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Reimbursement Coach for Dietitians

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Dietitian

Becoming an RDN Medicare Provider: What’s the Deal, Sis?

May 10, 2021 by amyplano 2 Comments

To Medicare? Or not to Medicare? That is the question! 

 

As the Reimbursement Representative (now known as the insurance payment specialist) for Connecticut, I was asked to speak about my experience of being an RDN Medicare Provider on a recent board meeting call. And the more I thought about it. The more I thought it would be helpful to share with you why I think becoming an RDN Medicare Provider is a pretty awesome idea. 

 

Full disclosure. I have been an RDN Medicare Provider since 2008. And like anything insurance-based it took me a long time to figure shit out. So don’t worry if enrolling with Medicare seems like a beast to navigate. Believe it or not, it’s actually one of the easiest insurance companies to work with. So don’t stress!

 

And if you are struggling with Medicare I am always here to help. My Group Reimbursement Coaching Program covers Medicare enrollment in a seamless fashion. 

 

But without further ado here are my 6 reasons why being an RDN Medicare Provider is pretty awesome. 

 

6 Awesome Reasons for Becoming an RDN Medicare Provider

 

  • An Incredible Population: You get to serve an incredible population. Medicare beneficiaries are 65 years old (and up). Or they qualify for Medicare based on disability. Medicare peeps are a lovely bunch of patients. They are typically kind, polite, respectful, curious (in a good way!) and almost always show up on time. Medicare peeps are generally excited to learn and actually do their ‘homework’ when you ask them.  Therefore, working with this population can be tremendously rewarding. Some of my most memorable clients have been my Medicare patients. And still ones to this day whom I will never forget.

 

  • They NEED us. From a dietary intervention standpoint, Medicare beneficiaries are ripe for MNT. Often their baseline level of education surrounding their disease(s) is low. In addition, they are on a limited budget and benefit tremendously from learning how to eat healthfully within their discretionary funds. Furthermore, many Medicare beneficiaries have several comorbidities in addition to either their diabetes or non-dialysis chronic kidney disease. Through our awesome skillset as RDNs, we can help them successfully navigate dietary interventions that help optimize their health and standard of living. 

 

Did you know? 

 

  • Easy to know what is covered. As of right now (May 2021) MNT for any form of diabetes stages 3-5 non-dialysis chronic kidney disease, and up to 36 months post kidney transplant are covered by Medicare. As long as the patient hasn’t used up their benefits for MNT for the year with another dietitian – then you will receive 12 units of coverage the first year of the referral and an additional 8 units every year after. So there is no guessing. And certainly no need to verify coverage. Even if the patient has a Medicare Advantage plan the coverage is pretty much also consistent with what I just noted. 

 

  • Unlimited visits. Yes, we are limited in scope for what we can use for units for CPT codes 97802 & 97803. But if the patient experiences a change in status that is communicated (to or) with the referring physician and we secure a second referral we can use G codes. G codes are particular to Medicare. Certain G codes can provide additional visits (in my experience fairly unlimited based on medical necessity!) beyond the 12 and 8 units respectively. Therefore, please don’t think you are ONLY limited to a low amount of actual visits with your Medicare patients. They need us! And as long as we follow the correct CMS protocol for securing additional visits we are golden. 

RD Medicare Provider

 

The Nitty Gritty of Being an RDN Medicare Provider 

 

  • Gatekeeper for secondary plans. Often a patient might have Medicare as their primary insurance. In addition, they have a secondary commercial insurance plan (like BlueCross BlueShield, Cigna, United Health Care, Aetna, or Humana). Say the patient has celiac disease. You know you can’t bill Medicare for that diagnosis. However, you called the patient’s secondary insurance and they gave you the green light for coverage for celiac disease. But guess what?

 

In order to bill the secondary, you NEED to first bill the primary (Medicare) and wait for the rejection. THEN you submit to the secondary insurance. And the plot thickens. To get the original rejection from Medicare you MUST be an RDN Medicare Provider. So even though you are in-network with the patient’s secondary insurance plan. You also MUST be in-network with Medicare. So it really pays to be a Medicare provider even if diabetes and renal disease is not your jam.

