Everything a Dietitian Practice Needs

State rules for dietitians differ, including what requires a license and what does not. North Carolina, for example, requires a license to provide medical nutrition therapy, which it defines as nutrition care services to manage or treat a medical condition, and to use the titles dietitian/nutritionist or nutritionist or the letters LD, LN or LDN. A new license usually means transcripts, proof of your supervised practice and exam, and verification of other licenses you hold.

The Dietitian Licensure Compact will let a licensed dietitian practice in other member states through a compact privilege, which the compact defines as equivalent to a license there. To use it, you hold an unencumbered license in your home state, either hold the registered dietitian credential from the Commission on Dietetic Registration (CDR) or meet the compact's education and exam standards, notify the compact commission, pay the fees, and meet any jurisprudence requirement in each remote state. A privilege expires with your home state license, and you follow the laws of each state where you use it. The compact's current status is shown with the compact details on this page.

Until a compact privilege covers you, you need a license in each state that requires one where your clients are. Where a board requires the applicant to submit their own application, we prepare everything and you submit it.

Medicare pays registered dietitians and nutrition professionals directly for medical nutrition therapy (MNT). To qualify, you need a bachelor's or higher degree with an accredited nutrition or dietetics program, at least 900 hours of supervised dietetics practice, and a state license or certification where you work. A registered dietitian in good standing with CDR is deemed to meet the degree and supervised practice requirements, and in a state with no license or certification, CDR registration meets the licensure requirement.

You must enroll in Medicare to bill MNT, and assignment is required, so you accept Medicare's allowed amount as payment in full. Medicare pays the lesser of your charge or 85% of the physician fee schedule amount. MNT cannot be billed incident to a physician's services, so it is billed under your own enrollment or reassigned to the practice or hospital you work for.

Medicare covers MNT only for beneficiaries with diabetes or renal disease, and only on a physician's referral. Renal disease here means chronic renal insufficiency, with a GFR of 15 to 59, or the 36 months after a kidney transplant. MNT is not covered for beneficiaries on maintenance dialysis, and it cannot be billed on the same day as diabetes self-management training (DSMT) for the same patient, though a patient can receive the full amount of both benefits in the same year.

Coverage is 3 hours in the first calendar year and 2 follow-up hours in each later year, with a new referral every year. Unused initial hours do not carry over. If the physician determines there is a change in diagnosis, medical condition or treatment regimen, a second referral covers additional hours. The referring physician's NPI must be on the claim, and claims without it are returned. The referral has to come from a physician; other practitioners cannot make it for this benefit.

Commercial plans set their own rules for nutrition counseling, including which diagnoses they cover, how many visits a year, and whether they need a referral or prior authorization. We load each payer's rules so claims go out right the first time, and we follow up on every claim until it is paid.

Medicare MNT runs on the referral. The benefit is built around an initial assessment, follow-up interventions and reassessments, and the hours covered in an episode of care cannot be exceeded without a second referral from the physician. The referring physician documents the referral in the patient's own record, and Medicare pays only for MNT the patient actually attended and you documented. Visits can be individual or group, without restriction.

Our EHR keeps each referral, its date and the hours used against it on the client's chart, so the scheduler can see when a new referral is needed before booking. Templates for assessments and follow-ups carry the codes and time from the note to the claim.

Commercial plans, Medicare Advantage plans and Medicaid managed care plans credential dietitians separately, and most rely on a complete, attested CAQH ProView profile. Some networks are closed to new dietitians in some areas, and when that happens we ask for an exception where your specialty, languages or availability fill a gap.

A virtual practice that serves clients in several states needs credentialing with the plans in each of those states, not just its home state. We build a payer plan from where your clients live, apply with each plan, and track every application until you have an effective date.

For a telehealth visit, the state that matters is the one where the client is during the visit. A client who moves or travels can put you outside your license, so we map your clients against your licenses and tell you when a gap appears.

Our telehealth platform runs HIPAA video visits that clients join from a browser with no app to install, covered by a signed business associate agreement. Medicare's current telehealth rules, with their dates, are shown in the callout here.

If you bill insurance electronically, HIPAA applies to your practice. Our program covers your security risk assessment, written privacy and security policies, a Notice of Privacy Practices, staff training, business associate agreements with every vendor, and a breach response plan.

Nutrition practices often use apps for food logs, glucose data, messaging and scheduling. Each one that handles client information needs a business associate agreement, and we review new tools before you start using them. We also review your website's analytics and ad pixels so client information never reaches an ad platform.

We set up the practice in the order that avoids waiting: entity formation coordinated with your attorney and accountant, an organizational NPI and tax registrations, insurance, licenses, then credentialing, because payer approvals take the longest. Your EHR, scheduling, intake forms, patient portal and payment processing are configured and tested before your first client.

If you want both insurance and cash-pay clients, we set up packages and memberships alongside insurance billing, with superbills through the patient portal for clients who want to seek reimbursement from their own plans. Payment processing accepts cards, HSA and FSA cards and ACH.