- Start working with insurances as a dietitian
- Determine your business entity
- Have a tax ID (usually your EIN)
- Get an NPI (National Provider Identifier)
- Get a liability insurance
- Fill out the CAQH application
- Advantage #1: Reach more people with your services
- Advantage #2: Bill as preventative services and the patient has no cost share
- Advantage #3: Build a network of people that refer you patients
- Advantage #4: Pay is solid
- Advantage #5: You can bill for any program or service
- Disadvantages of working with insurances as a dietitian
- HIPAA Compliant Platform to Grow and Scale your nutrition
Author: Amy Plano, the reimbursement dietitian
I am Amy Plano, the reimbursement dietitian and I teach dietitians how to get credentialed, bill the shit out of insurance and make the money they deserve.
Just a little bit about me, I am a registered dietitian. And I started accepting insurance right out of my internship in 2007. So I’ve been an insurance-based provider for over 15 years and I run a group private practice in Connecticut.
We are a hybrid so we do both telehealth and in office. My husband and I run a wellness program, my husband is a trainer, and so we kind of pieced the nutrition piece, the insurance based piece with the training piece to deliver optimal results in our clients.
With that being said, today, I wanted to bring you guys on a quick little journey about the first five steps of starting your insurance based practice. And then just kind of really kind of wrapping a little bit about the pros and cons of accepting insurance and some of the issues you may run into.
The first thing first is, when you are working with the insurance companies, there are going to be five things you definitely want to do before you even start the application process.
Determine your business entity
Regarding your business entity – you’re either going to exist as a sole proprietor, an LLC, a partnership, or an LLC getting taxed as an S corporation.
Obviously, as a savvy businesswoman, I would really like you to begin your career as an LLC so you are protected, and your assets are protected.
But the reason why we talk about that in an insurance-based practice is, you’re going to need to know your business entity before you get a contract with the insurance company.
We’re going to want you to know how you are going to exist in your business, and then we’re going to need your tax ID.
Have a tax ID (usually your EIN)
The tax ID is usually your EIN (Employer Identification Number), and you can apply for the EIN on the IRS website. If you already have a pre-established LLC, there’s a good chance you already have an EIN.
Applying for an EIN is free, but you need to have your business determine the structure, and then you want to have that EIN because when you get your contract from the insurance companies, they’re going to want that information.
We definitely do not want you using your social security number because that number will be used on all of your insurance claims.
Get an NPI (National Provider Identifier)
If you’re working for an institution now or another private practice, they probably already got you your type 1 NPI. Your type 1 NPI is tied to your Social Security, and your legal name. Every insurance claim we submit is going to be the rendering provider which is you, your NPI.
You can apply for both a type 1 NPI for you as an individual, and then you can apply for a type 2 NPI also on the same site.
Your type 2 is going to be an identification number for your organization. Remember, we were just chatting about business entities, we’re going to tie your type 2 to your LLC. So when we apply for your type 2, it’s the legal name of your business, and then it’s going to be your EIN.
Remember, your type 1 was associated with your legal name and your social security, while your type 2 is tied directly to your business. Certain insurance companies will require a type 2 as well as type 1. That’s why I say coming out of the gates, let’s do those things first.
Get a liability insurance
The insurance companies are not going to allow us to participate with them without liability insurance.
Before you even see your first patient, you definitely need liability insurance. And I believe the statutes are, coverage from 3 to 5 million per incident.
I, since the beginning of my career, have been getting my liability insurance through Mercer through Proliability, and this is directly through my membership with the Academy of Nutrition and Dietetics.
So it essentially gives me a discount, I want to say that I pay around $130 per calendar year for my liability insurance.
Fill out the CAQH application
The CAQH application (Council for Affordable Quality Healthcare), I’m air quoting because it’s not really an application at all.
Think about it, like Dicus, or if you are old, like me, when we applied to college in the 90s, we use a common app, the comment, so the CAQH is going to be a place for you to put all of your information in including all of those things that we just identified.
We’re going to load your EIN, we’re going to load your NPIs, we’re going to put in your office location, it’s going to be a place for the insurance companies to kind of circle back to you when they are credentialing you.
