Defining Success in Private Practice

What does being successful mean in private practice?

Definition of Success
We can’t talk about what successful means until we first define success. Merriam-Webster defines success as, “Favorable or desired outcome” and “the attainment of wealth.” Dictionary.com defines success as, “the attainment of wealth, position, honors, or the like.”

While these may be the definitions of success, they may not be how YOU define success since it is subjective.

For me, success meant filing my first insurance claim and then getting paid from my first insurance company (after many denials). I currently think of success as “mastering” something or accomplishing a task. I feel “successful” since I can do what I love in my private practice, while also teaching at a local Community College.

Defining and Achieving Your Own Success
I really like this quote from Anne Sweeney about success, “Define success on your own terms, achieve it by your own rules, and build a life you’re proud to live.”

Defining your own success in private practice involves thinking of your big vision, which can give you a sense of direction. Think about what you value, what motivates you, and the accomplishments you want to achieve.

I would challenge you to think beyond defining a number of clients or benchmark for income as your only parameters for success. Dig a little deeper into how you might feel when you are “successful” or what your day might even look like as a private practice Dietitian.

How Other Dietitians Define Success
I posted in a few Dietitian Facebook groups asking what others thought about the meaning of success. Here are some great quotes from fellow Dietitians as to how they define their own success.

“I feel like success is to be in control of your own destiny, and choose the career path that makes you happy and celebrates your worth.” Amy Hager

“Success is subjective. Success to me is being able to run my private practice efficiently without compromising precious time being mom and a wife. This means delegating tasks such as social media content creation, billing, and marketing to a team that can do them better than me.” Leonila Campos, MBA, RD – Founder and CEO of Fueled by Leo, inc.

“To me, success is multi-pronged but stems around achieving quality of life. By that, I mean you authentically help your clients/patients reach their goals and attain the quality of life they desire. Additionally, you as the practitioner achieve the quality of life you want in terms of fulfillment from your work and being able to provide both time and resources for your family.” Kelly Wagner, MS, RD, LDN – Nutriving LLC

Beware of the Comparison Trap
While looking at what others are doing in private practice can be motivating and open us up to the many possibilities in entrepreneurship, comparing ourselves to others can be a negative trap.

Check out more information on the Social Comparison Theory

As you look at what others are doing, you might start chasing a vision that isn’t your own. You might also get caught up in what you “should” do or what you are not doing enough of.

This comparison trap can feed imposter syndrome, insecurities, and negativity. There are so many factors that influence someone’s success in business and most of the time what you see online is a highlight reel of business.

Handling the Comparison Trap
If you start to feel like you are falling into this comparison trap, refer to your own definition of success. Focus on what makes you unique and remind yourself of your progress thus far.

When I start to feel negative about my own progress, I take a step back and focus on what I have and practice gratitude. I then think through things critically and ask myself, “If I don’t feel happy with my progress, what realistically can I change? How can I improve?”

Taking a moment to analyze my negative thoughts and create a forward moving action plan, brings me back to the pathway I want to forge in private practice. One that focuses on my vision and not someone else’s.

For more information, check out the My Dietitian Journey Podcast – How Should You Define Success For Your Private Practice?

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Private Practice Skills

What skills are essential for private practice?

1 – Organization
Being organized is critical in running a practice because you are juggling a lot – clients, billing, financials, contracts, emails, calls, etc.

Some of the ways I stay organized are to have a dedicated workspace (free of clutter), digital calendar (syncs with all my other calendars), paper calendar (I like the visual of seeing my week on paper) and filing folders (digital and hardcopy). Everything I store is labeled and easy to access. It is much easier to do this as you go instead of waiting and trying to find or reorganize everything later.

2 – Time Management
You are your own boss in private practice, so you need to be able to set goals and tasks and complete them in a timely manner. This means being productive with your time and prioritizing your tasks for the day.

Some of the ways I manage my time are to block my tasks, meaning I see clients certain days/times and do administrative stuff others and use a daily task list (like Google Keep) to prioritize and create a schedule.