 

  • Pay is solid. Medicare is typically the middle of the road for insurance reimbursement. They are not my highest payer. BUT they are certainly not my lowest payer either. I feel adequately compensated for my services when paid by Medicare. Plus, because it is a federal insurance plan, the fee schedule is public knowledge. Therefore, you can find the exact rates for your state. For example, in CT we receive $34.37 per 15 minutes (1 unit) on an initial visit.  And $29.60 per 15 minutes on a follow-up visit. Depending on how long your visits those rates are not too shabby. You can make more in 15 minutes as an RDN Medicare provider THAN you would make in exchange for 1 full hour of your time working a clinical job. 

 

Phew. That is a lot of information. But I hope if you are on the fence about becoming an RDN Medicare Provider I have convinced you to just go for it. They are a great bunch of patients to work with, desperately need our help, are straightforward to bill and Medicare reimburses us quite nicely. 

 

Are you already credentialed with the insurance companies and know how to bill the commercial carriers BUT want to add Medicare to your bag of tricks and become an RDN Medicare Provider? 

 

Then apply to my badass monthly reimbursement coaching program. I have an entire Medicare course that coaches you through the Medicare enrollment, billing, and payment process. Plus, you receive access to the resources, webinars, live calls and office hours that come standard with the monthly membership fees. 

 

Check it out here. When I tell you it is AWESOME I am not lying! 

Filed Under: RDN Medicare Provider, Reimbursement Dietitian Basics Tagged With: Dietitian, Medicare, provider, RDN

Dietitians billing for out-of-network patients: How to Do It

April 7, 2021 by amyplano Leave a Comment

In this short video, I review the 4 different options for dietitians billing for out-of-network patients. The term out of network simply means you don’t have a contract with that particular insurance company.  You might not have a contract for numerous reasons: you decided not to participate with them, the network might be closed or you may actually be in the credentialing process but are not yet considered in-network. Therefore, all of these options would qualify you as an out-of-network provider. When a patient reaches and wants a visit BUT they have insurance you don’t accept you have four options.

 

 

dietitians billing for out-of-network patients

 

The 4 different options for dietitians billing for out-of-network patients

 

1. Charge them your cash rate (in many instances known as your prompt pay rates), then collect the money at the time of service & ultimately provide them an invoice.

 

2. Issue them a superbill. Then on the superbill charge your usual and customary rates (aka your insurance rates), collect the money at the time of service & the patient takes the superbill & submits it to their carrier on their own. Most importantly, they will ONLY receive money from the insurance company if they have out-of-network MNT benefits on their policy. So there is no guarantee when you issue a superbill that the patient will ever see that money.

 

Need a superbill? I got you, Sis! I created one for you. Click HERE to scoop it up.

 

3. Charge their HSA card (Health Savings Account) your usual & customary rates by running the HSA card through your credit card processor. Remember you must be set up as a health care provider with the credit card company. If you are not the HSA card will be declined.

 

4. Submit the claim through your EMR or clearinghouse on behalf of the patient as an out-of-network claim. I would suggest collecting the money upfront (usual & customary rates in this situation as well) and THEN submitting it. If you click ‘no’ for box 27 on the CMS 1500 where it says ‘Accept Assignment’ IF the patient has out-of-network benefits on their policy the insurance company will send & issue the check to the patient (not you!).

 

The Reimbursement Dietitian is here to help …

 

Are you a dietitian who needs help starting with insurance? I am your chick. Check out my epic coaching services that help you get credentialed, bill the shit out of insurance, and make the money you deserve as a Registered Dietitian.

 

Want daily tips & guidelines (and a good laugh) on insurance and private practice? Follow me on IG HERE.

Filed Under: Business Tips, Reimbursement Dietitian Basics Tagged With: billing, Dietitian, insurance, out-of-network

Top 5 Challenges of Being a Private Practice Dietitian

July 1, 2019 by amyplano Leave a Comment

Top 5 Challenges of Being a Private Practice Dietitian

 

Last week, we got all pumped up about all the really awesome reasons to be stoked about opening a nutrition private practice. This week – The Reimbursement Dietitian is going to get real and address the challenges of being a private practice dietitian. This is by no means a way to discourage you. Absolutely. Friggin’. Not. I however, sometimes think that people think that running your own practice is all rainbows, unicorns and glitter. Girl it ain’t. So, let tackle:

 

challenges of being a private practice dietitian

 

You are the boss

 

You knew this was coming right? As much as being your own boss means you have total control over your job – it also means you are in charge of everything. This means all your policies, systems, forms and paperwork needs to originate with you.  

