REIMBURSEMENT CORNER
What You Should Know About Insurance Reimbursement N A N CY Z . FA R R E L L A L L E N 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. 5K now 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. 6P atient 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.
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