The Reimbursement Dietitian - Starter Pack contains all the forms for a nutrition private practice
The Reimbursement dietitian – Starter Pack is the answer to your prayers.
Are you a dietitian new to the fabulous world of private practice?
Overwhelmed with all the teeny, tiny details involved with operating a successful practice?
Wish you could click your pretty little red heels and all the important forms and documents you need would magically appear? Looking for all the forms for a nutrition private practice?
Girlfriend, your wish is my command. The Reimbursement Dietitian – Starter Pack is the answer
to your prayers.
Now, can I get an hallelujah?
The Reimbursement Dietitian – Starter Pack is my baby. After a decade of hustling hard in my practice, the documents you will receive are a result of my blood, sweat, and tears.
And Sis! There were LOTS of tears.
Starting a private practice was perhaps one of the hardest things I have ever done. There are just SO many things you need to do. With no one to tell you how to do them. What I would not have given for a product like this when first I opened my practice.
But truth be told – it did not exist. Because if it did – I would have bought it in a heartbeat! You see – I have absolutely NO PROBLEM seeking help. Nor should you. In fact, the KEY to being a successful entrepreneur actually involves asking for help when you need it. I abandoned the ‘go it alone’ mentality a long time ago. You will be surprised how quickly profits come in once you seek expert advice and apply it.
Therefore, the information I am providing you is seriously priceless.
By purchasing the Reimbursement Dietitian - Starter Pack you will:
- Save yourself tons (and tons!) of your most precious commodity – TIME
- Feel fully confident you have all the necessary resources you need to start seeing patients right NOW
- Experience of profound sense of joy knowing you are on the right path using the correct forms and documentation
- Have complete control over how to choose to customize and brand your resources
No more searching for all the forms for a nutrition private practice or guessing what paperwork you need to provide your new patients. The Reimbursement Dietitian – Starter Pack delivers the valuable resources your practice needs so you can focus on growing your empire.
No matter what your practice’s niche the products in The Reimbursement Dietitian Starter – Pack are resources you will NEED to operate your practice.
No need to reinvent the wheel. all your forms for a nutrition private practice are right here.
I have done all the hard so you don’t have to. And most importantly I have worked out all the kinks. The resources in this pack have evolved tremendously over time. I have learned what works and have gotten rid of what didn’t. Therefore, you are getting the most relevant, up-to-date information to run your practice. Here are pretty much all the forms for a nutrition private practice you will ever need.
Below is an overview of what you will receive in The Reimbursement Dietitian Starter Pack:
- A customizable MNT superbill template (word) plus AWESOME bonus content ‘Everything you Ever Wanted to Know About MNT Superbills and More!’ (pdf)
- A customizable HIPAA Privacy Practice Notice with Signature form (word)
- MNT Referral forms – one specifically for diabetes & the other blank so the MD can enter in their own ICD-10 codes (word)
- Four different customizable Nutrition Assessment forms – 2 adults forms, 1 pediatric form & 1 Diabetic form (word)
- A ‘How to Prepare Yourself for Your Nutrition Visit’ packet complete with a customizable Patient Demographic Form & Liability Form (word)
- A customizable Communication Guidelines form (word)
- A Medical Records Request form (word)
- Customizable receipts for payment for: a Initial Nutrition Visit, a Follow-up Visit, Insurance Co-Pays & No call/show missed nutrition appointment (word)
- A customizable Fax Cover Sheet (word)
- A customizable Weight Tracking Log (word)
- A sample script to provide to your patients for verifying their health insurance (word)
- A sample script to provide to your patients with exactly what to expect at their first nutrition visit (word)
And if that content was not knock-your-socks-off awesome enough – I have decided to be extra generous and include even more resources to help you grow a killer nutrition private practice. These bonuses which provide you with actual examples of products I use in my practice.
