Insurance reimbursement for acute care dietitians

Working as an acute care dietitian presents both challenges and opportunities when it comes to insurance billing and reimbursement. Although billing directly for inpatient nutrition services is not possible at this time, acute care dietitians still have opportunities to bill insurance companies for their services in areas connected to acute care. Some of these settings include patients in observation, mental health or intermediate care, and residential substance abuse.

Location, location, location

If your facility houses or is associated with mental health or substance abuse units, you may be eligible to bill insurance for nutrition services provided to these units. Just because a unit is within the hospital’s walls does not necessarily mean that it is part of the inpatient hospital. Mental health and substance abuse units, among other types of specialty units, can operate as completely independent facilities and have separate policies for billing.

Likewise, providers may consult you to see patients listed under observation status. Since these patients are not “inpatient” status, their billing procedures may differ from traditional inpatients. In fact, Medicare considers observation hospital visits to be outpatient care, and Medicare Part B covers these services.¹ Check with your billing department for the specific details for your facility.

How to approach billing for nutrition services provided in specialty units

If you are currently covering any type of unit separate from your inpatient units, here are the questions to ask to make sure you are not missing potential insurance reimbursement:

• Is the unit in question part of the hospital, or is it a separate entity?
• How is the unit classified?
• Who is responsible for the billing of that unit?
• Do the primary insurance companies billed in that unit reimburse for medical nutrition therapy (MNT)?
• Do those same insurance companies reimburse for MNT in that specific setting?

If you find out that the unit is not considered an inpatient level of care and you are able to reimburse for MNT, then proceed to get credentialed and start billing!

How to approach billing for nutrition services provided in observation units

If you are currently seeing patients under observation status at your hospital without billing, ask these questions:

• Who is responsible for billing for observation patients?
• Who is responsible for credentialing for practitioners at your facility?
• What is the appropriate credentialing to bill under observation/outpatient?
• What does the billing department need from the dietitian to bill for nutrition services?
• Start billing insurance companies for the observation status visits!

Although navigating insurance reimbursement can be intimidating, dietitians are responsible for elevating the value of nutrition in the healthcare world by charging what is due for our services. One way acute care dietitians can do this is making sure there are no unclaimed insurance dollars for the services they provide to units that co-exist with inpatient units.

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References:

1. Outpatient hospital services. Medicare.gov. https://www.medicare.gov/coverage/outpatient-hospital-services. Accessed July 19, 2023.

2. Coding and billing handbook. Academy of Nutrition and Dietetics. https://www.eatrightpro.org/-/media/files/eatrightpro/career/payment/coding-and-billing-handbook-final-5252232.pdf. Published 2022.