Update: Academy's Efforts Regarding Aetna's Mid-Level Practitioners Policy and Reimbursement

08/24/2022 - The Academy has been working with Aetna on changes to the company's Mid-Level Practitioners policy, which had resulted in a 25% reduction in the fee schedule for RDNs. The Academy recently held a successful meeting with Aetna executives in which the company decided to reverse its previous decision to reduce payment rates to RDNs, effective July 1 – a big win for the nutrition and dietetics profession.

However, RDNs in some states report that claims payments for dates of service occurring after July 1 are still being processed at 75% of previous fee schedules. The Academy understands that some members may be confused and frustrated with this issue. If you are experiencing reduced payments related to this specific issue, below are additional recommendations to inform your practice decisions.

Provider Notification Laws

Some states require provider notification periods such as 90 days. The notification requirement may apply to policy changes that result in reimbursement increases or reductions. It is possible that some states will not see the reinstatement of Aetna's previous fee schedules until October 1. Aetna reports that it is unable to provide the Academy with a list of states where this could be occurring, as notification requirements may only apply to specific lines of business. The Academy will continue to monitor the situation and provide additional information to RDNs in specific states as information becomes available. Practices and RDNs who continue to receive reduced claims payments for services provided after July 1 will need to seek clarification from Aetna Provider Services in their respective states to clarify the implementation date of the July 1 policy update. Aetna has posted updates internally for their network representatives and has stated it will reinforce the communication. As a reminder, Aetna did not agree to unilaterally adjust claims payments for the time frame in which the April 1 policy was in effect (through June 30).

The Academy encourages all providers to know their rights with payers, the existence of provider notification regulations regarding reimbursement/payment, dispute resolution processes and the existence of laws regarding timely claims payments in their respective states. Academy members can join the Reimbursement and Payment Online Discussion Community.

Other Reasons for Variation in Reimbursement Amounts

There may be explanations for variation in claims payment amounts that are independent of Aetna's earlier policy change. Examples include benefit differences, employer specific rates for services, insurance product type and other variables.

Verifying benefits for MNT and coverage, including when provided via telehealth, prior to delivering services is necessary to understand which payments to collect at the time of service, estimate payments, as well as comply with the No Surprises Act.

If your practice or organization is experiencing variations in payment that are not understandable in Explanation of Benefit statements seek clarification from the payer. RDNs may want to inquire about alignment of reimbursement for all types of payer products if there is considerable payment variation.

The Academy is committed to supporting members in the area of reimbursement by promoting the cost effectiveness of MNT with payers, including health insurance companies such as Aetna. Join the Academy's Reimbursement and Payment Community of Interest to dialogue with other members and learn from colleagues. In addition, the Academy will provide additional as updates as information becomes available.

Contact the Nutrition Services Coverage team to report any states where claims payments are still reduced and are specifically related to Aetna's policy.