with Krista Kolodziejzyk.

It was such a pleasure to sit down with Krista. She is a rock-star business coach like myself who offers resources, tools, and courses to support dietitians (and RD2B) in growing a thriving self-pay private practice. Check her out HERE.

Title: Insurance, Billing & Licensure for Your Practice with Amy Plano, RD

Episode summary from the host:

In this episode of The Dietitian Success Podcast, I sit down with Amy Plano, The Reimbursement Dietitian, RD, MS, CDE, CDN. Amy is a successful private practice dietitian passionate about helping dietitians create profitable nutrition private practices using an insurance-based model. Together with her husband, Marc Plano, she runs The Plano Program, a health and wellness-based center in Orange, CT. Through both her group-based coaching programs, online resources, and seminars, Amy teaches dietitians exactly how to use health insurance to make money in their nutrition practices.

Amy and I chat about:

>> The pros and cons of accepting insurance in your practice

>> High-level detail on what can/can’t be billed to insurance

>> Navigating MNT vs. health coaching and licensure in the world of telehealth

Click HERE to listen to the episode.

 

 

The Fearless Practitioner’s Podcast with Adrien Pacsoza.

This woman needs NO introduction. RD. Eating Disorder dietitian pioneer. Business mogul. Check her out HERE.

Title: How & Why to Crush it as an Insurance Provider with Guest Amy Plano 

Episode summary from the host:

I know there are a bunch of misconceptions about insurance out there, and that’s why today we have Amy Plano, the Reimbursement Dietitian, on the show. She will be clearing up the misconceptions, sharing the 5 steps you need to start today to become paneled, and also just being real about being a practice owner.

Click HERE to listen to the episode.

 

Dietitian Boss with Libby Rothschild.

Libby is a business coach for dietitians. She is the founder and owner of Dietitian Boss. She also created the Dietitian Boss Method™️ —a proprietary process that shows dietitians step by step how to attract and enroll cash-based clients using social media marketing. Check her out HERE.

Title: Licensure and Reimbursement as a Dietitian Boss with Amy Plano

Episode summary from the host:

In today’s episode, Libby is talking with Amy Plano. Amy Plano, The Reimbursement Dietitian, RD, MS, CDE, CDN, is a successful private practice dietitian passionate about helping dietitians create a profitable nutrition private practice using an insured-based model. Together with her husband, Marc Plano, she runs, The Plano Program, a health and wellness-based center in Orange, CT.

In today’s episode…

Licensure rules always follow where the patient is located, and what this means for you Each state sets forth their own rules and regulations regarding licensure Why Amy decided to leave the academy and pursue a private practice Hear why Amy feels like the core education dietitians receive should be updated to be in tune with the student.

Click HERE to listen to the episode.

Dietitian: What are your favorite dietitian podcasts? Who did I miss?!? Let me know in the comments below!

dietitian podcasts

Filed Under: dietitian media, Reimbursement Dietitian Basics Tagged With: licensure, podcasts

Michigan and Florida dietitians: what’s the deal with accepting insurance?

April 15, 2022 by amyplano Leave a Comment

Florida and Michigan dietitians this blog is for you

 

Florida and Michigan dietitians this blog is for you. 

I get tons of questions from Florida and Michigan dietitians relative to credentialing and accepting insurance. Therefore, I thought it would be helpful to let you know what I know. 

 

Let's start with Michigan

 

To the best of my knowledge, your state’s largest product Blue Cross Blue Shield of Michigan doesn’t allow Registered Dietitians to bill for MNT. This has to do with your lack of licensure. The BCBS Michigan product only allows licensed professionals to participate. So without a license, they don’t allow any dietitians to participate. 

 

Your affiliate for Michigan has been working hard on changing this. And I am optimistic for change. But currently, you are unable to credential and bill Blue Cross Blue Shield of Michigan. 

 

The same holds true for out-of-state providers for Blue Cross Blue Shield. If you are a provider who has a patient who has Blue Cross Blue Shield of Michigan when you call to verify their benefits the representatives will tell you the patient often has 6 covered MNT visits. This is a misquote of benefits. While they may quote you 6 covered visits, they will deny all 6 visits. For some reason on the BCBS of Michigan plans ONLY RDs can bill for MNT. Which makes no sense. BUT seems to hold true on these contracts.

