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With every level of access to my epic Reimbursement Coaching Program dietitians have 6-months of access to the following curriculum based-modules, resources, live weekly group calls, as well as my private Facebook Community. 

 

Scroll down to learn what each component entails. 

Training Modules: The Reimbursement Dietitian's Curriculum 

 

MODULE 1: PRE-CREDENTIALING
  1. Identify the importance of an NPI Type 1 & NPI Type 2
  2. Determine how to obtain an NPI Type 1 & NPI Type 2
  3. Identify the importance of Malpractice Insurance & purchase the one that best suits the needs of your practice
  4. Successfully complete the CAQH application

 

In this module, I set you up for success! We tackle literally everything you NEED to have before starting the credentialing process. We talk business structure, EINS (and why you NEED one!), liability insurance, and exactly HOW to successfully complete the CAQH application. I provide samples of completed CAQH applications so you can compare YOURS against mine.  NOTE – if this part of the reimbursement process is not completed accurately and in its entirety, down the road, you will experience issues.  

 

MODULE 2: CREDENTIALING
  1. Determine which insurance companies to apply to become credentialed with based on your state
  2. Understand the importance of building your insurance provider number ‘database’
  3. Apply for credentialing
  4. Evaluate an insurance contract & fee schedule 

 

In this module, you will be applying to the insurance companies you want to participate with. And trust me – there is a strategy.  I will teach you how to make your list and decide on who you want to work with. In addition, if the networks are closed (too many RDs already participating) I will literally give you everything you need to successfully appeal to the closed networks and become an in-network provider. 

 

MODULE 3: BILLING AND CODING 
  1. Determine which CPT codes dietitians can bill insurance with to maximize their reimbursement rates
  2. Identify the ICD 10 Codes dietitians can use to maximize both their patient’s MNT benefits and their reimbursement rates
  3. Define the necessary modifiers to be used on claims to ensure they get paid promptly
  4. Explain Z codes and identify the common Z codes RDs bill with
  5. Define the application of the Affordable Care Act (ACA) for dietitians
  6. Interpret preventative coding in the setting of the ACA
  7. Summarize the preventative policies for all the major insurance companies 
  8. Explain the 8-minute rule for billing insurance 
  9. Define exactly how each insurance company requires telehealth claims to be billed 

 

THIS module is literally everything! I say that only because we dive deep into how insurance works. We talk about how to set your fees (cash-rate, usual & customary (aka insurance rates) as well as your prompt pay rates. We talk about ALL the codes (modifiers, ICD 10 codes, CPT codes) and how to avoid deductibles and co-pays. In addition, we talk about how to EXACTLY bill for telehealth so you get paid. 

 

What to do while you are waiting to get credentialed 

While you are waiting (60-90 days) to get your contracts I created a series of actionable steps and activities you can be doing in your practice. This way you are utilizing this time to properly set up your practice and establish a rock-solid foundation. This module includes information about: 

  • Superbills
  • HSA/FSAs
  • Setting your cash rates 
  • Selling programs/packages and a la carte services 
  • Marketing your insurance-based practice 
  • Setting up automations for making your practice as efficient AF
  • Licensure 101 for RDs
  • Suggestions for personal growth  

 

This module is all about what to do while you are waiting to get those contracts in your hand. I really want you to be able to utilize all your time in my program. Therefore, in typical type A dietitian fashion. I tell you exactly what to be doing while you wait. 

 

MODULE 4: VERIFYING PATIENT MNT BENEFITS
  1. Define the importance of verification of a patient’s MNT benefits
  2. Identify the information needed to verify a patient’s MNT benefits
  3. Summarize how to document a patient’s MNT benefits
  4. Define medical necessity 
  5. Identify the information needed to collect from the patient at the initial visit to successfully bill insurance
  6. Determine which insurance companies typically require a referral for MNT
 

In this module, I explain exactly HOW to verify your patients’ MNT benefits. This step is SO crucial. YET so many RDs don’t take the time to learn the CORRECT process.  Trust me. If you skip this step you will have a hot-mess express on your hands. I provide you with literally everything you need to be successful this includes access to my verification of benefits script which has EVERY single IMPORTANT question that MUST be asked. 

 

MODULE 5: INSURANCE BILLING BASICS 
  1. Identify what services you can bill insurance for
  2. Identify what services you can bill the patient for 
  3. Summarize the typical fees collected at an insurance-based patient visit 
  4. Define balance billing 
  5. Describe prompt pay rates 
  6. Define the term usual and customary insurance rates 
  7. Define the term balance billing 
  8. Describe scenarios when a co-pay, deductible, or co-insurance may be applicable for your patients 

 

If I have to say if there is one area that seems to stump RDs billing insurance – I would have to say it is with the basics. In this module, we dive into all the things that make RDs heads spin – deductibles, co-pays, coinsurance, the difference between documentation and a referral, as well as how to secure referrals. 

 

MODULE 6: THE CMS 1500 FORM 
  1. Define what a CMS 1500 form is used for when seeking reimbursement for MNT
  2. Identify different MNT billing scenarios when a CMS 1500 form will be used 
  3. Identify the information that must be included on each CMS 1500 form submission
  4. Define the important areas on a CMS 1500 you need to fill out for each claim submission
 

This is the module you never knew you needed until I recorded it:) Trust me. You want to MASTER and dominate the CMS 1500 form. You will literally use it every single time you submit an insurance claim. I review with you what each section needs to have as well as the most important stuff – like where the referral information MUST go if you want to get paid. 