3 – Growth Mindset
A growth mindset refers to viewing our abilities as capable of improving. Having a growth mindset means you can enjoy challenges and new experiences. It also means you embrace imperfection and learn from mistakes.

Some ways to facilitate a growth mindset would be to continue to tackle your fears, especially in business (when everything can seem scary), utilize positive self-talk, and embrace change, even when it is uncomfortable.

4 – Critical Thinking
Indeed defines critical thinking as, “The process of analyzing information to get the best answer to a question or problem.” You won’t always know what to do in private practice and being your own boss means you don’t have someone else in your office to run and ask. You will be faced with situations (like figuring out insurance and billing) where you need to evaluate information you have, locate information to fill in knowledge gaps, and apply what you have read/learned to your specific situation.

5 – Communication
Communication is really a key component of any professional setting, let alone private practice. You always want to consider how you communicate with others, what you will say and how it may be received (which could be different than how you intended). Being an effective communicator involves actively listening, asking questions to confirm what is said, and questioning your own assumptions and biases.

Starting a private practice can feel overwhelming, but it is certainly doable! Remember, just because you can do everything, doesn’t mean you should. Hire out and contract with other professionals who have more experience than you (like an accountant for taxes and lawyer for contracts) and connect with others in the field for support. Being able to collaborate with others and learn from shared experiences can be invigorating!

For more information, check out the My Dietitian Journey Podcast – What Skills Do YOU Need to Run a Private Practice?

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Client Management | Cancellations, Free Advice, Etc.

Being a small business owner means I need to make decisions on tough situations like whether or not I should charge a cancellation fee or what to do if a client isn’t satisfied with services. Today’s post addresses the top 5 questions I get asked about business practices.

What do you do if a client cancels at the last minute, do you charge a fee?
I do charge clients for late cancellations and reschedules. My policy on late cancellations (less than 24-hours’ notice) and reschedules is clearly stated in my practice policies document that all clients are required to sign. What you decide to charge can be a nominal fee (like $15 or $25) or the cost of the full session. If you are an insurance provider, check your contracts since some do not allow you to charge for the full session if services are not rendered.

Once you create your policy, make sure it is clear and applied to everyone fairly. I remind my clients of the cancellation policy on multiple occasions including in email appointment reminders.

What do you do if a client wants to work with you, but you don’t think they are a good fit?
I often have clients reaching out to me that may not be a good fit for the practice. Some have conditions that I do not specialize in (like with clients who have eating disorders) and others are looking for specific services I do not offer (like meal plans).

Here is one of the ways I might respond, “Thank you for your interest, unfortunately, because of ____ (Insert clear reason here) I don’t think my practice would be a good fit for what you are looking for. I would be happy to refer you to another dietitian.” One reason I might not work with a client is because I don’t specialize in that area of dietetics. For example, I often get emails from parents wanting me to work with young children. In those cases, I might say, “My specialty is not in pediatrics; however, I can refer you to a dietitian who does specialize in this area if you would like?”

What do you do if a client is abusing your time, calling, or emailing too much between sessions?
If a client is taking up a lot of my time between sessions, I will redirect them to scheduling an appointment or moving their session closer. If I have a client with a lot of questions at the end of a session, I encourage them to write down any points for us to address during the next session. A lot of this comes down to having clear policies and boundaries set.

What do you do if people (like family) keep asking for free advice?
When I first started my practice, I used to get a lot of people asking for free advice. While I will often share tips with family, I really encourage people to schedule a session with me. I would caution any Dietitians reading this to think twice about working with family members in your practice. While it may be legal to see a family member, it can get muddy. Often for family, I will provide general resources (mostly websites) and then offer to refer to another Dietitian.

I highly suggest reading “Tip #94 Counseling Family and Friends”

What do you do if a client isn’t satisfied with your services?
You will likely run into situations where a client isn’t satisfied with your services. In these situations, I typically thank a client for their feedback, ask what they were looking for differently (could be miscommunication), and/or ask if they would like a referral for another Dietitian.