Florida and Michigan dietitians

Therefore, if you try to bill for a BCBS of Michigan plan you will likely not get paid. So don’t do it. Tell the patient their plan doesn’t cover MNT and collect your cash rate at the time of service. 

 

For whatever reason, the other national plans Aetna, Cigna, and United Health Care are also wonky. Some do accept Michigan-based providers. However, it is somewhat of a crapshoot In most areas in Michigan, as to whether or not you can participate and bill these products. I always say give it a shot – and request network status. The worst they can tell you is no. 

 

On the positive side, Medicare (a federal plan) is open to Michigan dietitians to participate as providers. All Medicare products reimburse for MNT for patients with diabetes and chronic kidney disease stages 3a-5 (non-dialysis). As I will mention below, many of the Medicare plans are Advantage plans. These plans will require in-network participation with both Medicare and the commercial side of the plan. 

The 411 for Michigan dietitians ...

 

In summary, due to your licensure limitations, your biggest insurance payer (BlueCross BlueShield of Michigan) will not allow dietitians to bill for MNT. This is not ALWAYS the case for the other national products (Aetna, Cigna & United Health Care). Often you can credential and bill for patients with these plans that have MNT coverage on their policies. However, call to see if this is an option for your practice. Medicare is also an option for dietitians in Michigan.


Now on to Florida ...

 

Now let’s chat about Florida and insurance. 

 

Florida is a licensure state. 

 

So while Florida-based dietitians don’t face issues related to licensure, they like Michigan experience issues with credentialing and billing their state’s BlueCross BlueShield product – Florida Blue. 

 

Florida Blue insurance is not currently accepting any dietitians into their network. The way I understand this is twofold. One they are saying the ‘network’ is closed and is at capacity for dietitians. But on the other side, if you look at their network they don’t list ANY dietitians who actually participate. 

 

On the flip side, if Florida Blue doesn’t credential dietitians then I think it’s fair to assume the majority of the policies will not cover MNT. So if you are an out-of-state dietitian credentialed with your home state plan, and you have a patient who has Florida Blue there is a good chance the patient doesn’t have MNT on their Florida Blue Policy. Some plans DO. But many plans don’t. 

 

So proceed with caution when you bill for these patients.

Florida and Michigan dietitians

In my experience, the commercial insurance plans at the time of me writing this post, Humana, and the Oscar networks are open to accepting new providers based in Florida. While this is in fact a positive for sure, these insurance companies are not super common payers in Florida. 

 

Cigna appears to occasionally appear open to accepting new providers. It seems to be based on your zip code. While the Aetna and UnitedHealthcare networks are repeatedly closed due to the networks being at maximum capacity for dietitians. 

 

It seems like the only way to credential with Aetna and UnitedHealthCare is if you are joining an existing group practice that has a pre-existing contract with these two insurance companies.

So my personal take on Michigan and Florida from an insurance standpoint?

 

I am very hopeful for Michigan dietitians. Given all the hard work the dietitians are putting into trying to make licensure a sure thing in Michigan, I feel in the future you will have access to Blue Cross Blue Shield of Michigan plans with MNT coverage. In the meantime, I would certainly credential with Aetna, Cigna, and United Health Care as well as Medicare if permissible. That way when something ‘gives’ with your BCBS product you will be ready to pounce on that opportunity. 

 

Yes. BCBS is a sizable product. BUT given your potential access to join some of the other major networks that will diversify your insurance portfolio for your practice. Plus, in my experience, Aetna and UnitedHealthCare tend to be the most popular Medicare Advantage plans. So you should really be good to go with billing most Medicare plans.

Michigan and Florida dietitians

Florida. I honestly don’t really understand the ‘why’ it is so difficult to work with the insurance companies in this state. Yes, your state has had some bumps in the road from a licensure standpoint. But currently, your license is not in jeopardy, and from what I know rock solid. I don’t know why Florida Blue doesn’t credential dietitians. Nor do I know why so few Florida Blue plans actually have MNT coverage. I can only tell you what I know. 

 

Oscar, Humana, and Medicare are open for new providers to enroll. But like I mentioned the enrollment of these plans is not super high. Yes. You will get some patients. And yes these plans seem to offer decent coverage for MNT. But I personally don’t feel like this presents enough of an opportunity to go all-in with insurance. 

Yes you can get into medicare but ...

