amyplano

 

 

It’s your girl, Amy P., The Reimbursement Dietitian, and you know my mission — to make the reimbursement process for dietitians and CNSs simple, profitable, and repeatable.

 

day, we’re diving into a question I get all the time:

 

“How much do dietitians actually make with insurance?”

 

 

You’ve probably heard the hype: 💰 “You can make $100/hour as a dietitian!”

 

 

Heck, I’ve said it too — because it’s technically accurate. If you’re credentialed with insurance, many commercial payers reimburse $100/hour or more. A sh*t ton more. Oregon, I am looking at you. 

 

 

But here’s the part most people don’t talk about…

 

 

Just because you make $100/hour doesn’t mean you keep $100/hour.

 

 

Let’s break down what that really looks like in a private practice that accepts insurance.

 

 

The Real Story Behind $100/hour

So you’re bringing home $100 per session. Sounds amazing, right?

 

 

But here’s where the hourly rate for insurance-based dietitians gets real:

 

 

After you factor in:

• Federal & state taxes
  
• Business software and EHR subscriptions
  
• Admin hours (follow-ups, scheduling, forms)
  
• Documentation time
  
• Credentialing and billing fees
  
• Time spent working without getting paid (emails, client prep, team meetings…)

   

You’re looking at closer to $60/hour in actual take-home pay. Not that is ‘bad’ by any means. It is just the truth of how business works. 

 

 

 

Why This Still Isn’t Bad News

This isn’t meant to scare you — it’s to help you be smart. If you’re wondering how much dietitians make with insurance, the key is to look at net income, not just gross.

 

👉 Smart RDs track expenses
👉 Smart RDs optimize their admin time
👉 Smart RDs build systems that scale

 

Because what matters most isn’t just what you bill — it’s what you keep.

 

 

Want to Build a Profitable, Sustainable Practice?

 

If you’re ready to start or grow an insurance-based practice that pays you well and keeps your sanity intact…

 

 

My coaching program teaches you:

 

 

• How to get credentialed fast
  
• How to bill clean claims and get paid
  
• How to grow without burning out

   

   

👉 Apply here to learn more. 

 

When a Client Wants Their Records: What the HIPAA Rule Actually Says

If you’ve ever had a client email you asking for “everything in their chart,” you’re not alone. It’s becoming more common as clients (and insurance companies) get savvier about their rights. 

 

But what are you actually required to share under HIPAA?

 

Under the HIPAA Privacy Rule, clients and their legal representatives have the right to inspect and obtain a copy of their records. 

 

That includes anything you use to make decisions about their care. You must provide the records within 30 days of the request; however, you may request an additional 30 days if you provide written notice explaining the delay.

 

Clients can request records in paper or electronic form, depending on what’s feasible for your practice. 

 

And no, you can’t deny access just because you’re worried they might disagree with your notes or misinterpret your recommendations. (Yes, even if you know they’ll take that “reduce sodium” note personally.)

 

 

What Counts as the “Designated Record Set”

Here’s where most dietitians get tripped up: not everything in your EMR is considered part of the “designated record set.”

 

You are required to share any documentation that informs decisions about the client’s care, such as:

• Initial and follow-up MNT session notes
  
  
• Nutrition assessments, care plans, and goals
  
  
• Correspondence with other providers (if it influenced care)
  
  
• Lab interpretations or summaries used in your recommendations
  
  
• Progress tracking or SMART goal documentation
  
  

What you don’t have to provide:

• Administrative paperwork (like scheduling notes or billing records)
  
  
• Personal reminders or draft notes are intended solely for your use.
  
  
• Copyrighted or generic educational handouts (though including them can show transparency)
  
  

This distinction is particularly important when handling MNT insurance denials. If a payer ever audits your documentation or a client requests records after a denied claim, you want your “designated record set” to be clear, compliant, and professional.

 

 

Do You Have to Include Handouts or Educational Materials?

If the handouts you provided were specific to the client’s plan of care—say, a customized carbohydrate-counting guide—it’s good practice to include them in the record release. However, HIPAA doesn’t require it.

 

Generic materials like “High Fiber Food List” or “Healthy Plate Visuals” don’t count as part of the legal record. That said, many dietitians still choose to include them for context or as a gesture of goodwill.

 

Can You Charge a Fee for Record Requests?

 

Yes, but only within reason. 

 

HIPAA allows you to charge a cost-based fee that reflects your actual expense in preparing and delivering the records. 

 

This can include:

• Labor for copying or scanning
  
  
• Postage (if mailed)
  
  
• The cost of a USB or CD (if applicable)
  
  

 

What’s not allowed? “Retrieval,” “review,” or “administrative” fees.

