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5 Hard Truths About Billing Insurance as a Dietitian That No One Talks About

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 Billing insurance as a dietitian isn’t for the faint of heart. Over the past 20 years, I’ve learned some tough—but valuable—truths about what it really takes to build a thriving insurance-based practice. These aren’t the things they teach you in school or on social media. They’re hard-earned lessons from the trenches of running a private practice and navigating the messy world of insurance reimbursement.

 

If you prefer the video format of this content, check out my YouTube video on this topic HERE 

 

 

If you’re just starting out or feeling stuck, here are the five biggest truths you need to know:

 

1. Everything Takes Longer Than You Think

 

One of the most frustrating parts of billing insurance as a dietitian is the timeline. From credentialing to verifying benefits to waiting on a CPA, nothing happens as quickly as you want. You’ll be told a claim will process in 30 days, but somehow it drags into 90. Expect delays, build buffer time into your workflows, and let go of the illusion of control. Running a private practice means surrendering to uncertainty while still showing up every day.

 

2.Feeling Overwhelmed Is Normal

 

Of course you’re overwhelmed—you’re learning an entirely new language. Billing insurance as a dietitian isn’t just one task; it’s dozens. Scheduling, charting, onboarding, dealing with software, handling personalities, verifying benefits—it’s a lot. The overwhelm doesn’t mean you’re failing. It means you’re building. And every successful dietitian you admire has been right where you are.

 

3.Think in Decades, Not Months

 

It’s tempting to want quick wins, but billing insurance as a dietitian is a long game. Your first few years may feel like a hot mess—more failures than wins, more confusion than clarity. But empires aren’t built overnight. The most sustainable businesses are the ones built slowly, on firm foundations. Keep a long-term mindset and stop measuring success in months. Think about where you want to be in ten years, not ten weeks.

 

4. Pain Is the Cost of Growth

 

Billing insurance as a dietitian will test you. You’ll mess up. You’ll get rejections. You’ll feel like quitting. That’s not a sign to stop—it’s a sign you’re growing. Every hard thing you face in business is a rep that makes you stronger. Pain isn’t punishment; it’s progress. The dietitians who win are the ones who keep going even when it sucks.

 

5. Focus Will Make or Break You

 

You can’t build a successful insurance-based practice if you’re constantly distracted by shiny objects. Billing insurance as a dietitian requires deep focus on the right systems: admin workflows, counseling skills, marketing consistency, and patient retention. Say yes early on to learn what works—but eventually, you’ll need to say no to anything that doesn’t move your business forward. The more you protect your focus, the more success you’ll create.

 

 

Final Thoughts

 

If you’re billing insurance as a dietitian and feeling behind, know this: you’re exactly where you’re supposed to be. Everything takes longer than you think; feeling overwhelmed is normal, and growth is always messy. But if you focus on what matters and play the long game, you’ll be amazed by what’s possible.

 

Ready to Stop Spinning Your Wheels with Insurance Billing?


If you’re overwhelmed, stuck, or second-guessing every step, know this: you’re not alone, and it doesn’t have to be this hard. I’ve helped hundreds of dietitians like you build efficient, profitable, insurance-based practices that actually work.

 

👉 Join my EPIC Reimbursement Coaching Program, get support, and take the next right step today.

 

Because your future success depends on what you do now, not what you “should” have done yesterday.

 

Successful Private Practice Dietitians Do This One Thing Differently

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I wish I had learned this lesson sooner.

At almost 48 years old, it’s wild to think I’ve been running a successful private practice since 2007. Over the years, I’ve made more mistakes than I care to count—but each one taught me something valuable. So if you’re in a season where your business feels like a flaming dumpster fire full of insurance denials and frustration, I want you to know: you’re not alone. I’ve been there.


The truth is, successful private practice dietitians don’t avoid hard things—they lean into them.


And the #1 thing they do differently?


They master the singularity of focus.

 

The Hard Truth Most Practice Owners Avoid

We’re trained to work hard, but not always to work smart. We create to-do lists, chase productivity, and stay busy with low-impact tasks. Why?


Because it’s easier. 

Busy work feels productive, but it often doesn’t move the needle. As a result, many dietitians spend too much time organizing and planning, and not enough time focusing on what grows their practice.


Even something as simple as charting CAN be done more efficiently. BUT dietitians love to make things more challenging than they have to!


Successful Private Practice Dietitians Do This One Thing Differently

Focus isn’t a personality trait. It’s a skill.

It’s what happens when we cut the noise, set boundaries, and commit to meaningful actions. That’s what successful private practice dietitians do.

 

Ask Yourself This ONE Question

When I feel scattered (which is quite often!), I pause and ask:

“What is the ONE thing, if accomplished, that would make everything else in my practice easier or irrelevant?”

Often, the answer is the one task I’ve been avoiding. For some, that is learning how to bill insurance for MNT.


For others, it’s marketing their insurance-based practice or streamlining systems. Whatever it is, successful private practice dietitians do this hard thing first.

 

Make That ONE Thing Visible

Now we can come up with a plan.


Here’s how to take action:

  • Write your “one thing” on a sticky note. Please put it on your desk, your mirror, your phone wallpaper.

  • List out every small task required to complete that one thing.

  • Start with tiny, clear actions. Here’s an example:

Example “one thing”: Tell more people about my insurance-based nutrition practice.


Mini-tasks:

  • Create a one-line elevator pitch.

  • Verbally tell five new people per day about your services.

  • Join a local networking group within 30 days.

  • Post that elevator pitch on one social platform daily for 30 days.

  • Send a monthly email newsletter introducing your services.

 

Focus on Less to Achieve More

Successful private practice dietitians eliminate distractions, focus on high-impact actions, and build habits that grow their business, especially when it feels uncomfortable.


Successful Private Practice Dietitians Do This One Thing Differently


On the other side of discomfort is the practice you’ve been dreaming of.


Sometimes, one conversation is all it takes to identify your “one thing.”


So… what are you avoiding?


Let’s tackle it together.

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. If you are overwhelmed by what documentation for dietitians MUST entail I did an EPIC Master Class on the topic. You can check it out HERE. 

 

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. AND I want to reiterate MANY insurance contracts prohibit THIS. Some contracts require you to be PHYSICALLY in the sate you are credentialing in. Insurance contracts often refer to this as, “Scope of Location.” This implies per your contract you are REQUIRED to located in the state your office implies while providing the service.

 

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. Once again, I can’t stress this enough ALWAYS consult legal counsel when practicing across state lines. 

 

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 Dietitian HERE. 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.”

 

Purchase 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 did a live presentation on this topic on Thursday, August 22, 2024, at 6:00 pm, on How to Integrate High Ticket Programs & Packages into Your Practice.

And of course we recorded it HERE.

 

HERE is a link to purchase the replay of THIS 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.

 

This is one of our most downloaded Master Classes — and trust me you will know why by the end of the recording.

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

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