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Written by admin@pcpierce.com on March 24, 2011. Posted in Nutrition Counseling

Prior to initiating nutrition services such as medical nutrition therapy services, RDs should consider whether a referral is necessary or appropriate. A variety of factors impact referrals including payer policies that may be providing direct reimbursement to the RD, the extent to which state licensure laws may define the need for a referral, facility policies such as those addressing quality clinical care and continuity and the type of service being provided by the RD. [For more details, see the August 2008 Journal of the American Dietetic Association article, “Referral Systems in Ambulatory Care–Providing Access to the Nutrition Care Process.”]

For example, the federal government, under Medicare Part B, explicitly requires a “treating physician’s” referral for Medicare Part B–covered medical nutrition therapy services for diabetes and non-dialysis kidney disease provided by RD Medicare providers. There are instances in which private sector payers do not require a referral, as in the case of many disease management programs where MNT or nutrition services are included as part of the disease management program. In many of these cases, patients/clients qualify for the service based on their existing health condition, such as diabetes or obesity, which allow the patients/clients direct access to MNT services without the need for a physician referral.

Currently, only a handful of the 46 state laws that regulate dietitians or nutritionists through licensure, statutory certification or registration explicitly require a referral or physician order. Still, RDs should not assume that their state does not have such a requirement. Even in explicit cases, the referral language may differ in each state’s legislation.

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