- Bonus: A sample Rate Sheet for initial & follow-up visits (pdf)
- Bonus: Sample rates for several Nutrition Packages (pdf & word)
- Bonus: Sample meal plans templates (pdf)
In order to access, view and use the contents of The Reimbursement Dietitian – Starter Pack you will need to have access to Microsoft Word. You will also need to have adobe acrobat to view the pdfs included in this pack. I have noted the document format next to each resource. Documents created in Word can be edited and further customized. While documents that are pdfs are provided for educational purposes and cannot altered.
Please note you are receiving the actual forms I personally use in my nutrition private practice. Therefore, you will notice that all of my information for my practice is included on the forms. I promise this is not a marketing ploy! I don’t think I that I am that awesome to plaster my name all over your stuff 🙂 I ONLY include this information so you can see exactly where you are going to put your practice’s info.
Below are the details on what (and why!) you will receive in The Reimbursement Dietitian – Starter Pack
Bonus: Everything you Ever Wanted to Know about MNT Superbills and More!’ (pdf)
Why you Need this Form in Your Practice
If you are a dietitian who does not participate with health insurance programs or you are considered in-network for some insurance companies but out-of-network for others – then you NEED to have a superbill to provide to your patients. The superbill allows your patients to seek reimbursement for your services from their health insurance company.
By making it known that you provide superbills to your patients it communicates the important message, “While I may not participate with your insurance, I can still provide you with the official documentation you need to seek reimbursement.” This has the potential to significantly increase your client pool.
After all, it is a no-brainer! Most patients want to use their health insurance benefits if they can. So, by providing them with a superbill for their visit you enable them to do so.
How to Use This Form
You will receive a word document containing a customizable MNT superbill. When you download the form you will see my logo at the top of the page. You will delete my logo and replace it with your own. I only include my logo so you can see where to put yours. You can customize the MNT superbill in any fashion you like. However, EVERYTHING that needs to be on a superbill is already there.
Note: As a dietitian, it is outside of your scope of practice to diagnose disease. Therefore, in order to properly fill out the MNT superbill, you will need to obtain the diagnosis (ICD-10 Code) from a physician who treats the patient. Therefore, you will use the MNT superbill in combination with the “MNT Referral” form (also included in the Reimbursement Dietitian – Starter Pack) to obtain the referral for the patient along with the appropriate ICD- 10 code (s). If you intend on providing the superbill to the patient at the time of service; you will need to request the referral prior to the visit.
The Reimbursement Dietitian Brownie Points: If you have the patient’s demographic information prior to their visit – I would highly suggest pre-populating the superbill form in advance. Then, once the session is complete, and the patient has paid you, print the superbill and provide it to the patient at the end of the visit.
You will also receive AWESOME bonus content – “Everything you Ever Wanted to Know About MNT Superbills and More!” (pdf)
The document “Everything you Ever Wanted to Know About MNT Superbills and More!” contains pretty much anything you ever need to know about an MNT superbill. I address all the common questions, misconceptions and concerns dietitians have about MNT superbills. I also carefully explain exactly what information needs to be on a superbill (and why!). Lastly, I hold your hand and walk you step-step through the process of filling out a superbill.
For newbies overwhelmed by all the forms, we use in private practice the information presented in this document is priceless!
Why you Need these Forms in Your Practice
The HIPAA Privacy Rule provides individuals a fundamental new right to be informed of the privacy practices of their health plans and of most of their health care providers, as well as to be informed of their privacy rights with respect to their personal health information. Health plans and covered health care providers are required to develop and distribute a notice that provides a clear explanation of these rights and practices. The notice is intended to focus individuals on privacy issues and concerns and to prompt them to have discussions with their health plans and health care providers and exercise their rights.
Since April 2003, covered entities, such as health care professionals (including dietetics professionals), hospitals, and clinics have been required to be in compliance with the HIPAA privacy regulations for use and disclosure of patient and client information. The rules require covered entities to:
- Distribute a privacy notice to all patients
- Post the privacy notice in practitioners’ offices
- Make a good-faith effort to obtain the written acknowledgment from the patient of their receipt of the notice
- As requested allow patients access to their records
- Complete training and train staff to understand and fully implement the privacy
By closely following the checklist provided by the Academy of Nutrition and Dietetics and using the two forms provided in The Reimbursement Dietitian Starter Pack you can ensure your practice will be compliance.