                 

Most dietitians charge between $ 10 and $30 for lengthy or complex record requests, although many waive the fee for electronic copies or short records.

 

 

How to Handle Record Requests Like a Pro

 

Having a clear process saves you from stress when these requests pop up, especially if they’re linked to MNT insurance denials or disputed claims. 

 

Here’s your quick checklist:

1. Have a written policy in your HIPAA Notice of Privacy Practices that outlines how clients can request their records.
   
   
2. Use a formal record request form noting the date, scope (e.g., “all MNT records from 2023–2024”), and format (PDF, portal, printed).
   
   
3. Redact any third-party identifiers, for example, if your notes mention a family member or another client.
   
   
4. Deliver records securely via encrypted email, patient portal, or secure mail.
   
   

 

Keep documentation of what was sent and when.

 

 

Don’t Forget State Law

HIPAA sets the baseline, but your state law may be stricter. 

 

Some states require you to fulfill requests faster (within 15 days) or limit what you can charge. Always check your state’s health record access laws to stay compliant.

 

The Bottom Line

When clients request their nutrition records, it’s not a personal matter; it’s their right. 

 

As a provider, it’s your responsibility to handle the request confidently, professionally, and in accordance with the law.

 

And if your record-keeping ever comes into play during an MNT insurance denial, having organized, compliant documentation can protect your practice and your reputation.

 

HIPAA isn’t here to trip you up; it’s here to remind you that good documentation is good business.

 

 

It’s your girl, Amy P., The Reimbursement Dietitian, and my mission is to simplify the reimbursement process for dietitians and CNSs. 

 

But here’s what most folks don’t know: I also run a multi-6-figure insurance-based group practice with a team of badass RDs — and learning how to manage a dietitian team has been one of the hardest, messiest, humbling, and most valuable leadership journeys of my life.

 

No one teaches us how to lead when we’re scaling. And I say this from a place of love: this sh*t is not for the faint of heart. Everything we are going to talk about today, I have royally f*cked up. 

 

So today, I’m giving you the ‘realest’ breakdown of how to lead your dietitian team without micromanaging, losing your cool, or getting stuck in the “I’ll just do it myself” trap.

 

Let’s talk about 6 key leadership skills that will help your RDs win — and help you stay sane.

 

1. Clarity of Vision

Your nutrition team can’t succeed if they don’t know where they’re going.

 

As the team leader, you need to define:

• Where are we headed?
• What does success look like?
• What do we not do here?
  
  

If you’re vague, they hesitate. 

 

If you’re clear, they move confidently. 

 

Managing dietitians starts with repeating your vision until they can finish your sentences. It’s not overkill — it’s leadership.

 

 

2. Fast, Intentional Decisions

Your team mirrors you. If you freeze, they freeze.

 

Teach your RDs to ask:

• “What’s the outcome I want?”
• “What’s the fastest decision I can make that aligns with our values?”
  
  

Intentional speed builds trust. And when things go wrong (because they will), model how to pivot without panic.

 

3. Accountability Is Respect

 

If you want to run a high-performing nutrition team, accountability is non-negotiable.

 

Set expectations. Track progress. Follow through.

When a dietitian drops the ball, say: “Here’s what we agreed on. Here’s what happened. Let’s close the gap.”

This is how you manage a team like a boss, not a babysitter.

 

4. Emotional Control Is Your Superpower

 

Your emotional energy affects the whole practice. Dietitians are intuitive — they pick up on your stress.

 

So when things go sideways (hello, insurance denials!), skip the eye rolls and stay steady.

 

Say: “This didn’t go as planned. Let’s troubleshoot together.”

 

Your calm is your power

 

5. Radical Candor

Want to grow your team? Give them feedback that actually helps.

 

Radical candor = “I care about you, and I’m going to be honest.”

Say: “I want to see you win, and here’s what needs to improve.”

 

Praise in public.

 

Correct in private.

 

Managing a dietitian team requires honesty and backbone, not avoidance.

 

6. High Standards, Always

Want excellence? Don’t tolerate mediocrity.
Late notes, missed deadlines, or sloppy communication? Nope.

Say: “We do excellent work here. That’s the standard.”
Your team will either rise to meet it, or self-select out. Both outcomes are a win.

 

Thinking About Hiring Dietitians?

If you’re building a team inside your insurance-based nutrition practice, and want support with the hiring, training, and leadership pieces, I’ve got you.

 

Inside my Hiring Program, I teach you how to:

• Hire right (no regrets!)
• Set strong expectations
• Onboard smoothly

Lead your team with confidence (and zero chaos)

 

👉 Click here to learn more.

 

Your future RDs — and your nervous system — will thank you.

