Why You Need to Understand Regulatory Bodies as a Registered Dietitian

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Access to and comfort with telehealth is making it easier than ever for registered dietitians to expand their businesses. As a registered dietitian, it’s important to remain up-to-date with all of the laws and regulations at play as you think about taking advantage of the opportunities presented in our increasingly digital world. 

As a registered dietitian, it is critical to remain apprised of licensure requirements that protect our profession. As a business owner, it is your responsibility to understand and respect the laws governing business practices across the country and in the states where your business operates. 

On the shortlist, and in order of importance, you should be well-versed in or seek professional counsel around:

  • Federal and state labor law
  • Federal insurance law
  • Individual insurance carrier contracts
  • National and state CDR registration / licensure regulations

We’ve recognized that private practice forums are buzzing with questions in this area, so we wanted to share some insights that may help any providers who are navigating this territory on their own.

Federal and State Labor Law

Do you have employees or 1099 independent contractors working for your registered dietitian private practice? If so, it is your responsibility as a business owner to know these laws and understand how they impact your business. The federal standard, referred to as ABC, is the standard for classification of independent contractors versus employees. The standard indicates that unless they meet ALL three of the below criteria, they must be classified as an employee and granted all rights and protections as such. The ABC standards (as simplified by Cornell Law):

  1. The worker is free from the employer’s control or direction in performing the work.
  2. The work takes place outside the usual course of the business of the company and off the site of the business.
  3. Customarily, the worker is engaged in an independent trade, occupation, profession, or business.

Please take particular note of “B” if your core business service is the provision of individual or group nutrition counseling and you perform this service either fully or in part through 1099 contractors. 

While many states have their own standards for this classification, all must comply at a minimum with this federal standard. It is important to research both your state and the federal laws to ensure your registered dietitian private practice is compliant. 

Insurance Law and Carrier Contracts

There are laws in place to protect patients from unethical business practices in healthcare. Anti-kickback laws intend to protect patients from referral practices that are made in the financial interest of the referring provider rather than the best interest of the patient. This is a federal law as it applies to Medicare / Medicaid and also present in most (if not all) private carrier contracts. In simple terms, you cannot pay or receive payment or financial gain from a referral (i.e. pay a gym a finder’s fee or referral fee for sending you people, give a doctor a percentage of collections in lieu of rent, etc.). 

Additionally, there have been conversations circulating about the ethics versus legality of contracting a registered dietitian in a state other than that in which they reside/practice. It is a best practice to thoroughly review your carrier contracts as in many, if not all, cases, the carrier specifically requires the address at which the service is performed. 

Just because you are getting paid on a claim, it does not mean you get to keep the money. When a claim is paid or denied, it is because the information you provided either does or does not match the coverage of your client. This has no relevance if you are audited and are in violation of any of the standards in your contract with an insurance carrier. They have the right to and will take back any and all payments during the audited timeframe. This is a whole topic on its own so we will follow up with another post on the specifics. The important take-away is that you should ensure that you understand and are adhering to the contract you signed with the carrier (i.e. service address, documentation, etc.), and not just assuming that you are all set because you are getting paid.

Insurance fraud is a felony. It is not our role to provide legal advice for registered dietitians in this post or any other forum; however, it is important to note if you have not thoroughly read the contracts you have signed with insurance carriers or state/federal insurance providers. 

CDR/State Licensure Regulations

Although last on the priority list, this seems to be the beginning and end of the research many registered dietitians do as they think about offering services out-of-state or contracting with RDs in other states. The CDR offers guidance to help navigate the varying protections of title/license/registration across state lines; however, this only applies to professional protections and liabilities. It is important to understand the distinction between protecting your license and the legal operation of your business.

Protect Your Private Practice

If you are the owner of a registered dietitian practice, you are the only one responsible for your choices. The Department of Labor, insurance carriers, and the CDR will not grant you leniency because another RD in a Facebook group told you to run your business a certain way. Protect yourself and ask for help when you need it. 

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