How to Use These Forms
First things first, I would download the Checklist for HIPAA Compliance (included inThe Reimbursement Dietitian Starter Pack) created by the Academy of Nutrition and Dietetics to ensure your practice is in compliance with HIPAA.
There are two documents that go with the HIPAA Privacy Notice. First, there is the actual HIPAA Privacy Notice which you MUST provide your patient’s access to or post in an area where all your patients can see. Secondly, there is the signature page in which you will have your patients sign acknowledging they received a copy of your privacy practices.
Note: There are several spots in the HIPAA Privacy Notice document were you will be inputting your practice’s information. I have highlighted these areas in yellow. I have left my practice information on the form so you can see specifically what information needs to be included. Make sure to review the information carefully so you don’t miss any spots that need to be adjusted in the document.
Once you have updated your practice’s information save a master copy of the HIPAA Privacy Notice. Then print out copies of the document and make them available to your patients.
At the patient’s initial visit have them sign and date the signature document acknowledging they have received your privacy practices. Then file this form in the patient’s chart.
The RD Boss Brownie Points: Rather than print out physical copies of the HIPAA Privacy Notice you may want to consider alternative formats of the document. My suggestions include having the HIPAA Privacy Notice on your website or even possibly having a laminated copy on your wall for your patients to view. However, you should also have a handful of copies available for those patients who may want a physical copy.
Why You Need This Form in Your Practice
It is inevitable that you will need to obtain a referral for your patients. As dietitians, we are not able to diagnosis disease. Therefore, if we intend to seek reimbursement for our services we need documentation of the patient’s diagnosis (ICD-10) and the reason for their visit.
Note: The only exception is if the patient has preventative coverage on their insurance policy. Then you do not a referral and can code with their BMI and corresponding ICD-10 code.
I am including a pdf of The Academy’s Guide to ICD-10 codes for reference. The ICD-10 codes listed are a representative list of diagnosis codes for which individuals may be referred to a dietitian for care.
How to Use These Forms
There is two types of referral forms included. One is specific to diabetes/renal disease. While the other referral form simply has blank slots for the referring doctor to enter the patient’s ICD-10 code(s).
I use the diabetes referral form for my Medicare patients. That is why it is specific to diabetes and renal ICD-10 codes. However, I thought I would include just in case you find yourself seeing a lot of patients from these demographics.
Note: If you work with a niche population (like diabetics) and find you are consistently seeing patients with the same diagnosis, you might want to pre-populate the ICD 10-code fields with common diagnoses. Then, you could just have the doctor ‘check off’ the patient’s corresponding diagnosis and sign/date the form. This might expedite the process of getting the referral back in a timely manner.
Whatever approach you choose, both forms can be customized to suit your practice’s needs. Per usual on the forms, I have included my practice’s information so you can see where your information needs to go.
Why you NEED these Forms in Your Practice
No matter what population you serve pretty much every dietitian performs some type of nutrition assessment at the patient’s first visit. And it does not stop there. Nutrition assessment is ongoing throughout the course of the patient’s MNT counseling.
So, if you know you will be performing an assessment why reinvent the wheel? After all, assessment forms can take hours to create. I have included three different documents for you to customize: 2 Adult and 1 Pediatric Nutrition Assessment Forms.
How to Use These Forms
The three forms are available in word. Therefore, you can go in and keep what you like and get rid of what you think you might not need. Almost all nutrition assessment forms generally evolve over time. So it is nice you can add different components as you see fit. If you work with homogenous populations you will likely find that you want to customize the form with information just pertinent to that particular popular. No matter what, you can make these forms work perfectly for your practice.
The Reimbursement Dietitian Brownie Points: Include a nutrition assessment form in your patient’s introductory packet. Or just email them the form prior to their initial visit. Request they send the form back once they have completed it. This will help you better prepare for the patient’s visit.