 

In private practice, you will soon begin to realize that every decision to be made in your practice is made by you and you alone.  If you have come from a team environment, and most of us have, it requires some adjustment. As the person at the top, there’s no one to run things by or team members to collaborate with. If you are new to being a small business owner some of this may seem daunting. However, it does not have to be! 

 

If someone had said to me, “Hey Am – I have all the resources, systems and forms to help you get started in private practice.” I would have been all in – in a heartbeat. There are SO many things you need to do when you are getting started in private practice. But save yourself a boatload of time and aggravation and purchase The Reimbursement Dietitian – Starter Pack.  This way you have all the resources you need and focus all your time growing your empire. 

 

The Reimbursement Dietitian Tip:

 

Don’t be afraid to ask for help. You don’t need to invent the wheel. While I did in fact create all the forms and systems in my practice from scratch; the only reason why I did this was because prefabricated resources DID NOT exist.

 

Increased financial risk

 

When you are an employee there is very little financial risk. You show up for work, do your job and get paid. Often your employer contributes a portion of your health insurance, they assume responsibility for your liability insurance and they even pay you for taking time off. 

 

In private practice the scenario is much different. While your potential income can be MUCH higher; so is the financial risk. 

 

Unfortunately, if your patients don’t show up for their visits you don’t get paid. That is not to say that you cannot charge them if they don’t properly cancel; however in order to make money in private practice you need to have a steady flow of patients. Also if you have a slow month; you still need to pay your rent and cover the cost of your utilities. 

 

There can be many financial challenges of being a private practice dietitian. Aside from rent you also have additional expenses like liability insurance and start-up costs like purchasing your own computer, printer and fax.  In addition, expenses such as small things like toilet paper and paper towels for the bathroom, paper and toner for the printer can all start to add up. 

 

The Reimbursement Dietitian Tip: Don’t quit your day job. Yes, there will come a time when you burn your bra and quit your day job. And I sincerely hope to be there to high-five you. But I would be lying if I said that  would be sooner than later. I worked for almost ten years as a clinical dietitian while working my side hustle of private practice. That way I had a steady, uninterrupted flow of income to pay for all the fun expenses of running a startup small business. Was it hard? Absolutely! Did I sleep much? Hardly. Was it worth it? A big giant “Hell Yeah!” 

 

Multi-tasking will likely become your middle name 

 

Hi my is Amy Plano and I am a Registered Dietitian and occasional secretary, accountant, social media manager, scheduler, biller, coach and anything else you can pretty much identify as a job title in a small business! In private practice we often wear many hats – most of them at the same time. 

 

While it seems evident that your main job should be seeing patients; this is not always the case. First, you have to market your services and get patients through your door. This may be word of mouth, via social media or traditional marketing channels. You also need to design packages and establish a fee schedule for your services so you have something to sell these patients. 

 

And let’s not forget the super fun finance piece. You need to bill for your services as well as perform accounting tasks and keep very detailed expense summaries. And sadly this is only a handful of tasks you are responsible for when you are running a nutrition private practice. 

 

I don’t tell you all of this to freak you out. But, the challenges of being a private practice dietitian are certainly real.  More importantly, I assure you none of these tasks are hard. You are fully capable of executing them all like the champ you are. I just want you to know what you are signing up for when you decide to open up your own nutrition private practice. 

 

The Reimbursement Dietitian Tip:

 

In the beginning, learn how to do ALL the tasks in your practice on your own. Even the billing. That way when your business grows and you are in a financially better position you can hire someone to complete the day-day tasks of running your business. 

 

However, if you jump the gun, and hire someone out of the gates #1: you likely don’t have the income to cover the cost and #2: you will never learn the important details it takes to run a successful private practice. You should know EVERYTHING about your business – especially the details. The details really matter. I can provide countless experiences about those dang details but I won’t bore you. Just know that you should know your practice inside and out especially before you let anyone else in. This is your baby and you need to protect all angles at any cost. 

