When you file a claim to an insurance company and it gets finalized, you, as the provider, will get remittance advice, which explains the insurance company’s rationale for that claim’s payment (or lack of). The remittance advice is sent to you as a written summary of what the insurance company will cover for a particular claim. The remittance advice outlines what the insurance company paid, the amount that was applied to a client’s deductible, and what amount may now be due from your client. It’s oftentimes accompanied by a check or statement of electronic payment.
Think about where you conduct the majority of your nutrition counseling visits – are they at your office, an MD’s office, or perhaps your home office? Do you conduct home visits or see clients via telehealth sessions?
Did you know there are approximately 100 different location codes for use when filing claims?
Do you have a burning billing question? We oftentimes receive questions from you – and there’s oftentimes overlap in the questions that you all need answers to! That’s why we’ve compiled a short list of questions and answers for you today to read and refer back to. We hope you find this helpful. And please let us know what questions you would add to this list – we’ll answer them in a future installment!
If Aetna is one of the insurance companies that you're participating with, or plan to participate with, please be aware that Aetna has updated its nutritional counseling reimbursement policy. The insurance company will continue to reimburse for preventive care, but this update will necessitate some coding shifts in claims that you, as RDNs, can successfully submit for reimbursement.
Pre-authorizations are a piece of the billing puzzle, helping to determine whether your client’s visit with you is deemed medically necessary. Let’s take a step back to explore this process and when these have to be conducted on behalf of your client.
Sometimes, insurance may need additional information to determine whether your nutrition counseling service is medically necessary. This is called a pre-authorization – you’ll sometimes hear this referred to as simply an authorization or a prior authorization.