[00:00:00]  Maureen Werrbach:  Hey everyone. Welcome back to another episode of The Group Practice Exchange Podcast. Today I have Jamie Magdic on. She’s a registered dietician. She owns Side-by-Side Nutrition, which is a group practice. It’s insurance based, and it has a bunch of registered dieticians in there with multiple locations.

[00:00:18]  Maureen Werrbach:  So I’m gonna be chatting with her about. What it’s like to bring on registered dieticians into your group practice If you are a mental health practice owner.

[00:00:40]  Maureen Werrbach: Welcome to the Group Practice Exchange podcast, where we talk about all things related to group practice ownership. I’m your host, Maureen Werrbach. 

This episode is sponsored by Therapy Notes. Therapy Notes is my favorite EHR, and it’s one that I’ve been using in my own group practice since 2014. They’ve got everything you need to be successful in your group practice, and they’re constantly making updates and have live support. If you want two free months of therapy notes, go to Therapynotes.com/r/thegrouppracticeexchange.com. 

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[00:02:22]  Maureen Werrbach:  Hey Jamie, how are you? Hey, I’m doing great. Thank you so much for having me. I was saying right before we started recording this episode that I was excited to have you on because just based on my own. Wanting to gain knowledge on bringing on registered dieticians. I came to know you from the internet and I was excited to be able to finally meet you sort of in person.

[00:02:42]  Jamie Magdic:  Yeah. Yes, same as well, and I hope to be a help to your listeners as far as how to get started and maybe why and when to consider bringing on a dietician. Yeah. The best I can. 

[00:02:52]  Maureen Werrbach:  Yeah. So tell me first a little bit about your practice. I know I just did the most generic and very quick sweep about your practice, but you [00:03:00] have a handful of dieticians with you and you’ve been around for a little bit.

[00:03:03]  Maureen Werrbach:  Mm-hmm. So, um, tell me about that. 

[00:03:04]  Jamie Magdic:  Yeah, you did a great job. So we are a group practice of dieticians. We have about 12 dieticians as of right now. We work with disordered eating, eating disorders. We value accessible care. So we take insurance and we’re constantly assessing how to just expand our reach and reach more people who maybe have barriers to access to care.

[00:03:26]  Jamie Magdic:  And we have a wonderful, very passionate team. We’ve been around for about six years and excited to continue helping the field. I love 

[00:03:33]  Maureen Werrbach:  that. So I was saying I. Know you through the internet or know of you, I should say, through the internet. Because in my own practice, um, for years, this will be like, as I’m talking, I’m thinking this, and I haven’t said this out loud before, but my practice is multi-specialty.

[00:03:49]  Maureen Werrbach:  We have, you know, nurse practitioners, mid management, psych testing, and I’ve always wanted to expand that multidisciplinary field to be more whole person [00:04:00] focused and yeah. One of those areas has always been around bringing on registered dieticians, but I’ve always been afraid, and that’s the revelation I was making as I started just talking to you.

[00:04:10]  Maureen Werrbach:  I was like, this is so interesting. This is about to come outta my mouth because I’ve never done it. And I think this is one of the reasons why I have sort of listened to some of the things that you’ve posted and stuff in different Facebook groups because it’s something that I’ve always been just a few inches short of like actually.

[00:04:29]  Maureen Werrbach:  Following through on. Yeah. And so I’m really excited just for my own, like I know mm-hmm. The audience will benefit from it because they talk about wanting to bring on different provider types in their practice. Yeah. Yeah. But even just to glean some information as to why I keep stopping myself from getting to that next step.

[00:04:44]  Maureen Werrbach:  Yeah. Yeah. You know, I take lots of risks in all these other ways. 

[00:04:48]  Jamie Magdic:  Yeah, yeah, yeah. Absolutely. Hopefully I can help with those couple of inches. Yeah, because it sounds like with, you know, the variety of providers you already have on your team, adding a dietician it would, would be very similar [00:05:00] Yeah. To that with, you know, of course a couple things to be mindful of, but no reason you can’t do, and I think it would really, really be that wonderful addition to what you already have for what you provide your clients.

[00:05:11]  Maureen Werrbach:  It’s something I talk a lot about just in forecasting and looking at what the future of our industry as mental health providers is, is that I really believe that working on the whole person is where we should be going, and so I think it’s, my personal struggle has been that although I’m not a psychiatrist, I’m not a nurse practitioner.

[00:05:33]  Maureen Werrbach:  Mm-hmm. I’m not a psychologist who does testing. Yeah. Because it’s in my field of mental health. Mm-hmm. It’s. Felt easier to take the step to bring on a provider who, I don’t fully know the actual work. Like I know what work they do, but I don’t have the licensing to provide that work. So there’s obviously like a knowledge gap when I hire those types of providers on, but it feels like I underst understand more like yeah, the [00:06:00] T codes is easier for me to figure like simple things like this.

