What You Should Know About Insurance Reimbursement

NANCY Z� FARRELL ALLEN

MS, RDN, FAND

REIMBURSEMENT CHAIR

As a private practice RDN, I began telehealth services in the spring of 2019� Fortunately, my HIPAA-compliant EMR and telehealth platform had been in operation a year before the COVID-19 pandemic hit�

Yet, many RDNs were thrust into a sharp learning curve of immediately embracing a new healthcare delivery and billing system at the same time� But seize the opportunities, we did!

Every week it seems a potential patient asks me “Do you accept my insurance?” Consequently, I am left to explain that it is the insurance company that determines whether or not to accept and credential my MNT practice as in-network or not� In addition, each insurance company has several plans, and the ownership of understanding the allowances of specific plans rests with the patient� However, the RDN must understand their responsibilities as the healthcare provider�

Tips to help you navigate the legal requirements of insurance reimbursement contracts:

1 Review the contracts you have with insurance payers� What are the terms for nutrition preventive services? What is the nutrition payment fee schedule?

How will you set your private practice fees? What will be your estimated “write-off” amounts?

2 Know the most common CPT codes an RDN should use for billing purposes� These include codes 97802, 97803 for individual

MNT visits; and 97804 for group education sessions�

3 There are new online digital assessment and management codes (98970, 98971, 98972)

RDNs can use for potential reimbursement from private payers for their electronic communication with established patients�

4 Know the ICD-10 diagnosis code(s) an RDN can use successfully without a specific diagnosis (such as Z71�3); and the terms for using other ICD-10 codes when a diagnosis is present�

5 Know that private-payer guidelines can vary from state to state� For example, in some states, some private payers do not accept the

RDN use of certain codes, such as E66�9 Obesity, unspecified�

6 Patient plans can differ under the same insurance company� You will find that some patients will owe a copay while others will not�

7 Understand that previous contract restrictions were lifted in 2020, allowing for greater member reach and care through healthcare provider telehealth services�

Know that these restrictions may very well likely be reinstated in some shape or form in the near future� Are you prepared?

8 If you are out-of-network with a client/patient’s health insurance company, do not assume that temporary telehealth policies apply�

9 The Academy has wonderful resources at eatrightpro�org/ resources/practice/getting-paid or you can email the academy at reimburse@eatright�org�

Nancy Farrell Allen is the owner of Farrell Dietitian Services in Fredericksburg, Virginia� She is active in Academy Nutrition Advocacy and Public Policy initiatives and serves as an Academy National Media Spokesperson� Nancy teaches a graduate leadership course at Rosalind Franklin University of Medicine and Science� Working in the commercial talent industry, Nancy gained insight on not only being in front of, but also behind, the camera