AWM: Payment for Services 2022
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
AWM: Payment for Services
It is reasonable and necessary for registered dietitian nutritionists or international equivalents to be aware of and utilize existing channels of payment for services for adults with overweight or obesity to improve client access to care.
Risks/Harms of Implementing This Recommendation
There are no known risks or harms of implementing this recommendation.
Conditions of Application
Dietitians should be aware of appropriate billing practices and codes to receive payment for adult overweight and obesity interventions when possible (Tewksbury, Nwankwo et al. 2022). Dietitians working in private practice or contracting with a primary care provider enroll as providers through the public and private payers common to clients in their area. To facilitate payment for services, dietitians obtain a National Provider Identifier (NPI) (Academy of Nutrition and Dietitics 2021). Dietitians can take advantage of resources available through the Academy to inform billing practices (Academy of Nutrition and Dietitics 2021). The Intensive Behavioral Therapy for Obesity toolkit gives detailed guidance on billing for obesity services (Academy of Nutrition and Dietitics 2017). Management for obesity may be more likely to be covered by public and private payers than management for overweight (Centers for Medicare and Medicaid Services 2015). For up-to-date best practices regarding public and private payer reimbursement for overweight and obesity management services, dietitians can contact their Academy Affiliate or their local association’s Nutrition Services Payment Specialist. Dietitians leverage demonstrated clinical and cost benefits to advocate for payment of services for adults with overweight or obesity under public and private payers’ fee-for-service and alternative payment models (Academy of Nutrition and Dietitics 2017).
Payers may or may not cover telehealth visits as they would in-person contacts, and dietitians work with clients and public and private payers to understand what services will be covered to ensure telehealth visits are covered when possible. MNT using a group delivery is unlikely to be eligible for public or private payer reimbursement, so clients will likely have to pay for these sessions out-of-pocket. Dietitians may wish to create a bundle of services related to overweight and obesity management intervention using a group delivery method for adult clients to purchase to increase usability and participation.
Dietitians play an important role in advocating for the efficacy of the profession and the importance of payment for overweight and obesity management services. Dietitians can utilize the Academy’s Action Alerts to take action on current legislation for better food, nutrition and health policies (Academy of Nutrition and Dietetics 2022).
Potential Costs Associated with Application
Potential costs of implementing this recommendation are time for the dietitian to access payment for services and/or outsourcing billing responsibilities to a medical billing specialist. Clients who have public or private payer reimbursement for MNT appointment costs must pay for services up-front and wait for reimbursement.
Payment of nutrition care services remains a major barrier to care for clients with overweight or obesity and the dietitians serving them. Accessing payment options, when possible, can improve access to care. LOW certainty of evidence demonstrated that overweight and obesity management interventions provided by dietitians may be cost-effective (Academy of Nutrition and Dietetics' Evidence Analysis Center 2021, Morgan-Bathke M 2022). Prevention of serious adverse health outcomes from dietitian services may allow for substantial cost savings over time. More information on the evidence supporting these recommendations can be found in the Summary of Findings Table and Relationships between Recommendation Statements and Evidence Table.
Recommendation Strength Rationale
Consensus recommendations are "best practice" recommendations. Effects of these practices are not easily or typically examined in research. However, expert panel members determined, based on clinical experience and related evidence, that these recommendations are important to consider when delivering weight management interventions.
No minority opinions.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
In adults with overweight or obesity, what is the cost-effectiveness of weight management interventions provided by an RDN or international equivalent, compared to usual care or no intervention from an RDN?
Hagberg L, Winkvist A, Brekke H,Bertz F,Hellebö Johansson E,Huseinovic E. Cost-effectiveness and quality of life of a diet intervention postpartum: 2-year results from a randomized controlled trial. BMC Public Health 2019; 19:38
Padwal R, Klarenbach S, Sharma A, Fradette M, Jelinski S, Edwards A, Majumdar S. The evaluating self-management and educational support in severely obese patients awaiting multidisciplinary bariatric care (EVOLUTION) trial: principal results. BMC Medicine 2017; 15:46
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
- Academy of Nutrition and Dietetics' Evidence Analysis Center. (2021, July 2021). Adult Weight Management Systematic Review. 2021. https://andeal.org/awm. Accessed on July 27, 2021.
- Academy of Nutrition and Dietetics. Action Center 2022. https://www.eatrightpro.org/advocacy/take-action/action-center. Accessed August 31, 2022.
- Academy of Nutrition and Dietitics. Intensive Behavioral Therapy for Obesity 2017. https://www.eatrightstore.org/product-type/toolkits/intensive-behavioral-therapy-for-obesity-putting-it-into-practice. Accessed September 17, 2021.
- Academy of Nutrition and Dietitics. Obtaining an NPI or EIN 2021. https://www.eatrightpro.org/payment/getting-started/becoming-a-provider/obtaining-an-npi-or-ein. Accessed November 4, 2021.
- Academy of Nutrition and Dietitics. Payment 2021 https://www.eatrightpro.org/payment. Accessed September 17, 2021.
- Centers for Medicare and Medicaid Services. Intensive Behavioral Therapy for Obesity 2015. https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=253. Accessed October 11, 2021.
- Morgan-Bathke M, Baxter SD, Halliday TM, Lynch A, Malik N, Raynor HA, Garay JL, Rozga M, Weight Management Interventions Provided by a Dietitian for Adults with Overweight or Obesity: An Evidence Analysis Center Systematic Review and Meta-Analysis. J Acad Nutr Diet. 2022 Mar 25;S2212-2672(22)00170-8. PMID: 35788061
- Tewksbury C, Nwankwo R, Peterson J. Academy of Nutrition and Dietetics: Revised 2022 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Adult Weight Management. J Acad Nutr Diet. 2022 Oct;122(10):1940-1954.e45. PMID: 35738538