Why You Need these Forms in Your Practice
It is always nice to have a streamlined package of information you can send your patients that tells them exactly what you expect THEM TO DO prior to their visit. This package should include information for patients about verifying and using their health insurance benefits, where you are located as well as what forms the patient should fill out and bring with them to their visit.
How to Use this Packet of Information & Forms
This package was created in word so you can adjust and edit to your liking. I have a heavily based insurance population. However, if you don’t plan on taking health insurance you can easily delete the first two pages of the packet.
As you will see the language is crystal-clear that in order to receive services from our practice you must supply a valid credit card. However, I am also very clear that the only time the card will be charged is in the event that the claim is rejected OR the patient does not show up for their nutrition visit.
Demographic & Liability Form
Collecting patient’s demographics is a drag – but something you just have to do. Also on top of the ‘must-haves’ for your practice is a Liability Form. This is absolutely, positively, non-negotiable. This form protects you and the patient by having clearly defined expectations.
As part of the ’‘How to Prepare for your Nutrition Visit” packet I am providing you with a patient Demographic Form so you can easily collect patient details. The Demographics Form can be customized. But right now there are fields for the patient’s name, address, date of birth, as well as a spot for the insurance information.
Included in this packet is also a Liability Form. On this form there is information about office policies such as payments, making and canceling appointments, using insurance as well as a spot for the patient to put in their credit card information. There are also clearly defined spaces on the Liability Form for the patient to initialize noting their understanding and agreement to comply with the rules you set forth on the liability form. Obviously, there is a section where the patient must sign and date the entire form acknowledging their acceptance of your policies.
You can edit both forms and customize the language to be consistent with your practice’s expectations and policies.
The Reimbursement Dietitian Brownie Points: Email or mail this form to your patients in advance. Request they send it back to you prior to their visit. That way you have all their information and credit card on file ahead of their visit. Therefore, if you want to pre-populate their MNT superbill or just enter their data in your billing software you have it. Also if they don’t show up for their initial visit with you – you can at least charge them for your time.
Why you Need this Form in Your Practice
Effective communication with your patients is SO critical. Just like having a straight forward set of office policies is important; having crystal clear guidelines on how you intend to communicate and engage with your patients is equally important.
By providing your patient with a set of formal Communications Guidelines you define clear expectations on everything from your office policies right down to how you intend to use email in your counseling relationship with the patient. While some of this information is already included on the Liability Form it pays to repeat it.
How to Use this Form
The Communication Guidelines is a form I would suggest having patients sign at their first meeting. It reinforces office policies about rescheduling and canceling appointments as well as outlines policies for emails and phone communication with your practice.
When you download the form you will see my logo at the top section of the form. I only include it so you can see where I would suggest putting your own personal logo.
The form was created in word so you can customize it to suit your practice’s personal communication plan.
The Reimbursement Dietitian Brownie Points: Once the patient has signed and dated the Communication Guidelines form I would highly suggest immediately making a copy of the form for the patient’s personal records. Keep the original in the patient’s chart.
Often people quickly sign forms not knowing exactly what they are signing. By providing them with a copy you are letting them know, “Hey this is important!” Therefore, if an issue arises with communication you can always reference the signed/dated form.
Why You Need this form in your Practice
HIPAA generally allows for disclosure of medical records for “treatment, payment, or healthcare operations” absent a written request. However, most state laws require record requests to be in writing and signed by the patient. I recommend you always obtain a signed, written release in a nonemergency situation, whether required by law or not.
How to Use this Form
This form can be used when requesting information from another provider on an active patient. Note this is different from the MNT Referral Form. The MNT Referral Form seeks a documented reason for the patient’s visit. Medical record requests often are created with the intention of securing aspects of the patient’s record including growth charts, lab work or progress notes.
Note: Don’t forget to make sure to have the patient sign and date the form before you send over the request.
Why You Need these Forms in Your Life
You must always provide your patients with a receipt or proof of purchase for anything over $75. A customer has the right to ask for a receipt for any purchases under $75 and you must provide them with a receipt within seven days of the request.