You want to make sure that all of the information is current, and that your liability insurance is all uploaded and it is correct. We do not reach out to the insurance companies until we have completed all of those steps.
So you have your business set up, you have the NPIs that you’re going to use, you have the EINs, you have your liability insurance, and then you have completed the CAQH application. Then at that point, then you can go ahead and apply to the individual insurance companies that you want to credential with.
But we are not going to pass go until we have completed all of those steps in their entirety. I will 1,000,000% guarantee if you try to kind of do anyone before the other in the order that I just identified, unfortunately, the insurance companies will more than likely reject your application when it comes to the credentialing process.
Those are the first preliminary things that you want to do to get started, I literally have a whole video on getting started and I elaborate on all of those steps. If you go to reimbursementdietitian.com and you go to the blog section, you will see I have a whole YouTube video that will elaborate and kind of flesh out each one of those steps.
Advantages of accepting insurances as a dietitian
Now we know how to get set up with the insurance companies at least the initial steps. Now I want to talk a little bit about the obviously the pros, so the advantages of accepting insurance, and then some of the downsides to accepting insurance.
So as an insurance based provider for the last decade and a half, I don’t see a ton of disadvantages to accepting insurance, but I want to illuminate the most prevalent ones.
Advantage #1: Reach more people with your services, especially the ones that need them most
When we accept insurance in our practice, we open up opportunities to the patients who can consume our services.
While it’s possible to be self-pay, it often means if you’re self-pay, you’re only catering to the patients who can afford your services, not necessarily the patients that need your services.
Part of my why, as a registered dietitian, is to serve as many people as possible.
And by accepting insurance, I can clearly kind of reconnect with my why, so there is no denying the fact, when you accept insurance, you are reaching more people with your services, especially the ones that need them most.
Advantage #2: Bill as preventative services and the patient has no cost share
In 2015, when the Affordable Care Act went into play, it really changed the game for registered dieticians with how we bill insurance. You don’t need to know the specifics of the Affordable Care Act, what that did is it allowed us to bill for preventative services.
Preventative services are often tied with an intervention that we provide that decreases the risk of mortality and morbidity associated with cardiovascular disease.
When our patients have those kinds of preexisting issues, we can bill them as preventative services and the patient has no cost share.
If we bill correctly, right, and that’s one of the things I teach in my group coaching program because each insurance company has a different version of preventative.
If we bill as preventative, the patient pays nothing for that visit, they’re able to see us generally as often as they need, and their services are covered at 100%.
Preventative services have changed the game. And for many of our insurance plans, we don’t even need a true diagnosis to bill, some of them we do but the big plans in most states allow us to bill and often get unlimited visits using certain codes.
So the Affordable Care Act changed how we bill, but it also increased their frequency, which equals more accountability for our patients.
Advantage #3: Build a network of people that refer you patients
Patients want to use their benefits, right?
We pay a lot of money, and I’m not complaining. But we pay a lot of money for our insurance premiums and we want to make sure that we’re utilizing them.
If most of the plans, if not all of the plans are mandated by the Affordable Care Act, to perhaps preventative services, your patients want to utilize those, and if you are a self-pay dietitian, which is amazing, you’re going to be competing with dieticians who can bill for those services at no cost for the patient.
So it’s a no-brainer, your patients want to use their benefits. Obviously, it opens up a whole network of people to serve as referrals, right?
Our biggest referral base in my practice is doctors and local providers. It is such an easy handoff when you are working with physicians in the community when you accept insurance, especially the same insurances that they accept, right?
It’s like such an easy handoff, there’s very little selling the doctor or the provider needs to do for you, they literally could be as basic as handing them a QR code and sending them to your website to make an appointment.
It really makes the marketing aspect of growing your practice super easy. Because you can get super busy really, really quickly just with a handful of referring doctors, and you do not need to rely on social media.
If you love social media, that’s great, but many dietitians are not super fans. By accepting insurance, it increases your referrals and who you can reach out to easily without having to have to sell your soul on social media.
Advantage #4: Pay is solid
I’ve been doing this for a long time. I work with dieticians in literally every single state in the United States, and I know all of the reimbursement rates, so I would say the lowest IC for an initial visit is about $120 all the way up to over $200.
