Reimbursement Frequently Asked Questions

Who covers services provided by an RDN?

Traditionally fee for service coverage has been (and still is) offered through Medicare, Medicaid and private/commercial insurance companies. 

There are other programs that will cover RDN services within the program:

Medicare: Diabetes Prevention Program DPP

Medicare: Diabetes Self Management Training (DSMT)

Medicare Preventive Services

Read more about covered services here

I would like to take insurance. How do I get started?

Here’s a quick step by step:

1. Obtain your NPI (National Provider Identifier) and EIN (IRS tax ID) numbers
   1. Are you interested in billing for Medicare patients? If so, fill out a Medicare enrollment application 
2. Have liability insurance in place.
3. Select the insurance plans you’d like to work with and contact each to discuss their process for becoming an in-network provider.
4. Complete your credentialing application for each insurer. The insurers will direct you to their credentialing process. Most companies use CAQH.
5. Receive your contract. This is the formal agreement between you and the insurer. READ IT THOROUGHLY, look up anything new to you, and make sure you understand the details. Please don’t sign until you understand it. Consider seeing a health care attorney if you need more help. Once you clearly understand one contract, you can probably make it through the others reasonably well.
6. Find an electronic billing system to submit claims. There are free versions available. If you have an electronic records system, billing may be integrated.
7. Educated yourself often! Here are some links to start with:
   1. “First Steps to Becoming a Provider”
   2. “Medicare Provider Enrollment”
   3. “Medicare MNT”
   4. “Coding and Billing”
   5. “All About Medicare”

What are some opportunities for reimbursement if I work in a clinic with other providers?

If the clinic you’re working in has a supervising physician or advanced practice nurse, there are many opportunities for reimbursement. 

RDN’s can see patients under fee for service contracts with private insurers and Medicare; services can be billed “incident to” these supervising practitioners for Colorado Medicaid and Medicare Preventive Services; RDN’s may be incorporated into programs such as the Medicare DPP or DSMT if the clinic is participating. 

If you’re working in a clinic or see an opportunity for RDN’s in a clinic setting, here are some additional resources to help promote what RDN’s can do:

“Resources for Promoting Nutrition Services”

I’ve heard that Medicaid doesn’t cover RDN’s in Colorado. Is that true?

Colorado Medicaid DOES cover services provided by RDN’s, BUT there are very specific requirements for billing.

Per federal law, only licensed practitioners can become Medicaid providers. Since RDN’s in Colorado are not licensed by the state, they cannot be Medicaid providers and bill Medicaid directly 

Coverage is still available for services delivered by a RDN, and here’s how:

Services provided by a RDN are coverable under Medicaid, when the services are billed incident-to a supervising physician (or advanced practice nurse) who is a Medicaid Provider in Colorado. Billing incident-to means that the supervising practitioner is in the facility (not necessarily in the room) at the time the service is provided by the RDN. The session is billed under the supervising practitioner’s NPI, not the RDN’s.

Can I see Medicaid patients in private practice?

Since RDN’s can’t legally be Medicaid providers and direct bill, a RDN working solo, or only with other RDN’s out of their own office can’t be reimbursed under Medicaid.

It may be possible as a private practice RDN to contract with a clinic and see the clinic’s Medicaid patients at the clinic. The clinic would need to bill MNT under the supervising physician as described above and would receive the payment. A contractual arrangement would need to be made between the private RDN and the clinic to detail the relationship, including what portion of the Medicaid reimbursement would be paid to the RDN.

How much are RDN’s reimbursed?

For legal reasons, we can’t discuss specific reimbursement rates here. You’ll need to do your own homework to determine your acceptable rate ranges. Here are a few resources and suggestions:

There are many ways to figure out your rates, but generally consider the following: typical take home pay salary for an RDN like you (here’s a salary calculator to help); business expenses; federal, state and local taxes; and the actual work time you need to do what you do.

There are two publicly available physician fee schedules to benchmark reimbursement pay for RDN’s. These rates are what physicians are paid for each procedure code under Medicare and Colorado Medicaid. RDN’s are reimbursed approximately 80% of a physician’s rates.

Medicare Physicians Fee Schedule (Select “Specific MAC” to get rates for Colorado. Enter the procedure code of interest from the HCPC box)

Health First Colorado Fee Schedule (click on “Health First Colorado Fee Schedule” to see the link to the most current fee schedule. Search the spreadsheet for the procedure code of interest.)

When you take into consideration your personal rate calculations and the rates from the public fee schedules, you can come up with a range of reimbursement rates that might be reasonable or expected, and with that, better negotiate your reimbursement.

Read more about setting fees.

What are Alternative Payment Models (APM’s) and as an RDN, should I care?

As health care costs continue to rise, different care and payment models are being developed to attempt to improve care and reduce costs. Some models focus on managing the health of defined populations, while others focus on care quality and value, financials, system utilization and more.

YES – RDN’s should definitely care and have a basic understanding of these models and how they work! 

WHY? Because the landscape is already changing and MNT is an integral part of improving health outcomes, reducing readmission rates and utilization, and reducing cost of care. If you work as an RDN in a health care system or facility, and even in private practice, there will be opportunities to create a space for RDN’s to be included in improving quality and cost in health care. Don’t get left behind!

To learn more see these links:

“Changes in Health Care Delivery and Payment”

“RDN’s in the New Primary Care” – Toolkit

Last Review Date: 10/2019