It is generally a good practice to offer a receipt to your patients at the time of purchase, regardless of the total amount.
How to Use these Receipts
I am including templates for receipts for A MNT Initial Nutrition Visit, an MNT Follow-up Visit, an Insurance Co-Pay as well as a receipt for a No call/No Show missed nutrition appointment. All four of these receipts were created in word and can be customized with your logo and practice information. Aside from that information you have the ability to alter the amount in which the patient was charged for the particular service as well as the date of service.
Why You Need this Form in Your Practice
Sooner or later you are going to need to send a fax! A fax cover sheet is a sheet that is faxed through to your recipient before your actual fax message. Its intended purpose is to identify the sender and provide your contact information, as well as to state who the intended recipient is for the information you are sending.
And It is SOOOO much more professional to include a Fax Cover Sheet when sending any fax. Also by including a cover sheet, it increases the likelihood of the information actually getting to the intended recipient. Winner-Winner!
How to Use this Form
This form was created in word. Therefore, you can customize it any way you like. The design is simple and straightforward. You can either print out of the form and enter the information by hand. Or you can open the form in Word and type in your information then print and send along with your fax.
Why you Need this Log in your Practice
Unless you are running a weight neutral practice, then you will likely be weighing your patients from time to time. Depending upon how you decide to chart (paper or electronic) and how often you see your patients, tracking their weight trends, on top of all your other important notes about their visits, their weights can get lost in the shuffle. Therefore, if it is important to your patients to know their weight trends you should have a dedicated log to track just that.
How to Use the Weight Tracking Sheet
This form was created in word. Therefore, you can customize it any way you like. What is nice about this form is that you print it and staple it to the inside cover of the patient’s chart. If you are recording their weight at each visit and you see them often you will have a lot of ‘data’. That way you don’t need to go through each note in their entire chart to locate their weight trends.
Why You Need this Script in Your Practice
Trust me – as MUCH as humanly possible you want to take yourself ‘out of the mix’ and automate as much as physically possible. This starts by having your patients verify their own health insurance MNT benefits. By providing them with a script you give them everything they need to call their insurance company and see what type of coverage they have on their particular policy for MNT.
Having this information available is an absolute game-changer. It not only saves you tons (and tons!) of time. But it also has your patient put some ‘skin in the game.’ They demonstrate they want your services bad enough to make the dreaded call to the insurance company.
How to Use the Script
You can customize the script any way you like. Obviously, you will want to personalize the insurance companies’ logos if you accept different ones than the ones I have listed. In addition, you will likely want to change the ICD-10 code language depending upon the particular population you work with. I bill mostly using preventative coding. Therefore, that is why I use the particular ICD-10 codes that correspond with preventative coding.
Patients have told me repeatedly that having this information ‘was so helpful’ when they called to verify their benefits. They knew exactly what questions to ask and were ready with the applicable codes if necessary.
The Reimbursement Dietitian Brownie Points: I might suggest putting this information on your website’s scheduling page. Or if you don’t have a website include the information in your preliminary email to the patient so they can get the ball rolling. It is nice to have something already prepared for your patients so you don’t have to do any extra leg work. Streamlining the process is critical.
Why you Need this Script in Your Practice
The goal of this script like many things in The Reimbursement Dietitian Starter Pack is to make your life easier. By having clearly organized scripts on commonly asked questions about your practice you make your life a heck of a lot easier. One such question you may find yourself getting, “What should I expect during my nutrition visits with you?”
This is a totally a legit question. But over the years I have found myself giving the same response over and over. Therefore, I am providing you with a sample script of what I send to my patients who ask this very specific question.
How to Use the Script
As you will see the script I include is written with one of my niche populations in mind – my lovely PCOS patients. It is written in word so you can edit the language and headings as you like.
However, you can customize the script to whatever population you choose to work with. You just want to be clear with your expectations so both you and your patients get what they want from their visits. The clearer you are with what you expect to happen in the session – the easier it is for you to deliver on your promise and provide awesome service to your patients.
