Insurance Didn’t Screw You. You Just Don’t Have a System.
Let’s get real, RDs. Insurance didn’t screw you. You just don’t have a system. After almost two decades of billing insurance, I can tell you that 95% of the “insurance problems” dietitians complain about are self-inflicted, and they almost always trace back to one of three fixable mistakes.
Mistake #1: You’re Not Verifying Eligibility
You’re not verifying eligibility. Some of you are not verifying benefits at all. Some of you have your patients verify (which is why #3 below happens). Some of you only verify once and never again. Here’s the thing – plans change mid-year, deductibles reset, coverage lapses. If you’re still billing off info you never personally checked (or understand), you’re gambling with every claim. Fix: build verification into your actual workflow, not a one-time step.
Mistake #2: Your Documentation Doesn’t Support Medical Necessity
You all tell me that documentation stresses you the F*CK out. Understood. Insurance pays for medically necessary care, and your notes have to prove it, every time. “Discussed diet, patient doing well” doesn’t cut it. Fix: every note should answer: why was this visit medically necessary, right now, for this diagnosis. For the freaking diagnosis. Not seeing a patient for a formal eating disorder (being too lazy to get the diagnosis documented), then billing UHC for Family History of Ischemic Heart Disease because you ‘heard’ that has good coverage. Stop doing this BS now. Struggling with documentation? I got YOU. Check out this master class here: Chart is Like a Rock Star – Documentation that Protects Your Credential.
Mistake #3: You’re Submitting the Wrong Codes Without Realizing It
CPT, ICD-10, modifiers- they all have to match the actual visit and the payer’s rules. Using the same code combination for every visit, regardless of what happened in the room, isn’t a system; it’s a guess, and it’s why being credentialed with multiple panels doesn’t automatically translate to revenue. The credentialing gets you in; the coding accuracy keeps you paid. There is a rhyme and reason, especially for preventative coverage for each payer. If you are struggling with this, check out my preventative cheat sheet here. Fix: know your top 5 visit scenarios cold, and know exactly which codes apply to each
Why This Actually Matters
None of this means insurance companies are being unreasonable. It means they’re enforcing rules that exist and can be learned once, then applied consistently. I made every one of these mistakes myself, more than once, back when I had zero guidance. The shift wasn’t that insurance got easier; it’s that I stopped treating billing like a mystery and started treating it like a repeatable process.
If you want the real math on what insurance-based billing can actually pay once the system is dialed in, that number gets a lot more believable once these three things are fixed.
Are YOU Ready to Actually Fix This?
If you want the full system, not just the awareness of what’s broken, that’s exactly what coaching walks you through, step by step. Book a call here to see what that actually looks like for your practice.
I’m cheering for you, but we need to stop some of this madness. K? Cool.
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