BELOW IS AN OVERVIEW OF WHAT YOU WILL RECEIVE IN THE REIMBURSEMENT DIETITIAN STARTER PACK:
- A customizable MNT superbill template (word) plus AWESOME bonus content ‘Everything you Ever Wanted to Know About MNT Superbills and More!’ (pdf)
- A customizable HIPAA Privacy Practice Notice with Signature form (word), plus a HIPAA-compliant checklist for your practice
- MNT Referral forms – one specifically for diabetes and CKD (for Medicare), one pre-populated with the most common ICD 10 codes, and the other blank so the MD can enter in their own ICD-10 codes (word & pdf)
- Business Associate Contract is a contract required between your organization and each of the individuals or entities identified in your Business Partner List who will use or disclose PHI on your behalf. This is also necessary if you hire Independent Contractors, Billers or anyone else who will have access to your PHI for your organization.
- Request to Access PHI Form Patients have the right to access a copy of their PHI maintained in a designated record set (medical records, billing records, and any other PHI that is used to make decisions about individuals) for as long as the organization maintains the information. The organization needs to have a formal process for requesting and releasing the information and this form allows the patient to submit a formal request for their PHI.
- Four different customizable Nutrition Assessment forms – 2 adults forms, 1 pediatric form & 1 Diabetic form (word)
- A ‘How to Prepare Yourself for Your Nutrition Visit’ packet complete with a customizable Patient Demographic Form & Liability Form (word)
- A customizable Communication Guidelines form (word)
- A Medical Records Request form (word)
- Customizable receipts for payment for an Initial Nutrition Visit, a Follow-up Visit, Insurance Co-Pays & No call/show missed nutrition appointment (word)
- A customizable Weight Tracking Log (word)
- A sample script to provide to your patients for verifying their health insurance (word) plus a pdf with clickable boxes
- A sample script to provide your patients with exactly what to expect at their first nutrition visit (word)
- Consent form - telehealth services (word)
- Consent form - non-covered services (word)
- Consent form - Consent to Receive Medical Nutrition Therapy (pdf)
- A sample ABN Form for Medicare Providers
- A sample Credit Card Authorization Form
- Access to my personal Practice Policies for The Plano Program Dietitians
- Fax Signature Language - using a fax cover sheet with the appropriate notices/disclaimers for all of the organization’s fax transmissions is a key component of the policies and procedures for Facsimile Machines. I provide you with the exact language to use on the bottom of your fax cover letters.
- Email Signature Language - using an email signature with the appropriate notices/disclaimers for all of the organization’s email transmissions is an important step. The email signature template takes into account best practices for email transmission.
And if that content was not knock-your-socks-off awesome enough – I have decided to be extra generous and include even more resources to help you grow a killer nutrition private practice. These bonuses provide you with actual examples of products I use in my practice.
- Bonus: A sample Rate Sheet for initial & follow-up visits (pdf)
- Bonus: Sample rates for several Nutrition Packages (pdf & Word)
- Bonus: Sample meal plans templates (pdf)