Setting the expectation for the session and services is key to ensuring we are all on the same page. Sometimes I find that I need to be clearer about my scope of practice and my area of focus. This can be accomplished in a few ways: having a description of what nutrition counseling is on my website, having clear scope of practice and consent document that each client signs, and avoiding imperatives with marketing (i.e., you WILL lose 10 pounds).

It is important to note that not everyone will like your style (and that is okay) and not everyone is ready for change (and that is not a reflection on you as a Dietitian)!

For more information, check out the My Dietitian Journey Podcast – Client Management

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

5 Tips for Keeping Organized in Private Practice

How do you stay organized in private practice?

There are a lot of moving parts in private practice and likely, you will start your business as a one-person show! So, today’s post includes my top 5 tips for keeping yourself organized.

Tip #1 – Have a Dedicated Workspace
Having a dedicated workspace is beneficial for a few reasons: it can keep you mentally focused on work, reduce distractions, and help with maintaining work-life balance. Even if you can’t have a full home office set-up in a separate room, try to have a small nook or space just for business. This also helps with keeping you organized as all of your business documents and resources are in one spot versus strewn about your living space.

Tip #2 – Have a Method for Filing
In private practice, you may be handling protected health information documents that need to be properly stored to maintain HIPAA compliance. There are a few ways you might choose to store files: locked in a filing cabinet, digitally via Google Drive (if BAA signed with Workspace), digitally with encrypted external drives, or with an EMR.

Whether storing documents with PHI or not, make sure to keep everything easily accessible with a labeling system.

Tip #3 – Create Systems and Automations
When I first started seeing clients, I was organized, but not efficient. A few years ago I invested in an EMR which really helped me to streamline things. I was able to automate appointment reminders, pre-build templates to use for charting so I am now charting faster and more consistently across clients and create digital paperwork to easily send to clients securely. I also embedded a scheduling tool on my website so clients can manually schedule initial sessions without having to call or email back and forth.

Tip #4 – Create Checklists and Protocols
Establishing protocols or checklists for usual tasks really helped me to stay organized and be more efficient. Having a clear protocol can also make the transition easier for onboarding new Dietitians, should you choose to hire, or other contract employees.

Currently, I have a clear on-boarding process for new clients (what I review with them, what actions steps I need to take), a checklist for verifying insurance coverage, a weekly Friday task list (to prepare for following week), and a post session checklist which covers billing and charting protocols.

Tip #5 – Use Project Management Tools
While I am a fan of a paper planner, I have gotten more into using project management tools for daily tasks and sharing of tasks with interns. There are quite a few platforms out there like Trello, Asana, Microsoft Planning, and Google Keep/Tasks. Try out the different platforms and get a feel for what will work best for you.

Personally, I use Google Keep a lot since I use Google Workspace for one portion of my business. I like that I can easily add tasks on my phone, copy task lists to Google Drive, and share lists. Keep also shows up on the side of my Gmail so I can quickly see any tasks for the day when I login.

For more information, check out the My Dietitian Journey Podcast – How to Stay Organized with Your Private Practice.

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Dietetic Intern Q & A

Did you know that April is National Preceptor Month? Having been a dietetic intern myself, and now as a dietetic internship preceptor within my private practice, I thought it would be fun to do a Q and A with dietetic intern, Rebecca Vidal. Rebecca has a Bachelor of Science in Nutritional Sciences – Dietetics from Rutgers University and was with me during an elective rotation. Thank you to Rebecca for taking part in today’s blog post!

What made you interested in the field of dietetics?
Rebecca: A few years ago, my father and I faced the ravages of chronic diseases. We tried everything from conventional medical doctors, nutritionists, dietitians, and so on. What we discovered is that nutrition acts as the foundation for overall health. In our cases, adopting a plant-based diet is what restored my health in full and what has sustained my father as he continues to battle chronic Lyme disease. Ultimately, that led to my interest in the field of nutrition and surely enough I knew that I wanted to become a dietitian and help others prevent and treat diseases through nutrition.

