Fee splitting is a state law issue that prohibits some professionals from sharing their professional fees with others who were not involved in the care of the patient. For example, if a surgeon offered to share a portion of his or her professional fee with the primary care physician who referred the patient, that would be considered fee splitting in many states. It is a type of prohibition on kickbacks. The exact nature and extent of fee splitting prohibitions varies from state to state. In general, if a professional is paid for the services he or she performs, fee splitting can be avoided. For example, if a physician employs or has an independent contractor relationship with the RDN (where the physician bills for the RDN's services) it would not be considered fee splitting in most states. Arrangements in which an MD or RDN pay money to each other in exchange for referrals could be considered prohibited fee splitting and may also violate other kickback prohibitions.
Charging for Services and Fee-Setting
While the Academy does not collect fee information from RDN members due to anti-trust laws, there are a few resources where fee data is available to the public regarding payment levels for RDNs, such as the fee schedule for RDN Medicare MNT providers. The Medicare fee schedule lists payment rates for MDs, and RDNs by law are paid 85% of the rate physicians receive under Medicare. The medical nutrition therapy codes (97802-97804) are time-based codes, so the rates are for one unit of the code (individual MNT code is 15 minutes and group MNT code is 30 minutes).
The Academy also published a compensation survey, which describes salaries for dozens of core dietitian and dietetic technician jobs, broken down by region, education, experience, supervisory experience, supervisory responsibility and much more. While the publication does not show hourly rate, there is information on private practitioners' compensation that might be of interest to you.
Private Insurance and "Incident to Physician's Services"
If RDNs do not have contracts with private insurance plans (e.g., with Anthem VA), but they are employed by physicians who would like to bill private insurance companies for nutrition services, the MDs should review their contracts with the insurance plan(s). According to the American Medical Association, physicians should, with respect to commercial insurer regulations, keep in mind that each commercial insurer has its own policy for billing for non-physician practitioners' services. Some require the non-physician practitioner's services to be billed using the non-physician provider’s number, while other commercial insurers require the non-physician practitioner services to be billed under the physician's provider number. If a physician is unsure how to bill, he or she should call the insurer's provider relations director. Physicians should also make sure they are aware of state laws regarding billing for other non-physician practitioners. Some of these payment mechanisms hinge on current state regulations.