Getting started with virtual visits requires more than just a video chat link.
From logistics for visit scheduling and paperwork to reimbursement and payment, there are important considerations for Registered Dietitians (RDNs).
There is a misconception that RDNs have either an in-person or virtual practice. In reality, many nutrition private practice owners are blurring that line with a hybrid practice that offers clients options.
Insurance coverage for virtual visits is expanding. RDNs that are knowledgeable about telehealth are positioned to take advantage of the growth of online nutrition counseling.
Telehealth Basics for Going Virtual
To support going virtual, RD2RD hosted a telehealth basics learning series. Our RDN guest experts focused on topics such as logistics, counseling skills, billing/reimbursement as well as marketing.
This learning series was organized to address the need for RDNs during COVID-19, but the information applies beyond this crisis.
In this article you’ll find tips gleaned from their Q&A sessions as well as links to resources.
To dive deeper and watch each guest expert’s interview, visit Going Virtual, Telehealth Basics for RDNs.
1. Help clients feel at ease
Clients may be apprehensive about virtual visits. Just because your client has experience using video technology such as FaceTime or Skype doesn’t mean she’ll feel confident seeing a health care provider that way.
One the most important things we can do to help clients feel at ease is to set expectations. This starts with anticipating questions your clients will have about the process. It also includes providing tips that will ensure a smooth and successful experience.
Nicole Goodrich: We obtain consent using a telehealth specific form and provide clients with a tip sheet prior to each visit.
Amy Helms: People are worried that they have to still be perfect. I gave clients some guidelines about being comfortable, being in a quiet place and avoiding distractions if they can.
Provide a Tip Sheet
Once you’ve identified a list of frequently asked questions or best practices, create a resource you can share with your clients. Include this tip sheet with your visit reminders or in your onboarding paperwork.
Grab our tip sheet template and customize for your practice.
Take time for small talk
When seeing clients in person, there is often a natural flow of conversation as you settle into the office or consult room. Usually this involves some small talk or lighter topics with a transition to the session over the course of the first few minutes of the visit.
With virtual visits, don’t skip over taking time to connect and have light conversation. It can be tempting to dive right into reviewing the nutrition history form or education topics. However, establishing a relationship and building rapport are just as important in a virtual environment as in person.
Amy Helms: One thing I’ve heard from other practitioners is that sessions are shorter because they don’t have that small talk before and after. But I think that small talk is what our clients so desperately need.
2. Create an onboarding process forms, appointment reminders, etc.
Nutrition practice owners often see clients both virtually and in person. However, using the same paperwork and process for both can create confusion for clients and extra work for you.
Simple references in your forms or appointment notices to “bring with you to your visit” can be confusing for clients.
Have a well-designed process for virtual clients. From scheduling to paperwork and visit reminders, there are many steps involved in a successful telehealth visit.
Leverage automation for your virtual nutrition visits
One of the keys to making visits efficient is to use automation. This often involves technology tools such as practice management software.
For a monthly or annual fee, these services provide you with an integrated way to run the day-to-day elements of virtual practice.
Common features include online scheduling, secure payment for credit cards, insurance billing, electronic paperwork, charting templates/documentation and secure video for your online visits. These tools also are HIPAA compliant.
While it isn’t required to have a software tool, it is one of the smartest investments you can make for your virtual practice.
Below is a list of practice management software programs with HIPAA compliant telehealth.
Don’t wait to automate
In the early stages before you have a fully booked practice, you may have time to handle lots of manual tasks such as back and forth messages to schedule visits, sending reminder emails or charting. However, as your practice grows, this will change.
Taking time early on to create process that will scale up easily as your practice grows is a smart decision. Automation will allow you to spend more time in direct care that generates revenue and not manual office tasks that could be easily handled by technology.
Nicole Goodrich: Our practice [Anderson’s Nutrition] is fairly large. We’ve serviced over 1500 clients in the past 10 years. From that, you learn. We went paperless more than 6 years ago. If you’re a paper-based system, your first obstacle is to get into a paperless system.
Test your process from the client perspective
Once you’ve setup your onboarding process, you need to test it. Many practice owners only take the time to examine their process from the provider perspective.