Can you tell the readers a bit about your internship program?
Rebecca: I am currently finalizing my dietetic internship with Gulf Coast Dietetic Internship Program, which is a distance program. Distance dietetic internship programs involve interns finding their own preceptors and rotation sites rather than the program guaranteeing them. My program consists of four main rotations: community, clinical, elective, and entrepreneurship. There was no requirement to complete them in any order. In the past, dietetic interns needed a total minimum of 1200 hours; yet, in response to the pandemic, the total minimum was reduced to 1000 hours.

Since you are in a distance program, what tips or suggestions can you give to aspiring interns for finding preceptors?
Rebecca: The path towards finding preceptors most certainly is not an easy one. I’ve learned a lot and I’d love to pass on advice towards prospective distance dietetic interns.

First, I HIGHLY recommend using eatrightPRO’s “Find A Preceptor” database. I CANNOT stress this enough. That is precisely how I found the vast majority of my preceptors, including Felicia Porrazza at Porrazza Nutrition LLC and My Dietitian Journey. Visit the website for more information!

Second, I suggest reaching out to any former mentors, professors, work supervisors, current distance dietetic interns, and most importantly, your program director for preceptor contacts. You’ll find that the Dietitian world is very interconnected, and someone is bound to know someone who can take you on for a rotation.

Third, the clinical rotation will probably be the hardest to secure. You will most likely receive a lot of rejections before an acceptance, but do NOT give up. You will find a site! Call your local clinics, hospitals, and long-term care facilities.

How do you stay organized during your internship with balancing rotations, preceptor tasks, and homework assignments?
Rebecca: Calendars! Everyone’s organization style is going to vary. In my case, writing down all my tasks and adhering to their respective deadlines on a calendar made everything doable. Given that my program is accelerated, meaning at least 40 hours a week for the rotation alone, there were many occasions where I would have to make the personal sacrifice of using weekends to finalize assignments, projects, and internship related practice quizzes.

What was the biggest takeaway you learned from your internship experience?
Rebecca: The biggest takeaway was learning that the possibilities for a dietitian are endless! I find that people outside of the field assume that dietitians either end up in a clinic, hospital, or are simply unaware of what dietitians are truly capable of. I’ve worked with dietitians in private practice, traditional clinical settings, meal-kit start-up companies, major corporations, government organizations, as professors for accredited colleges/universities, and more!

For more information on the career paths in the field of dietetics, check out the blog.

Any other words of advice you want to share for dietetic interns for success in their internship?
Rebecca: The dietetic internship process will be time consuming, and you may feel overwhelmed at moments; however, it’s temporary and you will get through it. Also, I do have one general rule: always remain professional and thank your preceptors for taking you on! They are taking their time to help you grow within your career, and quite frankly, that is an honor. I wish any current or prospective dietetic interns the best of luck!

Thank you to Rebecca for providing great insight into the dietetic internship from the perspective of a current intern. To all of my fellow Dietitians out there, if you have the availability to take on a Dietetic intern, please do so! Being a preceptor is rewarding in so many ways, with the biggest being able to give back to the profession and elevate the field of dietetics. You can also obtain CPE hours for precepting from the CDR, which is another win! I continue to learn through my dietetic interns and although precepting can be time consuming, it is well worth it!

Do You Need a Business Coach?

Do you need to hire a business coach to succeed in private practice? Today’s post discusses whether or not you need a business coach and what things to consider if you do decide to hire one.

What is a Business Coach?
A business coach is essentially someone who will guide and assist you in various aspects of business (like starting a private practice as a Dietitian or how to get clients). A business coach is usually an experienced entrepreneur and may be present in all areas of business (not just dietetics). A business coach is there to provide personalized advice specific to your needs.

What Does Coaching Entail?
Coaching is a collaborative relationship, a partnership really, between a coach and client (or coachee). The process of coaching can be structured with regular meetings; however, the agenda/topics are typically created together.

What are the Benefits of Having a Business Coach?
A business coach can: help you design a vision for your business, help you create business goals, provide guidance, accountability, and support, provide feedback, resources, tools, share their experience to help you avoid mistakes (learning experiences), keep you on track and ultimately, demystify the process of starting and growing a business. It is important to note that a coach won’t be doing things for you. They also won’t inherently make you successful or eliminate all business problems you will encounter; though they can certainly help to guide you through those problems!

