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!
Documentation, what gives?
I KNOW this is SUPER-DUPER annoying.
And just to repeat. This is a SCOPE of PRACTICE thing. NOT an insurance requirement.
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.
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 Progam 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 is 2008.
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.
P.P.S. Are you WAY more advanced than a newbie? Check out my Reimbursement Academy for dietitians who are already credentialed and know how to bill. BUT need help scaling their practice.