 

No one tells you whether or not you are doing a good job

 

I know what you are thinking. How the heck can this be one of the challenges of being a private practice dietitian? Big girls don’t need external validation, pats on their backs or gold stars. Well, sister I am here to tell you we do. We need all of those things to succeed not only in life; but more importantly in our private practice.  

 

When you work for yourself there is generally no one to critique your performance. You don’t have a supervisor who regularly monitors your performance, provides guidance, and/or feedback. You are the boss after all. Therefore, sadly you have no idea if the job you are doing running your practice is satisfactory or requires improvement. 

 

And after 10 + years of running a successful nutrition private practice what I can tell you with 100 % certainty is this –  we can all improve in some manner. Whether it be in our skill set as practitioners, how we conduct ourselves in our business transactions or just in our day-day systems. In private practice there are so many areas in which we can improve and further develop.  But when you work for yourself these areas are not always so self-evident. 

 

The Reimbursement Dietitian Tip:

 

There are no performance appraisals or annual reviews. Which may seem like something you applaud. However, working for yourself requires you to be introspective in nature. You need to be able to systematically assess all areas of performance in your practice and constantly ask yourself what am I doing well? What do I need to improve on? While this may seem pretty straight forward, it requires time, discipline and dedication to yourself and practice on an ongoing basis. I would highly suggest getting a coach or mentor when you first start your practice. That way you have someone to help supervise what you are doing in your practice and provide constructive feedback. Or at the very least provide your clients with comment cards or regular patient satisfaction surveys. 

 

Professional isolation

 

Professional isolation is a little bit of a sleeper when it comes to the downfalls of being in private practice. No matter how many patients you see; without professional interaction it can get a little lonely in private practice. I so clearly remember the early days in my private practice. I had planned for many things, but I had not developed a plan to manage the isolation that so many solo practitioners face.

 

Most counselors do not intend or desire to operate in professional isolation. Yet to maintain high patient loads, many of us are forced into over-scheduling clients back to back on days or during periods when both client and counselor are available. Over time, daily pressures and life circumstances leave dietitians in private practice often with limited time for adequate breaks between counseling sessions or time to attend to professional needs, such as supervision and consultation for difficult cases. 

 

The Reimbursement Dietitian Tip:

 

The simplest approach to addressing the issue of professional isolation is for dietitians to seek direct feedback on essential counseling skills such as case conceptualization, treatment planning, intervention, and feedback with difficult cases. I highly recommend and encourage dietitians to stay connected. Whether it be on DPG listservs, closed-facebook pages, seeking out a private practice mentor or joining your state affiliate and becoming involved. 

 

There are SO many ways to stay connected directly to our profession. Technology aided communication can help dietitians in private practice exchange information and perspectives on theoretical interventions, new approaches, clinical treatment, emerging issues and legal and ethical issues.  

 

There is no lack of opportunity for us to engage in professional networking that can lead to personal and professional awareness, and hopefully improved outcomes for our patients. 

 

 

challenges of being a private practice dietitian

 

Social Media Links:

The Reimbursement Dietitian FaceBook Page 

Dietitians in Private Practice Closed Facebook Page 

Insurance Credentialing and Billing for Registered Dietitians Closed Facebook Page 

The Unconventional Dietitian Closed Facebook Page 

Dietitian HQ Community – for RD Entrepreneurs closed Facebook Page 

 

 

Conclusion: 

 

 So, it not a surprise that there are clearly some awesome benefits to being in private practice. But there are also some challenges of being a private practice dietitian. However, as a veteran private practice dietitian, I can tell you with an honest heart that the benefits outweigh any of the negative aspects. 

 

Is running a successful practice super hard? Yes, especially at first. But just like with anything in life there is nothing you cannot do if you put your mind to it. 

 

More importantly, The Reimbursement Dietitian and her services help soften the blow. Aside from the free resources offered in this section here, The Reimbursement Dietitan offers additional paid resources and services to help make your dream of running a successful nutrition private practice a reality. 

 

Interested in learning how The Reimbursement Dietitian can help you turn your dream of running a successful nutrition private practice a reality? Click here to watch my program video. 

 

Filed Under: Reimbursement Dietitian Basics Tagged With: Challenges, Cons, Dietitian, Private Practice

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