What Should You Consider When Working with a Business Coach?
Make sure your coach will be TEACHING you how to do all the things you need and not just TELLING you what to do. A good coach should set you up for success long-term and not keep you in a space where you NEED them.

Here are some suggested questions you should consider asking a potential coach:
-What is involved in business coaching?
-What is their approach or coaching process with clients?
-How many clients do they currently have?
-Do you get one-on-one time or is this a group coaching program?
-How accessible are they if you have questions?
-Is coaching customizable?
-What is the cost? Is it a one-time cost or an on-going fee?
-What is their experience? (A coach should hopefully have walked the walk!)
-Do you offer a freebie session? (This can allow you time to ask questions, get a feel for their approach, and ensure this is a good fit).

I identify myself as both a coach and mentor, as I provide guidance and expert advice while partnering with my client to ensure we are collaborating together. I work primarily with Dietitians in the beginning stages of their private practice, though I have also worked with Dietitians looking to grow and expand their services! With that said, my coaching program is flexible, tailored to my coachee’s needs.

To learn more about Dietitian services, check out my website!

In summary, you don’t need to have a coach/mentor to be successful in private practice; however, they can certainly make things easier for you!

If paid coaching isn’t an option for you, check out the free resources and coaching through SCORE mentoring, SBA, your local library, and the NEDPG (free resources/mentoring for members). There are also Facebook groups you can join for support, Dietitians who post podcasts and videos on business topics (like me!) and books you can purchase to help you along the way! Some other RDs who provide coaching include: The Reimbursement Dietitian and The Dietitian Project.

For more information, check out the My Dietitian Journey Podcast – Do you need a business coach? ”

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Do You Need Clinical Experience as a New RD?

Do you need to work in clinical for 2 years after becoming a dietitian? Today’s post discusses the pros and cons of going into clinical practice right after becoming a Dietitian, other options for first jobs, and how this can all tie in to starting a private practice!

Why Clinical?
I heard this in my undergrad from instructors and throughout my dietetic internship, “Do 2 years of clinical.” Mostly it is about getting experience and “paying your dues.” Some clinical settings can include hospitals, nursing homes, long-term care facilities, rehabs, etc.

A clinical dietitian’s job will vary by location; however, some duties can include: instructing patients on different diets they are prescribed in the hospital, implementation of MNT (see below), teaching classes, calculating tube feeding recommendations, and screening patients for nutritional risk. Medical Nutrition Therapy is defined as, “Evidence-based medical approach to treating certain chronic conditions through the use of an individually-tailored nutrition plan.”

Here is a link to a Position paper from the AND on the role of MNT and RDNs.

There can be a lot of benefits of going into clinical practice as a new dietitian! You can learn more about MNT and different disease states, you will likely be working with other RDs in a team, which can be great for helping you learn more about not only clinical but the dietetics field, and it can be a great opportunity with competitive a salary. If you’re not sure what you want to do as a Dietitian, this could be a good first job to get more experience and this can provide you with a starting point.

Why Not Clinical?
While clinical practice can be very beneficial, it won’t necessarily teach you about private practice or running a business (i.e. finances, billing insurance, marketing, how to get clients, etc.).

If you are thinking about going into private practice, you can certainly start there; however, there are some things to consider. You won’t get clients right away, so income could be a concern. If you plan to become an insurance provider, it takes some time to get credentialed and ready to accept clients. There’s also the business expenses (on top of your personal ones) that you want to ensure you can pay as an entrepreneur, without the cushion of a steady income from being an employee.

It might be worthwhile to start working part-time or full-time and then building your practice on the side. I started my private practice after getting credentialed as a Dietitian in 2014, but didn’t take on any clients right away (I really just had a website and blog). My first jobs were as a Dietitian at a YMCA (non-profit community center) and a retail Dietitian. The community jobs were more relevant to my long-term goal of going into private practice versus in-patient clinical work! I became an insurance provider in 2015, grew my business and started taking on more clients. In December of 2016, I left my full-time job to pursue private practice full-time.

