Setting Up Shop
The Most Important Forms You Need in Your Nutrition Private Practice
So, you secured some killer office space. Pimped it out to match your brand and cater to your niche. Now you are ready to see your first patient. But are you? Do you have all the forms and paperwork you need to get the ball rolling?
If you are feeling a bit uncertain on how to answer that question it is okay. Frankly, it’s not every day you open a private practice. Right?
Therefore, it is not expected out of the gate that you are innately super well-versed in all the documentation you will need. However, with that being said, before you even see your first patient it is critical that you obtain (or create) the required forms, documents and paperwork that is necessary to get your nutrition private practice up and running.
Here are what I consider to be the top ten most important forms and documents you should have in place before you open the doors to your practice.
- A MNT superbill
- A MNT referral form
- HIPAA forms
- Medical record request form
- Nutrition assessment form(s)
- Patient demographic form
- Liability form
- Communication guidelines
- Rates, fees & services
- Invoices & receipts
Let’s go through each form, what it entails as well as why you should have it in your practice.
A Medical Nutrition Therapy (MNT) superbill
Essentially, a MNT Superbill is an itemized list of all the services provided by a dietitian to a client. The Superbill also contains additional information about the patient’s visit including your practice’s information, the amount billed for the visit, CPT codes, the patient’s diagnostic codes (a.k.a. ICD-10 codes), as well as the referring doctor’s information. So needless to say, there is a lot of important info on a superbill.
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.
The Reimbursement Dietitian is going to hook you up! Want your very own MNT superbill for your practice? Download my editable MNT superbill and explainer companion here.
A MNT Referral Form
As a dietitian it is outside of your scope of practice to diagnosis 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. 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. Therefore, you will need a signed form from the physician supporting the reason for the patient’s referral to you.
Why You Need This Form in Your Practice
It is inevitable that you will need to obtain a referral for your patients. I will repeat this again as I strongly believe it is worth repeating again – 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 supporting 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 preventative ICD-10 code (Z71.3)
Just for reference here is The Academy’s Guide to ICD-10 codes. The ICD-10 codes listed are a representative list of diagnosis codes for which individuals may be referred to a dietitian for care.
A HIPAA authorization form should state who the patient is and exactly to whom the patient is disclosing their health information. HIPAA regulations specify that “Covered Entities” must comply with certain regulatory requirements.
Wondering if you qualify as a covered entity? Use CMS’s covered entity tool to find out!
If you determine you are a covered entity then you will need to provide two forms to your patients:
- HIPAA Privacy Notice – this forms details your patient’s privacy rights
- Patient Written Acknowledgement Confirming Receipt of Privacy Notice – this form must be signed and dated by the patient and placed in their medical file.
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 acknowledgement 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
Here are additional resources on HIPAA: Checklist for HIPPA compliance
Medical Record Request Form
This is a a form that should be used when requesting information from another provider on a mutual patient. Don’t forget to have the patient sign and date the form before you send over the request. This form gives you permission to communicate with the authorized medical provider regarding your patient’s treatment.
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.
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.
Nutrition Assessment Form(s)
One’s health and well-being are influenced by many different things, including lifestyle, family history, emotional health, and nutrition/eating habits. Nutrition assessment forms come in all shapes and sizes. Some practitioners have one form while others may utilize different forms for their varying populations. The benefit of having a niche is that you can design a nutrition assessment form that parallels the exact needs of your chosen population. While the sky is the limit in creating these forms some things to consider including in a nutrition assessment form are:
- Patient demographics
- Height & weight
- Weight history
- Physical activity
- Food allergies
- 24-hour food recall
- Social history
- Medical history
- Digestive history
- Diet history
- Eating style
- Nutrition & exercise goals
As always you want to keep in mind your specific population (if you have one! Which I hope you do!) when you are creating these forms. For example, if you are dealing with an elderly diabetic population you may need to be mindful that the font is large enough on the form for them to view. Or say your special niche in your practice is renal patients. You may want to have a dedicated space on the assessment for them to report their most recent labs from dialysis as well as their usual and ‘dry’ weight.
By considering these key details you are able to obtain the most comprehensive medical histories for your patients. Therefore, enabling you to design the most effective nutrition interventions.
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.
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.
Patient Demographic Form
Patient demographics form the core of the data for any medical institution including your nutrition private practice. Forms like this are often referred to as a patient registration form, patient information form or patient registration information form. Call it whatever you like – but just make sure to get the important details about the patient. Below are some suggestions to include on your form:
- First & last name
- Date of birth
- Home address
- Mailing address (this may be different from where the patient actually lives)
- Telephone number
- How the patient wants you to communicate with them? Email? Cell phone? Work phone?
- Email address
- Health insurance information
- Name of person responsible for the bill with their address and phone number
- Reason for visit/referral
- Who they were referred by
- Current doctor/address/phone number
You are by no means limited to information noted above. Obviously, you can choose to include any additional information you feel might be important. But the above list covers what I like to consider the basics.
I would provide this form to your patient (if possible) prior to their visit. This way they don’t waste time filling out during their visit.
Why you NEED these Forms in Your Practice
Collecting patient’s demographics is a drag – but you just have to do.
On this form there should be information about all of your important 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 should also be clearly defined space 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.
Why you NEED these Forms in Your Practice
The liability form is a ‘must have’ for your practice. This form is absolutely, positively, non-negotiable. This form protects you and the patient by establishing clearly defined expectations.
Having a form that notes how you will engage in communication with your patients is critical. I would suggest having patients sign this form 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.
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
Effective communication with your patients is SO critical. Just like having straight forward 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 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.
Rates & Fees
Before you open up shop you want to make sure you have your services and rates clearly defined. That is not to say you can’t change them as your practice evolves. But generally speaking one of the first things people are going to want to know (aside from how soon can they get an appointment with you!) is what the visit (s) cost as well as what they include.
Therefore, while determining your rates is a whole conversation in and of itself – before you even start promoting your business sit down and clearly define your services and fees. That way when opportunity knocks – you will be ready to rock and roll 🙂
Why you Should Make your Rates & Fees Visible
To post your fees or no? The age-old question.
I strongly believe that 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.
Invoices & Receipts
Did you know that there is a difference between an invoice and a receipt? You betcha’ there is!
An invoice is a request for payment while a receipt is proof of payment. Depending on the service offered customers often receive invoices before they pay for a product or service and receive receipts after they pay.
Depending on the services you offer may be using a combination of both types of statements. However, no matter what I would highly recommend getting a credit card to keep on file, so you don’t have to chase your money.
Generally speaking I would suggest including the following on your invoices.
- The date that the invoice was created
- The date the service was provided
- Name and address of the client
- Description of services purchased, including prices and quantities
- Terms of payment
Then, once the payment has been received you can simply note the date and mark the invoice as “paid.” Provide a copy to the client and keep a copy for your accounting records.
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 good practice to offer a receipt to your patients at the time of purchase, regardless of the total amount.
Wholly guacamole! That’s it. Those are the top ten forms I personally think you really, really, really should have before you ‘open’ your nutrition private practice. I hope after reading this you can either breath a sigh of relief knowing that you have all your bases covered or at least now know what you need to start working on. Both can be equally as empowering!
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