Test every step of your process from the client perspective. Simple mistakes such as having your office address added by default to your appointment confirmation messages can cause confusion for clients.
Better yet, have a family member or friend that is unfamiliar with your business, or has never had a telehealth visit test it out.
3. Make your paperwork a priority
There are essential forms every nutrition practice owner must have and there are a few extra considerations when you’re providing services virtually.
Get consent (have telehealth specific language)
When seeing clients in an office environment, you have more control over what happens during the visit. You likely have practices in place to ensure privacy of visits.
When your client visits are virtual, you need to advise them of the privacy considerations of telehealth.
Nicole Goodrich – The consent form is really about their risks and outlining best practices. Even if you as a provider are using a HIPAA compliant telehealth platform, your client may be sitting at a coffee shop on speaker and everyone can hear that conversation.
For a deep dive into the logistics, technology and more of a virtual practice, watch session 1 of the Going Virtual series. Nicole Goodrich walks through these in detail.
There are sample consent forms you can use as a template when creating your own, but it’s always advisable to obtain review by an attorney that can consider your unique situation and any laws specific to your state or states your clients reside in.
Check out complete telehealth start up form from Nicole Goodrich’s RD2RD store.
Have strong policies and get them signed
The convenience of telehealth doesn’t mean that clients won’t be late or no show. Having strong policies is important for your virtual practice. This includes office policies covering topics such as cancellations, no shows and financial responsibility.
Be sure that you verify the client has signed your paperwork in advance of the visit. It’s hard to enforce a cancellation policy that your client didn’t agree to.
A common practice is to require that office policies be signed and returned at least 2-3 days in advance of a client’s scheduled visit. Other paperwork such as your nutrition history or profile sheet may be done at the first visit, if you prefer.
Electronic paperwork makes this process more convenient for both clients and you. Secure online forms and digital signatures is a core feature of most practice management tools.
4. Understand billing and insurance benefits
The topic of billing and insurance for nutrition counseling is complex. A complete review is beyond the scope of this article. Instead, specific details unique to telehealth billing will be included.
As nutrition practice owners, we often bill insurance on behalf of our clients using a CMS-1500 form submitted electronically. This process does not need to change for telehealth visits.
Telehealth is still considered a face-to-face visit. The claim form will indicate that the service was performed using telehealth, not in-person.
Typically, this includes updating the place of service as well as adding a modifier to indicate that you utilized a video technology.
For a deep dive into how to complete a CMS-1500 form for telehealth, watch session 2 of the Going Virtual series. Steve Della Croce walks through the essential elements.
Steve Della Croce: What I love about doing billing for nutrition is that we only have a couple of codes to choose from. Don’t over-complicate things. Do the basics.
Coverage for telehealth varies. Add to your eligibility and verification of benefits process/script specific questions related to telehealth coverage. Take notes and keep record of information you’re provided.
Grab this free tip sheet for verification of benefits.
5. Connect with others and use resources
You don’t have to figure everything out on your own. There are resources and communities that can help you.
Here is a list of helpful tools.
Going Virtual, Telehealth Tips for RDNs Learning Series
Access video replays of all sessions.
Session 1: Logistics, Workflow and Technology for Virtual Visits with Nicole Goodrich, MBA, RDN
Session 2: Coverage, Billing and Reimbursement with Steve della Croce, MS, RDN
Session 3: Marketing Your Business During a Crisis with Jamie Mass, MS, RDN and Alissa Rumsey, MS, RDN
Session 4: Behind the Scenes of a Virtual Practice with Gabbi Berkow, MA, RDN
Session 5: Counseling Skills and Best Practices for Virtual Visits with Jessica Edelglass, MS, RDN and Amy Helms, LMSW, RD, CEDRD-S
Practice Management Software Programs with HIPAA Compliant Telehealth
Academy of Nutrition and Dietetics Resources (membership required to access):
Going virtual is an exciting opportunity for RDNs. Face-to-face visits using video technology offer convenience for clients. Insurance companies are also expanding coverage for telehealth.
Recognizing the opportunity and taking action to incorporate virtual visits is a needed step for RDNs.
There is a learning curve but connecting with others, utilizing available resources and leveraging technology tools can make the process easier.