As a Dietitian, there are many career paths you can take and it really boils down to what you want to pursue. Maybe clinical is for you. Maybe another community setting is right for you. Maybe you have the opportunity to go straight into private practice.

I know some RDs who work part-time in a hospital setting and have a practice on the side. I know other RDs (like me) who teach college-level and have a private practice. The point is, there are many options to suit your needs (professionally and personally) and you don’t NEED to go into one area first (like clinical).

For more information, check out the My Dietitian Journey Podcast on “Clinical Vs. Non-Clinical As a New Dietitian.”

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

How to Get Clients

Today’s blog post is all about how to get clients in private practice! The first part of this blog focuses on ways to enhance your online presence, which helps with SEO (search engine optimization) and the second part focuses on how to reach your potential clients.

Build a Website
First things first, you want to have a website! People want to get to know you before committing to your services. You can certainly hire someone to build a website for you, although there are many more user-friendly web builders out there now.

Some of the key things to include on your website are an about you section, services/products offered, contact page (email, phone, contact form), and a newsletter opt-in or a way to get email addresses. If you have multiple webpages with your website package, include your contact information or scheduling link on various ones to make it easy for clients to connect with you.

Have a Social Media Presence
Having a social media presence can be key in attracting new clients and adding to your credibility as a nutrition professional. A blog and/or YouTube channel can be a great way to share nutrition tips or recipes. Facebook and Instagram can be great platforms for sharing blogs, posting tips, and going “live.” You don’t just need to use one platform, as you can cross-promote content! I would suggest utilizing the business pages and business accounts to separate your personal social media from your professional life. Be consistent with posts, authentic, and provide value (don’t just pitch your services).

Become an Insurance Provider
While you certainly don’t need to be an insurance provider to have a private practice, I will say, it helps a lot with gaining clients. About 95% of my current clients use their insurance. Being an insurance provider is a huge selling point for me when I am trying to create new partnerships with local businesses. You can certainly thrive without taking insurance, so do some research and decide what you think will work the best for you. It does take time to become an in-network provider, so I would suggest starting that process early!

Network (Even with “Your Competition”)
There are plenty of clients to go around! Connecting with other Dietitians in the field can strengthen the profession and be a referral source for you! I have referred clients to Dietitians with different specialties than me or for face-to-face appointments (since I primarily do telehealth).

Think About Strategic Paid Marketing
Before paying for an advertisement, think about whether the ad will target your ideal client. Running Facebook ads could be a great way to promote your business page or a new event you are hosting.

Connect with Local Businesses
When I first started, I made a list of all the different gyms and health centers near me. Before reaching out to them, I would browse their website and social media to get a feel for their mission, clientele, and company offerings (to ensure this could be a good fit). Other professionals you can connect with could be family medical practices, specialists that align with your niche (like gastroenterologists or endocrinologists). If you do plan to accept insurance, see if you can connect with local fire departments or government programs as many might offer health care incentives for their employees. My first few years in business I also joined a Chamber of Commerce which was great for networking with local businesses!

Building your online presence can take time and getting clients will not happen overnight. To break down the process, start with a master list of everything you would want to accomplish with getting clients (online presence, building partnerships, etc.). Then, prioritize your list and choose 1-2 things you can start doing this week!

For more information, check out the My Dietitian Journey Podcast on “How to Get Clients.”

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Setting Rates and Insurance Billing Basics

Back in 2017, I wrote a blog called “Tips for Setting Fees in Private Practice.” Today’s blog post is an updated version of what to consider when setting your rates in private practice as a Dietitian. I added in some more resources and identified some of the basics with insurance billing (if you decide to become a provider).

**As a reminder, all information provided in this post is for educational purposes only. This information is not a substitute for medical or legal advice.**

Setting Your Hourly Rate

When thinking about your hourly rate, there are three key things you want to consider: what other RDs in the area are charging, your demographic area, and your experience and education. When I first set my rates, I started much lower than where I am today. Over the years with gaining experience, getting my masters, and obtaining specialty certifications, I slowly increased my rates to match the value I bring as a Dietitian.

