Mastering Insurance Billing for Couples and Families: A Guide for Dietitians

April 08, 2024

If you are a dietitian looking to expand your practice by offering group, family, or couples sessions, navigating through the maze of insurance billing can seem like a daunting task. However, armed with the right knowledge and strategy, insurance billing can add a worthwhile stream of income to your practice.

That’s why we spoke with Amy Plano, aka the Reimbursement Dietitian. She helps other dietitians navigate insurance billing and get paid well for their work.

Amy said it took her the last decade to learn all the ins and outs of insurance billing. She’d like to pass on her knowledge to help dietitians bill insurance so they can earn a healthy income while helping patients get more access to high-quality nutritional services. She says it took her so long to learn insurance billing practices because the information is scattered and the resources are sparse. She didn’t want the same to happen to other dietitians, so she created resources to share in her free offerings and paid services

“I had to create these [resources] because I didn’t have a choice. And for me, personally, I started accepting insurance in my practice because I wanted to serve people who needed our services, not just ones that could afford it.”

And so dietitians and other practitioners can learn from Amy’s many years of mistakes and trials in billing insurance. Let’s see what she recommends to look out for when billing couples and families.

Insurance billing for couples and families can increase errors

When done incorrectly, billing insurance can waste both your time and money. Billing errors or omissions mean you’re reimbursed less money despite having performed the services required.

Amy’s take: It’s easy to make mistakes when billing couples and families. Many practitioners new to insurance billing may not benefit from jumping right away into counseling groups, even though it may seem financially attractive. That’s because each individual in the group may have different health insurance, and each service needs to be billed to each individual.

However, there are benefits to treating couples and families, but Amy wants practitioners to know what common pitfalls to watch out for.

Master the one-to-one insurance billing basics first

Keep in mind that managing a group requires a slightly different skillset than one-on-one sessions. While the idea of seeing multiple clients at once is tempting, group sessions have their own unique set of requirements. Don’t worry though, with a little practice and focus, you’ll be able to master both one-on-one and group interactions.

Treat each patient as an individual, even when in a group

Understanding the nuances of insurance billing in a group setting is foundational. Each patient treated, despite being part of a group, will require an individual account and a separate claim.

This holds true whether dealing with family sessions, couple consultations, or larger group settings. Billing insurance can become much simpler when you align with the updated regulations and guidelines.

The differences in CPT codes for groups vs. individuals

First off, there are several billing codes to know when billing insurance for groups, such as couples and families. Not knowing the differences between them can cause you to miss out on important reimbursement income.

For example, Amy says CPT code 97804, Medical Nutrition Therapy for groups, is billed in 30-minute increments, whereas code 97802 is meant for initial assessments in 15-minute increments for individuals. If you don’t structure your care plans and services properly, warns Amy, you can end up under-charging and under-earning, or risk having your claims rejected.

Individual assessments for groups and couples

Before you can counsel in groups or couples, each person requires their own assessment. Amy ensures she blocks off enough time for one-to-one assessments, in accordance with insurance billing policies:

“I am making sure, number one, in my schedule, I have enough time. So in my world, I allocate 90 minutes if I’m working with a couple and I actually don’t treat that as a group. I treat that as two separate individuals: 45 minutes with one client, 45 minutes with the other.”

For this initial nutritional assessment, the billing code 97802 is applied for each individual, and not for the couple or group combined.

It’s also important that each patient, whether providing services solo or in a group, needs their own CMS 1500 form. Missing this step would mean missing out on insurance reimbursement for that patient.

Insurance coverage can vary among family members

In scenarios involving couples or families, the variability in individual insurance coverage comes into play.

“Generally speaking most family members will have the same insurance plan,” Amy says, “but there’s also a possibility that they may not if both spouses are working and both have awesome insurance, then they may have their own independently.”

If there are different insurance plans in the mix, there may be different ICD 10 codes accepted, so it pays to do your research.