 

MODULE 7: SUBMITTING INSURANCE CLAIMS 
  1. Identify the 3 different places where you can submit insurance claims 
  2. Identify the major EMRs designed for RDs
  3. Describe the benefits of signing up for an Availity account if your state participates 
  4. Successfully set up an account in Office Ally [if you choose not to use an EMR]
  5. Submit claims using Office Ally [if you choose not to use an EMR]
  6. Understand how to successfully determine the next steps for insurance claim rejections [if you choose not to use an EMR] 

 

In this module, we review the basics of how to select an EMR. I go over the reasons why I decided to switch to Simple Practice in 2020 as well as exactly how to use the most basic clearinghouse to walk you step by step on how to submit your first freaking claim (yay!). When I say I hold your hand when it comes to submitting claims, I am there with you every step of the way! 

 

MODULE 8: HOW TO SET UP, BILL & CORRECT REJECTIONS IN SIMPLE PRACTICE 
  1. Determine how to set up the back-end of Simple Practice 
  2. Identify the 3 main reasons why Simple Practice is a good choice for insurance-based practices
  3. Understand how to correct rejected claims in Simple Practice 

 

In 2020, my practice switched from Office Ally to Simple Practice. (Then in 2022, we switched to IntakeQ. I talk more about the second switch in module 7) And while Simple Practice is not perfect (I changed it as it was expensive for a GROUP - pricing is solid for a solo provider!), it sure does make submitting insurance claims pretty simple. In this module, I walk you through the fundamentals of billing using Simple Practice. Don’t worry if it feels a little overwhelming at first. We are ALWAYS here to help you navigate Simple Practice. Attend the office hours and we can answer any and all of your questions about this EMR. 

 

MODULE 9: HOW TO READ AN EXPLANATION OF PAYMENT (EOP)
  1. Define the importance of an EOP
  2. Identify the critical components of an EOP
  3. Determine where/how to locate an EOP
  4. Recognize what to do with an EOP once you have read it
  5. Determine how to set up electronic payments with each of the major insurance companies 

 

In this module, I walk you through how to read an EOP/EOB/ERA. This is basically an invoice both you and the patients receive for the services you provided. I will teach how you to determine if you were paid in full, whether or not your patient has a deductible or cost-share for the visit as well as how to enroll with receiving electronic payments. 

 

MODULE 10: HOW TO MAXIMIZE YOUR PATIENT’S INSURANCE BENEFITS – GROUP COUNSELING, CORPORATE WELLNESS & REFERRAL NETWORKS
  1. Explain how to utilize group counseling in your practice to maximize your reimbursement rates using a health-insurance-based model
  2. Identify how to develop key alliances with local businesses to administer corporate wellness programs using a health-insurance-based model
  3. Build strong alliances with local doctors who treat your target patient population

 

In this module, we tackle how to market your insurance-based practice like a rock star. Trust me, Sis. It doesn’t involve social media. What it does involve is creating authentic, long-lasting relationships with your community. Marketing your practice is going to be fun and not nearly as hard as you think. After all, what you have already is gold. And we just need to get your story and marketing message out there to the right peeps. In this module, I supply you with samples of everything I send out and use in my practice. You will see sample business cards in all shapes and forms, rack cards, postcards, and MD introduction letters. You can also share what you are working on during one of our live calls or in our private Facebook page for honest feedback. I got you boo! 

 

MODULE 11: Medicare Basics
  1. Identify who qualifies for Medicare
  2. Identify what RDs can bill Medicare for
  3. Summarize the 3 different Medicare enrollment applications 
  4. Recognize the 6 unique billing factors of Medicare 

 

This is a basic module on Medicare. BUT when you join my group reimbursement coaching program you automatically get access to my stand-alone Medicare course. This course literally walks you step by step through the Medicare enrollment, billing, and claim submission process. So when you join the group coaching program – you get a whole other course within a course! 

 

MODULE 12:   DOCUMENTATION OF AN INSURANCE CLAIM
  1. Identify the key criteria required for insurance-based documentation 
  2. Identify the critical mistakes not to make when documenting in your insurance-based practice 

 

This is an entire module dedicated to navigating the ins and outs of documenting in an insurance-based practice. I provide a documentation checklist and several samples of exactly what documentation MUST look like for all of your insurance-based visits. This module is a true gem as most RDs don’t know needs to be in their documentation. 

In addition to the curriculum-based modules noted above, you will receive 6 months of access to the following resources: 

 

  • Access to my stand-alone Medicare Course
  • Access to the following Master Classes: Licensure 101, How to Bill a la Carte Services, Billing and Coding 101, How to Bill out of state Insurance Companies & How to Ace your Insurance Audit 
  • Access to my kick-ass CheatSheet for Billing the Major Insurance Companies
  • Access to important reimbursement resources like referral forms, verification forms, and scripts that save you tons of time & money
  • Resources on telehealth, licensure, basic info on taxes & what is expected from a documentation standpoint. 

Private Facebook Page Community for my Reimbursement Coaching Clients 

 

With all levels of my coaching programs, you receive 6-months of access to my private Facebook Reimbursement Group Coaching Community. Here you can ask questions on anything related to insurance and private practice, celebrate wins, vent, post referrals for patients you are not wanting to work with as well as network with other rock-star RDs. I check in on the FB page 2 times per day Monday through Saturday. I stay off social media on Sunday. So all questions posted after 3:00 pm on Saturday will be answered first thing Monday morning. 

Live Calls Galore! 

 

An important component of my coaching program is the live group office houses. Typically 3-4 times per month I offer office hours. Here is a link to our current calendar of events. During this time (60-minutes) everyone who wants to join in during office hours logs into ZOOM and I answer your specific personal questions on a first-come, first-answered basis. They can be questions on anything related to private practice and reimbursement. No questions are off limits :) And you can join during office hours even if you don't have questions. Often someone else's question might spark your question! So don't be bashful.