When considering your rates, you also want to think about your desired yearly income. While this won’t be what you make right away, this could allow you to set monthly goal targets. Check out the blog for more information on setting income goals.

Consider Offering Packages

Offering packages can be a great way to offer services at a discounted price OR lump together two types of services (like personal training and nutrition counseling or nutrition counseling and coaching). When designing your packages, make sure you are clear about what is included (think “package perks”). I would also suggest having a breakdown of the services and related cost in the event you are billing a portion to insurance. 

I offer a freebie session for all new clients (Dietitians included) and this is an opportunity for me to not only ensure we are a good fit, but also, review the services and package options I offer. Personally, I also post my rates on my website so clients know what to expect ahead of time. **Important to note that while you can post your rates (i.e. what you charge), you cannot share your reimbursement rates from insurance if you are a provider. This may vary by insurance plan so please review your individual provider contract.**

How This Relates to Insurance Billing

Billing insurance (to be covered in a later post) slightly changes the game. When you bill insurance, you will still bill your usual and customary rate (i.e. your set hourly rate); however, you will only be reimbursed your contractual allowance. This is all based on your set fee schedule, which is provided by each insurance company (and typically provided in the contracting phase). Dietitians are considered “fee-for-service” providers, similar to other healthcare professionals, which basically means we render the service and then bill insurance for reimbursement. 

Key Terms to Know for Insurance Billing

With insurance, there are a few key things you will need to understand to bill appropriately. 

The first are CPT® (Current Procedural Terminology) codes, which describe professional services rendered by healthcare professionals (including Dietitians). Two codes many Dietitians utilize are: 97802 (initial assessment – face to face – individual) and 97803 (reassessment – face to face – individual). CPT® codes are billed in 15-minute increments (1 “unit” being 15-minutes). Billable time for insurance is the real time interaction you have with a client that is synchronous. This can be done face-to-face (like in an office setting), via secure video (HIPAA compliant), or via telephone. This wouldn’t involve the time you spend preparing for a session or emailing clients resources (although email/text coaching could be an add-on). Each insurance company has specific policies regarding telehealth and reimbursement so make to review them. 

The second is ICD-10-CM codes which describe an individual’s disease or medical condition. It is important to note that some codes will require referral from a physician (to specify the diagnosis) and some codes are not billable by Dietitians. One example of an ICD-10-CM code would be Z71.3, which is “Dietary counseling and surveillance”.

Billing insurance can be daunting to learn, so drop a comment below with questions you have about the process.

Insurance Billing Resources

• If you are interested in seeing Medicare’s fee schedule, here is a link for the public information
• For information on the CMS’ 8-minute rule.
• Today’s Dietitian has a post on billing and reimbursement with information on CPT and G codes.
• The Reimbursement Dietitian has a short blog explaining CPT codes commonly used by RDs.
• For information on ICD-10-CM from the CMS
• The Academy of Nutrition has resources on payment.

For more information, check out the My Dietitian Journey Podcast “All About Getting Paid”.

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.

Preparing for Your First Client as a Private Practice Dietitian

Today’s blog post is all about how to prepare for your first client in private practice! For more detailed information on starting a private practice, check out the blog, “Starting a Private Practice: First 5 Steps.”

Business Essentials to Have in Place
There are a few things you will want to make sure you have in place before you see your first client. Basic essentials include: new client forms, a business bank account, method of accepting payment (credit card/checks), how you will record those finances (can be a simple excel sheet), and your location for client sessions (virtual/face-to-face).

Forms/Client Paperwork
Some of the practice forms I have include: a new client form (medical history, goals, insurance information, etc.), business policies, informed consents for nutrition services and telehealth nutrition, privacy notice, acknowledgement of privacy notice and release of information (if needed to share information). I also include a new client welcome letter with information about the first session and a checklist of the forms required. Within the welcome letter, I also include my reschedule and cancellation policies (also in my business policies form).