It may be necessary to employ different billing codes or monitor a unique set of sessions for each participant. Ensuring that each group member receives a comprehensive individual assessment is vital, not only for your professional records but also for accurate insurance billing.

Know what’s required for each billing code

It’s the dietitian’s responsibility to understand what codes are accepted under which plans, Amy explains. Further, some insurance plans require qualifying diagnoses, such as celiac disease, for certain treatments or services. Other codes might require a doctor’s referral. If not everyone has a referral, or not everyone has the same diagnosis, not all family members can be billed in the same manner.

You can see how it can get confusing, fast. If you do your preparation ahead of time and research each insurance plan’s billing policies, you set yourself up for success.

Plan ahead to reduce your insurance billing workload

As if you didn’t have enough paperwork to deal with, the administrative demands of group sessions can easily overshadow your responsibility as a healthcare provider. To avoid this extra burden, approach these sessions with a well-defined plan, strategy, and a patient-centric outlook. You can even set your schedule to accommodate families and couples.

Amy ensures she has “enough time and bandwidth because working with families requires a lot of bandwidth.” Adopting a proactive approach in planning each session ensures excellent care while simplifying the billing process.

Meticulous organization of patient information is essential. Guarantee that each patient has an individual account and file and that no participant is overlooked in the billing cycle. Preparation steps, such as obtaining credit card authorization forms for all patients, might be a pain but are crucial for minimizing errors in the future.

Stay flexible and adapt when billing insurance for groups

General guidelines exist for conducting group insurance billing, but it’s important to recognize that each case is unique. Variances in individual needs, family dynamics, and insurance coverage and plans necessitate a flexible and adaptable approach. While having systems, automations, and templates in place will save you time and frustration overall, you can then tailor your billing strategies to meet the specific requirements of your patients.

Use technology to make billing insurance for couples and families easier.

The rapid advancements in technology have ushered in a variety of reliable platforms capable of simplifying pitfalls associated with combined billing. These technological solutions can significantly streamline your billing operations, freeing up more time to focus on patient care rather than administrative duties.

For example, the Claim.MD insurance billing integration within Practice Better can help you track all of your claims within your EHR, and not on a spreadsheet. Using technology can further increase your efficiency, or even the efficiency of your medical biller if you hire one, and help you grow your practice without getting bogged down by extra data entry.

A view of the Claim.MD insurance billing integration in Practice Better.
View all of your claims and their status in one easy interface, right in your EHR in Practice Better.

When treating groups or individuals, offer value and deliver quality

However, you choose to run your practice, Amy reminds us that the key to success lies in the amazing care you provide. Whether you’re working with a group or a couple, always strive to exceed your patients’ expectations. Sometimes, the value can get diluted when you’re trying to balance the needs of all patients in a group, so it’s important to constantly assess whether the group approach is right for you and for your patients.

“You have to be able to critically think and also serve up killer value. And in the insurance-based world, sometimes we get away from that because we’re not selling on social media as much, but you have to have a product, which is your session, that delivers killer value that gets people coming back.”

Make every session count by delivering personalized interventions that cater to their unique needs. This can be harder in group sessions when everyone has different wants and needs, but it’s still crucial. By giving the best patient experience you can, you’ll build an incredible client base that will stick with you for the long haul. Focus on providing top-notch care, and watch your practice thrive.

Get billing with confidence

Transitioning into group, family, or couple sessions with confidence requires a strategic, patient-centric approach. By mastering the basics, planning meticulously, offering unparalleled value, remaining flexible, and leveraging technology, you can ensure your practice thrives while providing your patients with the essential healthcare services they need. Keep in mind that despite the challenges that may arise, nothing is insurmountable with the right knowledge, strategy, and tools at your disposal.

If you want to learn more about Amy, The Reimbursement Dietitian, you can check out her website.

Practice Better has an insurance billing integration with Claim.MD that can help you by submitting, tracking, and billing it all from one platform. Not a customer yet? Start a free 14-day trial to see how you can turn hassle into happiness.

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