While you can enroll and bill for Medicare. My main concern is most Medicare patients have Medicare Advantage Plans. These are Medicare plans managed through a commercial carrier like Aetna, Humana, Cigna, and United Health Care. The claims for the advantage plans typically (although not always) require you to be in with both Medicare and the commercial plan. These types of claims get submitted to the commercial payer. Therefore, I am concerned that given the major commercial networks are closed, you will even struggle with participating with Medicare at a level that makes sense. 

So, that is all I got for you Michigan and Florida dietitians for now. Fingers crossed for a brighter future for the commercial networks in these states. I am rooting for you all. 

 

Note: this point was posted on 4.15.22 just for a post a reference for the information posted in this blog. 

Filed Under: Billing Policies, Insurance, Reimbursement Dietitian Basics Tagged With: Florida dietitians, Michigan and Florida dietitians:, Michigan dietitians

Personal growth for dietitians

September 6, 2021 by amyplano Leave a Comment

Personal growth for dietitians

Well hello, my smart, sassy-mouthed dietitian.

 

Today I wanted to share with you something a little different.

 

NOT insurance-related but something EQUALLY important (if not MORE important) personal growth for dietitians.

 

Plus, I imagine me talking your ear off about insurance can get a little old after a while.

 

So let’s change the channel … time to tune to a new frequency related to personal growth for dietitians.

 

If you guys follow me on Instagram you know that personal growth and development are HUGE for me. So huge in fact that I think I owe a good deal of my success in my career to this aspect of my life.

 

While I enjoy taking courses and webinars, working with business coaches, and attending seminars that help support my development as an RD, entrepreneur, and coach the one thing I LOVE most is reading.

 

I would have to say I probably read on average one book per week.

 

And I am not saying this to brag. Because many of you are probably thinking if I have that type of time I should probably get another job! Seriously, Sis!

 

But honestly reading a book per week was NEVER my intention.

 

My actual intention is to JUST read 10 pages of a personal growth book per day. Anything else is a BONUS.

 

So each night I sit down with my book and my trusty highlighter. I pick up where I left off and go from there.

 

If I get to 10 pages and that is all I am feeling that night I stop. I put down the book and then I feel like I have ‘earned’ my scrolling time on Instagram.

 

However, some nights I might read more than 10 pages. But no matter what the day I ALWAYS do my best to get to at least 10 pages.

 

For me, it is the simple LITTLE disciplines like this. The productive, mundane actions repeated over time that has given me the clarity I have needed to grow my private practice beyond my wildest dreams.

personal growth for dietitians
That’s YOU, Sis!

 

Success is not a random act.

 

Your private practice is not the lottery. You are not all of a sudden going to wake up to a bank account full of money.

 

Personal growth for dietitians is ON-going. It NEVER ends. Period.

 

But more importantly, the truth is success is grown: it is planted, cultivated, and ultimately harvested.

 

It begins in our heads and moves to our hearts.

 

But you don’t have to be a superhero to accomplish great things.

But you do need to do something.

 

I want this something to be to read at least 10 pages of a personal growth book every night. 

That is my challenge to you. 

And to keep you accountable tag me on Instagram @ reimbursement_dietitian

 

I want to see what you are reading.

 Not a book a week.

Not a book a month.

Just 10 pages per day.

That is all I am asking of you. 

 If you don’t read those 10 pages will your business fall apart?

Of course, not!


What I have learned is that successful people do what unsuccessful aren’t willing to do

 

But what I have learned is that successful people do what unsuccessful aren’t willing to do. And being great at something like private practice is NOT predetermined.

 

You have full control over just how awesome your practice will become. But you need to act. You need to make a decision right now that you ARE going to be successful no matter what.

 

For things to CHANGE you need to change. For things to get better, you need to get BETTER. And it all starts the simple mundane tasks you do day in and day out like reading those 10 pages of a great personal growth book per day.

 

And if you need some inspiration of course I have a list of awesome books. Some I have read as many as 3 times. Shoot me an email amy.plano@yahoo.com and I will send you my list!

 

As I said, I think this little task of just reading 10 pages a night has really been one of THE contributing factors to my success.

 

It keeps my head on straight. Keeps me grounded. And provides me with the headspace I need to get shit done.

 

Also, don’t forget to TAG me on Instagram so I can keep you accountable, Sis!

 

I am so excited to see what you are reading!

personal growth for dietitians

Filed Under: Business Tips, Reimbursement Dietitian Basics Tagged With: books, personal development, personal growth for dietitians

What are the differences between documentation and a referral for MNT?