• HIPPA sample notice on US Dept of Health and Human Services
• Sample HIPAA forms on AND Website
• HIPAA (CDC)
• HIPAA (HHS)

Scheduling Considerations
During the first interaction with a client for scheduling, I confirm the session type (video or phone), payment policies (if self-pay), insurance information (if using for the session), my policy on reschedules and cancellations, and my nutrition philosophy (to ensure we are a good fit). I also make sure to let them know of any required paperwork and relevant referrals. My policy is that all forms need to be filled out via my EMR 24-hours prior to the first session. Once the client has filled out their paperwork via my EMR, I enroll them in appointment reminders (based on the consent forms I have on file).

• Referral link for Simple Practice ($50 credit towards your next SimplePractice subscription renewal)

Preparing for the First Session
Right before the session, I make sure my background is appropriate (for video sessions) and that I have a notepad to take quick notes. I typically don’t fill in the full chart as I go since this tends to be distracting. Before the first session with a client, I review all client forms and hone in on the following key items:

• What diets have they been on in the past?
• What are their main health concerns?
• Why are they seeing a Dietitian?
• Goals they are hoping to achieve
• Red flags that indicate a referral to another professional
• Unclear responses I want to verify during the initial session

Tips for the First Session
Starting the Session
Normally, I start my session with a “thank you” for filling out the forms and a brief overview of what to expect for the session. I follow that with an open-ended question like, “What do you hope to get out of today’s session?” I try to make the client feel comfortable and build initial rapport during the first few minutes (and throughout the session).

Sometimes, a client will jump right into what they are looking to get from the session. Other times, the client may not be sure where to start, so I might start by saying, “We can start off in a few ways – reviewing your current eating plan with a food recall, brainstorm about your wellness vision, or general healthy eating tips. Do any of those options spark interest for you or do you have something else in mind?” This is also where you can tie in relevant information from the paperwork like, “I noticed in your paperwork you were interested in disease management, could you tell me more about that?”

Keeping the Session Flow
Motivational interviewing is my go-to approach with most client sessions as I find this communication style leads to collaboration and engagement. Using open-ended questions and reflections throughout the session really promote discussion and help me to learn more about the client to better help them. While the client is talking, make sure to be actively listening versus planning out your next response. Watch the client’s body language and listen to their vocal tonality.

• For More Information on Motivational Interviewing

Closing the Session
There are a few ways you might choose to end the first session. I tend to lean towards offering a brief session summary followed by, “We have about 5 minutes left in today’s session. Was there anything that we didn’t cover that you want to touch on now or in a future session?” I normally follow this with, “Were you interested in scheduling for a follow-up now, or did you want to reach out to me to schedule?”

Usually, clients schedule right away; however, some clients may have gotten enough information from the first session to go at it alone or some might find this isn’t the best time for them to continue with sessions (financial or personal reasons). I find asking if they want to reach out to schedule avoids some awkwardness in having the client say “no.” Always leave the door open for scheduling by letting the client know the best way to contact you if they are interested in following up.

What to Do After the Session
Charting
Charting format may not matter too much if you are in private practice; however, if billing insurance you will need to make sure your client chart includes these key things: time of session (start and end + minutes), CPT/ICD codes, provider signature, and clear/relevant session notes. Always check your insurance contracts for additional required information and medical policies.

If using an EMR, they typically have pre-made templates you can use as a starting point. I typically chart in an ADIME format: assessment (food/nutrition hx, biochemical, anthropometrics, client hx), diagnosis (PES), intervention (nutrition prescription, nutrition education, goals), and monitoring and evaluation (follow-up, what’s included).

• For More Information on ADIME
• For More Information on the NCP

Other
Other things to do after the session include: billing insurance (if you are a provider), sending relevant handouts/emails (if requested by the client), scheduling the client’s next appointment (in your EMR if using), and of course, reflecting on the session (what went well, what needs improvement), and congratulating yourself on that first client!

For more information, check out the My Dietitian Journey Podcast on preparing for your first client session!

Disclaimer: Information provided is not intended to constitute legal or medical advice. All information is for educational purposes only.