 

Hugs & High Fives – Amy

 

Hey there, it’s Amy P., The Reimbursement Dietitian. This week, I want to share some real talk about a topic that makes most dietitians in private practice sweat: insurance audits.

 

You might think I’m immune to the stress of audits by now—trust me, I’m not. Even after going through this process many times, I still get that sinking-stomach feeling every time I receive the dreaded fax.

 

Most of our audits come from Anthem Blue Cross Blue Shield, and while I know they’re just doing their job, it never feels “easy.”

 

I’m writing this while we’re smack-dab in the middle of an audit—yes, one that landed during my vacation in Florida (because of course it did). So I thought now would be the perfect time to give you tips on handling insurance audits as a dietitian.

 

1. Know That Insurance Audits Are Inevitable (Not Punitive)

Insurance audits are part of doing business with insurance companies. They’re often random and used as part of internal checks and balances, not because you did anything wrong. The companies usually select a handful of patients at random.

 

 

2. What to Send in an Audit

They’re typically looking for:

• Your chart notes
  
  
• Any educational materials or resources you gave to patients (meal plans, handouts, etc.)
  
  
• Referrals (if applicable—but not always required)
  
  

Be sure your documentation is thorough and reflects the services provided. That’s your safety net.

 

3. Deadlines Are Tight—But Extensions Are Possible

You usually have 10–12 days to respond. However, in many cases, you can request a short extension. Don’t panic—just plan.

 

4. Don’t Freak Out—Most RDs Are Doing Just Fine

 

Many dietitians worry their notes won’t “pass.” But in my experience, most documentation is more than acceptable. If you’re unsure, I have a Documentation Master Class that explains precisely what to include to stay audit-ready.

 

5. Watch for Third-Party Requests

Medical record requests usually come from third-party companies like Inovalon or Ciox, not directly from the insurance company. Many RDs mistake these for scams, but they’re legit.

 

6. Submit Your Notes Safely

You can fax your notes or send them via a secure mail label provided by the audit company. Standard mail with a tracking label is often acceptable, and the company will typically cover shipping.

 

 

7. Expect a Mix of Patient Types

Auditors may request single-session notes, multi-session visits, or long-term patients seen weekly. That’s typical—don’t overthink it.

 

Bonus Resources

👉 Want help streamlining your charting process? Some coaching clients created a tutorial on using AI software like Heidi for easier documentation. Click [insert YouTube video on AI Charting] to check it out.

 

👉 Need help preparing for audits? I offer two Master Classes—one on documentation and one on insurance audits—where I show you what I’ve submitted and how the process works step-by-step.

 

 

Why 95% of Dietitians’ Insurance Problems Are Actually Their Fault

 

Let’s get real, RD fam—95% of the “insurance problems” you’re whining about?

 

Yep. They’re actually your fault.

 

Claims denied, money lost, screaming “insurance sucks”?

 

Not insurance—it’s a knowledge gap.

 

I’m Amy P., The Reimbursement Dietitian. I’ve been billing insurance since 2007, and I didn’t just learn this in a textbook. I broke it, fixed it, and now I teach dietitians like YOU how to do it without creating dumpster fires of confusion and lost money.

 

 

The Knowledge Gap That’s Costing You Money

Most dietitians know just enough to be dangerous. Winging it with CPT codes, ICD-10 codes, preventive vs medical MNT, and benefit verification isn’t cute—it’s expensive, confusing, and soul-sucking.

Go scroll a public FB billing group for dietitians: one RD says, “Always bill Z71.3,” another says, “Only medical codes,” and someone’s asking for help setting up EFTs. Fifty shades of… yeah, you get it.

 

 

Insurance Isn’t the Enemy – Confusion Is

Insurance isn’t scary—it’s an opportunity in disguise. The real problem? Fear and lack of clarity.

 

Preventive vs Medical MNT: Understanding the Difference

Many dietitians don’t know which MNT benefits to bill. Preventive? Medical? Each plan has quirks, and mistakes cost money.

How Benefit Verification Can Make or Break Your Claims

 

Checking eligibility and understanding a patient’s benefits isn’t glamorous, but it’s the difference between getting paid and crying into your leftover kale salad.

 

What’s Possible When You Master MNT Insurance Reimbursement

 

Imagine this:

 

✔ Your schedule is manageable.
✔ You’re not begging clients to Venmo you.
✔ Patients can come in as often as they need—and actually afford it.
✔ You scale your practice without burning out.

 

That’s insurance done right. While everyone else hustles for random cash-pay clients, you’re building a system that works while you sleep.