You might want to include this information on your website or keep in handy so when patients do ask that common question all you need to do is send them the attachment and you are golden.
Why You Need these Sample Rates Sheets in Your Practice
I strongly believe being transparent with your rates and package fees is really super-duper important. By having your rates readily available there is no question about what you are charging for your services. By being straightforward and clear, people know right away whether or not they can afford your services. This allows you to protect your most valuable asset; your precious time.
How to Use the Sample Rate Sheet
I created this rate sheet in Canva (a FREE online graphic design website) and then converted it to a pdf. Therefore, the rate sheet isn’t customizable.
I decided to include my rate sheet as a bonus in The Reimbursement Dietitian Starter Pack because I feel it is a common question among new private practice dietitians on how to price their services. While you don’t need to mirror my rates – you can see that the more follow-up sessions the patients purchases, the lower the rate per session. I like this approach because it rewards people for purchasing more sessions. However, how you choose to sell your sessions is entirely up to you.
The Reimbursement Dietitian Brownie Points: I highly encourage using Canva. It is free, user-friendly and has awesome features. I use it to create all my pdfs forms and handouts. I cannot say enough great things about this product.
Why You Need these Nutrition Package Rates in Your Practice
One of the greatest things you can do in your practice (especially if you don’t plan to participate with insurance companies) is to create packages for your practice. This is a great way to draw your clients in and keep them coming back more.
While there is absolutely nothing wrong with offering your counseling services a-la-carte, a package can help your clients commit to what you already know: change is HARD and healthy habits don’t develop overnight.
When clients have the option to buy a package, they purchase not just one session, but a comprehensive plan to work towards their goals over a fixed period of time.
This isn’t just a great financial strategy (Hello, more revenue!), but it’s better for your patient’s outcomes as well. After all, we all know accountability is King (or Queen!) right?
How to Use These Sample Rate Packages
I have included three different examples of nutrition packages as a bonus. Like with my Sample Rate Sheet, I provide these packages just to serve as an example for you to model after in your practice. I have found over the years, that many dietitians are uncertain about how to package and leverage their services. I felt by providing three very different types of packages for different populations you could get a solid sense of how to effectively bundle your services.
As you will see some of the packages are in pdf form while other examples are in Word. I don’t think the format matters that much. As you will likely just using the language and the context of the packages to further customize our own killer packages for your desired population.
Why You Need Meal Plan Templates in Your Practice
Many dietitians starting off in private practice are super overwhelmed when it comes to meal plans. So many patients request them, but if you are new to private practice you may not have any sense where to start. Therefore, I have included several different examples of meal plans I have created in my practice.
How to Use the Meal Plan Templates
Once again the meal templates I am providing are for educational use only. They are in pdf form and therefore can’t be customized. I have included several different examples of meal plans I have created in Diet Master Pro for my clients. This is the software I use in my practice. You could also easily create these meal plans by hand or in word but that would likely require more work.
More often than not, I only include three days of meals for the patients. I feel like three days provides them with a good starting point. I tend to believe on some level that meal plans can ‘handicap’ people as they learn nothing just by following a plan. As you will see this particular software also creates a shopping list based on the foods in the particular meal plan. This is a nice feature but also not necessary.
Phew. That is a ton of stuff!
After years of being in practice, the forms I have included in The Reimbursement Dietitian – Starter Pack are all forms you need to have in your practice. I can’t stress this fact enough. They are pretty much non-negotiable. Therefore, the bottom line – I am not providing you with ‘fluff.’ I am providing you with the exact resources you need to run a successful nutrition private practice.
So, you can either download them right here and smile ear-ear knowing you got the most kick-ass deal on the planet.
Or you can spend years (and years!) creating them on your own.
And quite frankly, you are far too smart to spend your time doing that. After all, you have a killer private practice to run. Your time will be better spent working on your business, rather than in it.
So what are you waiting for? Your empire awaits my friend.