July 2, 2021 by amyplano 2 Comments

Today I want to talk to you about the differences between getting documentation for using specific ICD 10 codes and needing an insurance referral for MNT.

 

If you are in my group coaching program, then you already received the smackdown on this. But if I have not had the privilege of coaching you I still want you to have the 411 as well.  After all, you know I would NEVER leave a sista’ hanging!

 

So, what is the DIFFERENCE between ‘documentation‘ and ‘referrals for MNT‘ as they relate to insurance billing for dietitians?

referrals for MNT

Documentation, what gives?

 

Anytime we plan to use a medical code (say diabetes, renal disease, celiac disease) we need documentation from a health care professional who can diagnose. Either an MD, APRN, PA, DO or therapist are common providers who can diagnose. We can’t!

 

Even if we know for a fact that our patient has celiac disease. If we intend to use the ICD 10 code to denote celiac disease (K90.0) on an insurance claim or superbill then we must have that ICD 10 code documented.

 

This documentation can come in the form of a referral, progress note, discharge summary, lab slip, etc.

 

Having documentation of the diagnosis is NOT an insurance thing. It is an RD scope of practice thing. We can’t diagnose therefore, we need to seek documentation from someone who can.

 

The insurance companies DO NOT require documentation BUT our scope of practice does as we are registered dietitians (think BIG brother!)

 

When we are billing under Insurance Health Reform (aka preventative coverage!) and we are using Z-codes which many plans accept WE DO NOT documentation. It is considered within our scope to use this particular set of ICD 10 codes.

 

However, (and I know you are going to want to gut-punch me on this!) if you decide you want to bill with E codes like E66.3 (overweight) or E66.9 (obesity) even though technically we know how to calculate overweight and obesity using BMI codes. We are NOT supposed to use these codes UNLESS we have documentation from a provider who can diagnose.

 

I KNOW this is SUPER-DUPER annoying.

 

 

But like I mentioned the ONLY ICD 10 codes we can use WITHOUT documentation are Z codes (like Z71.3, Z72.4, Z82.47 & BMI codes). E66.3 and E66.9 are deemed by the AMA as medical codes. And all medical codes REQUIRE documentation.

 

And just to repeat. This is a SCOPE of PRACTICE thing. NOT an insurance requirement.

 

The insurance company is NOT checking to see if you have this documentation. They are assuming based on your contract you are following all the rules of your discipline.

 

referral for MNT

So how is documentation DIFFERENT from a referral for MNT?

 

A referral is WAY different.

 

A referral is an INSURANCE thing. NOT a scope of practice thing. If a referral is required – it is REQUIRED by the patient’s INSURANCE plan.

 

While most insurance plans DO NOT require a referral for MNT (with the exception of Medicare) you may find a handful do.

 

referral for MNT

 

 

On the referral you need to have the ICD 10 code you will be seeing the patient for along with the referring provider’s full name, NPI, signature, and date.

 

If a plan requires a referral this information will be noted in box 17 on the CMS 1500 form when you submit the claim.

 

If you need documentation you will only refer to the documentation you for the ICD 10 medical code [box 24 on CMS 1500 form] but don’t need to do anything special on the claim.

 

So think of referrals as insurance requirements and documentation like scope of practice requirements. 

 

A referral is a TYPE of documentation. But it is not the only we can seek out. As mentioned above progress notes, discharge summaries, lab slips can also serve as the necessary documentation when it comes to using medical ICD codes. 

 

Okay. Cool. That was a lot to digest. So I will stop there.

 

But if you loved what you just read and want more you may want to consider joining my Group Reimbursement Coaching Program. Due to its high demand, I just turned it into an Evergreen platform so you can apply at any time. Here is a link to APPLY.

 

Even if you are already credentialed, you don’t know what you don’t know, Sis!

 

My Group Reimbursement Program teaches you how to get credentialed, bill the shit out of insurance & make the money you deserve as a badass dietitian. It is the EXACT program I wish I had when I started MY practice in 2007.

 

Hugs & High Fives – Amy

 

P.S. Are you following my shenanigans on IG? I provide daily tips and guidelines on all things reimbursement and private practice. Click HERE to follow me.

 

 

Filed Under: Billing Policies, Reimbursement Dietitian Basics

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