Follow-up visits tend to kind of fall between $75 all the way up to $160 and $170. These rates are always dependent upon your state and the policy in which you’re billing but I can easily say confidently that I know very few dietitians who are not making 100 plus dollars per hour billing insurance.
Advantage #5: You can bill for any program, service including a la carte services
There’s this misconception that you can’t bill for programs, services and a la carte services. That is a myth.
In my practice we bill for high ticket packages, and a la carte services like body fat testing, and metabolism testing, those are all things that we can kind of continue to bill to the patient, not to insurance, but it decreases the cost of entry.
So like I said, I could go on and on and on and talk about the benefits, but I really don’t want to be super biased, but I do want to talk about some of the downsides of accepting insurance.
Disadvantages of working with insurances as a dietitian
So obviously there’s this big giant learning curve and my programs, my services, my coaching programs, my memberships, I really try to kind of minimize that piece.
My programs walk you step by step through each process.
But with that being said, there is a learning curve, we were not taught this stuff in school. We need a mentor, we need somebody, a coaching program, a system that teaches us these things. And luckily my practice does that and my services do that.
But that can be really frustrating. And it can be really paralyzing to not know what you’re doing.
Getting started can be very overwhelming, but once you’re in it, it can literally change the game for your practice and your career.
Billing is not universal
One of the things I teach is the fundamentals of billing each of the major insurance companies.
We have Aetna, Blue Cross, Blue Shield, we have Cigna, United Healthcare, we have Medicare, and then we have some smaller subsidiaries like Humana, each one of those insurance companies is a little bit different to bill, but it’s like riding a horse or learning how to do a TPN, once you do it once, you are a rock star and a superstar.
So you do have to practice but you will soon learn that it’s not as complicated as you think. We literally bill with five or fewer codes, we just need to know what combination to use for each of the insurance companies.
Not all networks are open
When I started credentialing in 2007, I was blocked out from Aetna and I was blocked out from United.
Something I teach in my coaching program is how to aggressively appeal to those closed networks, and that is something I did, and I’m so grateful because Aetna is like my highest payer right now, but I was boxed out.
It can be frustrating, you’re all fired up and ready to go with insurance, and then it is a closed network. So that can be frustrating.
Better coverage for certain conditions
And lastly, there’s better coverage for certain conditions.
I work in a practice, we do a lot of weight management, and we have awesome coverage. In the world of weight management, things like overweight, obesity, prediabetes, metabolic syndrome, and CVD, are all like taking candy from a baby when it comes to billing.
When it comes to disease conditions, things that are medical conditions like celiac disease, or IBS, IBD, and lactose intolerance, are a little bit different to bill.
It’s not to say that most plans and policies don’t cover those, but those are not considered preventative services, so your patient may have a cost share.
A cost share could be their deductible hasn’t been met, they have a copay or they have coinsurance.
So once again, there is amazing coverage out there for MNT for almost all disorders that are within our scope, there are just certain ones that fall under preventative, and then there are certain ones that fall under medical.
Once again, I go deep with each one of those definitions when I’m working with my RD clients.
I could go on and on and on and on about these topics, but I have lots of different resources out there, so let me just rattle off a bunch so you guys know where to go when you have insurance based questions.
So obviously, if you go to reimbursementdietitian.com I have tons of free and paid resources.
I offer coaching programs, I offer masterclasses, I offer cheat sheets, and tell me what else you need, I will create it for you, but those are all found on reimbursementdietitian.com.
The other part where you can have some fun is to follow me on Instagram.
Every single day I have a tip or a guideline about billing insurance, and then I do a live tip or guideline in my Instagram stories.
While I understand insurance can be super overwhelming and the thought of getting started can be paralyzing when I tell you I literally have no regrets about doing it in a time in my practice when I knew nothing.
When I say I have literally written the manual on accepting insurance in private practice, I am not joking. But yes, it is not all rainbows and unicorns and butterflies, I do wish it was because I would be a super happy camper, but you guys are registered dieticians, you have got this.
And go check out my resources, follow me on Instagram, and let me know how I can best support you in your insurance-based practice.
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