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Increasing access to dietitians: 5 myths about direct billing addressed

Four years ago, I transformed the way I ran my business by deciding to offer direct billing services to my clients. At the time, I was primarily a stay-at-home mom seeing a few clients a couple nights a week, and had plenty of time to take on a bit of extra paperwork. I didn’t really know what I was doing, but had the time to learn, along with the admin staff at the clinics I worked out of to help me along the way.
I knew that there was a large demand for direct billing from my clients, but I had no idea that offering this service would actually triple my business. It got to the point where I had to hire a team of dietitians to meet the client demand.

First, let me explain what direct billing is for those that may not know: Direct billing of medical services, or “assignment of benefits,” is where the client signs over their reimbursement for services to the service provider. If the client has $500 per year to see a dietitian, then that $500 can be signed over and paid directly to the dietitian after each appointment for the fee stated.
The benefit to the client is that they don’t have to have the financial burden of paying up front, and then submitting their claim. They can come and meet with the dietitian and go home to focus on the reason why they came to see you, their nutrition.
If using employee medical insurance and direct billing clients seems confusing and like a lot of extra work, you are not the only one that feels this way. It is extra work, but it is absolutely worth the hassle if you want your business to grow!
The benefit of using medical insurance to increase access to dietitian services is a huge topic. This is just scratching the surface, but below are the five biggest myths I hear regarding direct billing:
Myth 1: Direct billing takes too much time.
  • Offering direct billing does add extra time to your day and paperwork, but you can put systems and templates in place to streamline and automate the process. Once you have that set up, you can easily plan to use your time more efficiently.

Myth 2: Direct billing has too much financial risk.
  • If you do what I did, which was learn by trial and error, there have been some costly mistakes. For example, a claim may be rejected and then you wouldn’t get paid for your service. However, as you take on more clients with coverage and learn to work with the insurance companies, you will quickly learn how they operate. You will also become familiar with the questions to ask so that you don’t file a claim wrong and get it returned without payment. You only make that mistake once.
Myth 3: Direct billing cost more in postage and paperwork.
  • No. It doesn’t cost more money to direct bill, even if you have to mail in a claim. The average credit card processing fee is between $2.50 and $3.50 and if you are sending off multiple claims then it can actually save you money. Plus, you can work your costs of direct billing into your fees, just as you would with credit card fees. For example, I’ve seen some clinics charge a $5.00 fee to clients if they want to direct bill, and some insurance companies do cover this handling fee. 
Myth 4: You need to have a high client load to make it worth it.
  • Yes… and no. When dietitians reach out to me for advice on direct billing, I usually tell them that they should have a high client load (i.e. 10 or more clients per week) to make it worth direct billing. The reason why I say this is because it can take up to four weeks to get paid. If you are only seeing a few clients a week and then you have to wait for weeks to be paid, it could be a long stretch before you get your payment for service. However, if you have a higher volume and you can submit your claims weekly, then eventually you will be paid weekly. It all depends on how fast you need the money.

Myth 5: Some companies are better to work with than others. 
  • No. They all have the same process and all have their own quirks, which make them equal to work with. Some companies offer better features to service providers, like electronic claim submission or direct deposit, while others do not, but it doesn’t make them better to work with. I’ve had one of the top (really great to work with >>>insert sarcasm<<<) insurance companies code an entire two weeks of claims under OT vs. RD. It took me four weeks to get it rectified and finally paid.
This post might not seem terribly encouraging to move toward direct billing in your practice, because it ismore work than being paid on the spot and getting on with your day, but I see a huge problem arising if we don’t start to offer this service.
Many other allied health care providers do direct bill and they have won the attention of medical insurance companies, which provide them with open portals and communication streams to be paid directly. 
We are never going to get the insurance companies to recognize us in the same way dentistry, massage, and physiotherapy are recognized if we don’t start to try to direct bill. The more dietitians that offer this service, the easier it will be to work with the insurance providers.
We’ve also been seeing that others working in the nutrition field (non-RD’s) are being covered by medical insurance companies and are offering this service. We need to be competitive by connecting with insurance companies through the services they provide.
Offering direct billing services has been incredibly beneficial for my private practice. I’ve tripled my business in the last two years and have hired a team of five dietitians! I also get more referrals from doctor’s offices because they know I offer this service. It is great to be in line with other allied health care providers that insurance companies recognize, like physiotherapy and massage. 
I hope this post has encouraged you to try direct billing. Just jump in and try it. It will only get easier as you become more familiar with the process and your private practice may flourish because of it!
Editor’s note: I had the pleasure of being at the DC National Conference in Winnipeg to see the excitement and interest in this topic among attendees. The DC consulting dietitian’s network, along with an active action group in BC, have been working hard to increase insurance coverage for dietitians. Do you think more RDs offering direct billing could help their efforts? 

Have you started offering direct billing in your practice? What were your biggest challenges and successes? Please share your experience, and any comments or questions for Susan below.
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