💥 Real talk: this isn’t magic. You will need to see patients, put in the work, and understand the codes. But unlike a cash-pay side hustle, insurance lets you make six figures without selling your soul. However, notice that ‘BUT’ is in caps – you need to work hard, see patients one-on-one, and experience a learning curve. I am not sugar coating THIS sh*t.

 

Stop Guessing – Build Structure and Clarity

 

What’s really holding dietitians back?

 

• Lack of structure
• Not knowing codes & benefits
• Chaos in your system.

 

The fix? Structure, clarity, and proper training.

 

Credentialing & Verifying Benefits

Knowing how to get credentialed with commercial insurance companies like BCBS, Cigna, Aetna, and UHC is your first step. Skip this, and you’re leaving money on the table.

EMR Mastery & Tracking Metrics

Once you understand billing and coding, track your results. Metrics help you grow without guesswork—and yes, more money rolls in.

 

How to Go From Confused → Confident → PAID

My Reimbursement Coaching Program walks dietitians from frustration to freedom.

 

You’ll learn:

✅ Credentialing & verifying insurance benefits
✅ Billing & coding like a pro for MNT
✅ Marketing your insurance-based practice without stress
✅ EMR mastery and tracking metrics for growth

 

Follow the system → grow your practice → help more patients → finally make the money you deserve.

 

Takeaway: Confusion Is Your Enemy, Not Insurance

Stop guessing.

 

Get structured.

Get paid.

Insurance isn’t the villain—your lack of clarity is.

When you master the rules, your patients love you, doctors respect you, and your checks (and EFTs) actually roll in.

💁‍♀️ Ready to turn insurance into your shortcut to six figures?

Check out my coaching program and start getting paid like the boss RD you are.

Click here to learn more & apply!

 

Billing Insurance as an Out-of-Network Dietitian: What You Need to Know About Superbills

Today’s hot topic: billing insurance as an out-of-network dietitian and how superbills come into play.

Superbills can be incredibly helpful for dietitians working with clients whose insurance plans you’re not credentialed with. 

But here’s the catch—they’re more complex than most RDs and CNSs realize.

The patient still needs to understand their out-of-network (OON) benefits, and even then, reimbursement is not guaranteed.

 

What Is a Superbill?

A superbill is a detailed document (like an invoice) outlining the services provided during a patient visit. 

It includes:

• Dates of service
• CPT codes for the services rendered
• ICD-10 diagnosis codes (if documented by a diagnosing provider)
• The fee charged for each service.

Patients can submit this form to their insurance company along with a claim form to get reimbursed for their nutrition services.

If you’re billing insurance as an out-of-network dietitian, the superbill is your client’s only tool to attempt reimbursement. You can’t submit claims for them—you’re out of network.

 

When Can You Provide a Superbill?

This is key.

 

You can only provide a superbill if you are truly out-of-network with the patient’s plan.

 

• ✅ You’re out-of-network → You can provide a superbill.
• ❌ You’re in-network → You must submit claims on the patient’s behalf.
• 🚫 You’re in-network, but their benefits are exhausted or not covered → There is no superbill because you’re still technically in-network, and the service isn’t reimbursable.

Note: Medicare doesn’t accept superbills, so skip it entirely with those patients.

Will the Patient Get Reimbursed?

 

The million-dollar question. And the answer?

 

It depends.

 

When billing insurance as an out-of-network dietitian, reimbursement is based entirely on the patient’s OON policy. 

 

Some plans have:

• High OON deductibles (mine is $8000!)
• Limited coverage
• No OON benefits at all

Insurance might reimburse them for sessions with you only after they meet their OON deductible and cost-sharing requirements.

 

What Diagnosis Codes (ICD-10) Can You Use?

 

Here’s a big mistake many dietitians make when creating superbills: using random ICD-10 codes without documentation.

We can’t diagnose. 

 

Even if we know the patient has diabetes or celiac, we can’t slap that on a superbill unless it’s been officially documented by a diagnosing provider.

 

To successfully navigate billing insurance as an out-of-network dietitian:

 

• Use diagnosis codes that are documented in the patient’s medical records.
• Know what codes are accepted by different plans.
• Understand how preventive vs. medical coverage affects reimbursement.

👉 Want help with this? Check out my ICD-10 Cheat Sheet here.

 

Final Thoughts

Providing superbills sounds simple, but it’s more nuanced than it looks. You can’t just toss “Z71.3” on every form and expect magic.

 

Reimbursement depends on what’s covered, the documentation, and how well the superbill is filled out.

 

So, if you’re committed to billing insurance as an out-of-network dietitian, ensure you’re doing it right, from coding to communicating expectations with patients.

 

Do you need a free PDF that explains how to fill out a superbill step by step?

 

Click HERE to grab it.

 

As always, I’m cheering for YOU!