Overview of reimbursement for nutrition counseling
Applying for reimbursement for nutrition counseling can be a complex and time consuming journey. The following information and links should help you successfully complete this undertaking.
Health care institutions/Community Clinics
The health care institution often has established contracts with individual insurers. In many instances, the dietitian can simply bill using the institution’s provider number. Medicare allows the dietitian with a NPI (National Provider Identifier) to assign payment for services to be paid directly to your facility for Medical Nutrition Therapy (MNT) covered services. Currently the only medical conditions covered by Medicare are diabetes and pre-dialysis renal nutrition.
Private Physician Offices
Many insurers offer "incident 2 coverage" whereby the physician is allowed to bill withhis/her providernumber for services which someone in their officeoffers. The physician would have to check with each insurer to see if this is allowed.
Private Practice Dietitians
If you are setting up a private practice you may apply directly with the local insurance companies to become an approved provider for nutrition counseling services. Most companies require that the dietitian be licensed (MDA website has info on obtaining licensure). Many require that you obtain an NPI (National Provider Identifier) number (see below for info on this).
In general, if you are setting up a practice we suggest you apply for state licensure, and then an NPI (National Provider Identifier). Once you have these, you can successfully complete the applications to each insurance company, including Medicare. Anticipate that this process will take several months to complete, if you aren’t already licensed.
With regards to becoming a provider for the insurance company, please be advised that the application process is unique to each insurer. It may take several weeks/months to complete the process. Beware that the insurer may decide to cap the number of dietitian providers for a particular geographic area.
Rates of Reimbursement
Information on actual rates of reimbursement is highly confidential. To complicate the matter, most insurance companies have numerous contracts, and determining reimbursement is often contract specific.
Summary
The members of the reimbursement committee of MDA contacted seven Massachusetts insurance companies to ask about nutrition counseling coverage. We found that we often received conflicting information depending upon which customer representative we spoke with. Many of the companies would only provide information when we could identify a specific patient number, explaining to us that coverage varied from contract to contract.
As the MDA Reimbursement Chairperson, I contacted the Academy of Nutrition and Dietetics to see if they can be of assistance. They confirmed that information is difficult to obtain and suggested that we survey our own members to seek information on reimbursement. We are in the process of setting up this survey and will share this information with MDA members.
Despite these difficulties, I am pleased to offer you some valuable resources as you begin looking into reimbursement issues.
Susan Lewis, MS, RD, LDN
Chairperson, Reimbursement Committee, MDA