Direct billing and dietitian insurance reimbursement: Pros & Cons

If you run a private practice, you may have asked yourself whether or not you should set up direct billing (also commonly referred to as “accepting insurance”).

What is direct billing?

Direct billing means that you are listed as an in-network provider with insurance companies, so that clients don’t have to pay out of pocket for your nutrition services. You bill the service directly to the insurance provider, instead of the client. Then, the insurance provider reimburses you, the dietitian, for the service. The DSC Courses – Getting Started with Insurance Billing cover the simplified step-by-step approach for setting up insurance billing in your dietitian private practice for both US and Canadian dietitians. Including: benefits and drawbacks, how to set up insurance billing, billing and coding (including CPT codes for nutritional counseling), proper record keeping, and more!

Should you set up direct billing for your dietitian private practice?

Let’s review some of the pros and cons…

Pros & Cons of Direct Billing

Pros of Direct Billing

You are listed as a provider through insurance companies, so consequently, you have visibility to all of the people that would be looking for an RD through their provider. So it’s a form of free marketing for your business.
It’s clearly more accessible for clients who can’t afford to pay out of pocket for your nutrition services. If you’re working with a population group who may not be able to afford to pay out of pocket, this is a great way to ensure that they are able to receive care.
Setting up direct billing insurance and reimbursement can be a great way to get recurring clients through the door, especially if you are just starting out in your practice. This is one of the biggest challenges when you’re first starting your business since you haven’t established yourself in the community yet and haven’t had the opportunity to benefit from client referrals. Clients referring their friends and family to you is one of the MOST effective marketing tactics.
Another benefit is that insurance clients often can and will want more of your services and support. However, providers can only bill insurance for face-to-face time with the client using dietitian CPT codes (CPT codes for dietitians indicate the nutrition counseling service being provided). One way to meet the needs of your client is to share your “a la carte” services that they may be interested in. Then, the client can pay you directly for these additional services. This allows the client to have some dietitian services (consulting) covered by insurance, while freeing up more of their out-of-pocket dollars to spend with you on advanced or unique nutrition services, such as meal planning, grocery store tours, etc.
Taking insurance also allows you to increase your referral network as a dietitian – thereby increasing your client base. You can email, call, or visit local providers (i.e. doctors, dentists, chiropractors) to share your information, services, and which insurance companies you are in-network with. Your referral network has an easier time recommending a dietitian’s service when they know the cost of the service can be covered or shared with their client’s insurance company.

Cons of Direct Billing

Let’s face it, it’s time consuming to set up and can be tedious to manage for each client. The process for getting credentialed with some insurance providers in the US can take up to 6 months.
- Note: some EMR (also referred to as EHR platforms or Practice Management) platforms have direct billing integrated into their platforms to speed up the process, like Jane.app and Healthie. Check out our blog post on this topic here.
The rates you are paid may be lower than cash paying clients, as you have to accept and/or negotiate a rate with the insurance company.
There is a time delay between seeing the patient and getting reimbursed by the insurance provider, so you may not get paid as quickly as when you are working with cash-paying clients.
A part of the learning curve to accepting insurance is that each insurance company operates differently. If you’re completely new to the insurance world, you may benefit from only becoming credentialed with one company to start and then adding companies from there as you gain experience and confidence.

The DSC Courses – Getting Started with Insurance Billing cover the simplified step-by-step approach for setting up insurance billing in your dietitian private practice for both US and Canadian dietitians. Including: benefits and drawbacks of accepting insurance, how to set up insurance billing, billing and coding (including CPT codes for nutrition), proper record keeping, and more!

Is direct billing right for me?

Direct billing might be right for you and your practice if:

- You are a dietitian who is just getting started in your practice and you’re looking to get consistent, recurring clients. As mentioned above, this is the most challenging part about being a new practitioner and establishing yourself in your community takes time. If you’re looking to start bringing money in quickly, this might be a good option for you. You can always transition out of direct billing once you build up your online presence and start attracting cash paying clients from your website or social media platforms.

- If your target audience is likely to choose practitioners who offer direct billing and may not be able to afford out-of-pocket, then this might be something you want to implement.

However, even if you do offer direct billing, it’s imperative that you continue to put consistent time and effort into marketing your practice to attract cash paying clients in the long run.

Need help setting up direct billing?

With our Nutrition + Business membership, we offer step-by-step instructions for how to set up direct billing insurance and reimbursement for Canadian and US dietitians. Plus, we have dozens of other courses, a dietitian business community, and 1:1 business Q&A to help you start and grow your practice!

Check out our membership options today!