[00:06:03]  Maureen Werrbach:  And I think where I have gotten stuck is a registered dietician is. A completely different, we obviously we support Yeah. Clients in, in similar ways, or we can support the same types of clients. But I think the first barrier for me, and I’m assuming for a lot of other mental health therapists who own a group practice, who wanna bring on other provider types that are not mental health providers.

[00:06:25]  Maureen Werrbach:  Yeah. Is like, what do dieticians need to feel successful in a group practice? Like what does billing look like? How, I mean, how different is it in terms of like what kinds of codes you could and, and I guess some of this could be looked up, but I think the biggest one for me is how do we make sure that we can bring on a dietician and they feel like they’re getting the support they need?

[00:06:46]  Jamie Magdic:  Right. Right. Such an interesting and important question. And, and it’s funny because from the dietetic standpoint, these are the same questions I have and the same feelings and fears I have about potentially bringing on a therapist because, you know, we work with eating [00:07:00] disorders and disordered eating, so all of our clients have a therapist on board.

[00:07:03]  Jamie Magdic:  And so of course that brings into mind, well, what if we have, we can have an in-house that’s going to, you know, have a lot of benefits to our clients and side by side. And so I’ve thought about the same thing and had the same hesitancies. So to best support that question. I think that your knowledge and group practice owners who are therapists their knowledge already of different billing and systems, things to consider with legalities and compliance and all of those things are really gonna aid in the understanding, uh, of bringing on a dietician and.

[00:07:33]  Jamie Magdic:  The things that I would say as far as what people should be mindful of when bringing on a dietician to best support them in being successful in, you know, mental health practice and in general would be probably very similar, which is gonna be I. You know, number one, having a super, like a dietician, a supervisor, someone who can support them in their continued education, in monitoring their cases.

[00:07:58]  Jamie Magdic:  And so having that person to [00:08:00] go to who knows their stuff and who has been trained. Right? So that would be one thing. The other thing that you mentioned is gonna be billing and insurance. It is medical. And so is a different kind of billing. I have worked with a few different billers, few different billers have been at side by side, and we have a wonderful one.

[00:08:19]  Jamie Magdic:  And every time they also work with therapy practices and every time they’re like, wow, nutrition and medical is a different beast, right? It’s just, it’s a different, there’s a lot of nuances and, um, it, it’s a lot of denials, a lot of changes. And so as far as, and we have an external biller. We don’t do our billing in-house.

[00:08:41]  Jamie Magdic:  And so I know a lot about billing and insurances and there’s some gaps I have because of the complexities from the get go. I’m like, we’re gonna have someone do that for us and help us out there to support us. So that’s something to be mindful of. But again, if you have, if you start small and learn from there and [00:09:00] learn, does my practice have the capacity and ability to support?

[00:09:05]  Jamie Magdic:  These clients with how these different major insurance groups functions in, you know, the states we serve. Right? Um, and do we have a knowledgeable biller? Do we have like the Lee Leeway, cushion, and support, support and resources? In experimenting with that, but it’s really just gonna be experimentation and bringing on, you know, those specialized folks, like a biller, like a supervisor, and then addition.

[00:09:31]  Jamie Magdic:  Another key important person to have access to would be a legal person to just look over things and to be able to go to when certain things arise. Because one of the things that we found challenging and we continue to find challenging as diet dieticians in working with eating disorders is that. When clients bring something to you that falls, they may disclose something that you as a dietician, who is not a [00:10:00] therapist, still needs to take care of and handle.

[00:10:02]  Jamie Magdic:  There are no regulations which. Then gets confusing as to how we take care of this client in this situation. And so having that as part, you know, we always work with a therapist, but there’s certain things that they bring to us that then we need to also take care of and protect the clinician side by side the client.

[00:10:23]  Jamie Magdic:  And so having that trusted legal partner to consult with and have, you know, on, on. Text to be like, Hey, let’s hop on a call quickly, has been extremely helpful. So those are the three things that I would consider and as a dietician, building a group practice has had to learn about and consider. So I would say very similarly, it’s just a learning experience and having those right people and being willing to experiment and having that resiliency and, you know, being smart about it and getting mentorship.

[00:10:56]  Jamie Magdic:  Yeah. To make that process easier. 

[00:10:58]  Maureen Werrbach:  That makes a lot of sense. I guess [00:11:00] a bigger surprise for me is realizing yes, that dieticians Bill Medical. Yeah. I don’t know why. I mean obviously, but I don’t know why that was. That hasn’t been something I thought about. So of course group practice owners that are listening, yeah.

[00:11:14]  Maureen Werrbach:  Already likely have billing support in place because they’re group already. Mm-hmm. But it, I can imagine it would be. A process of, of learning something very new in terms of medical billing, do you guys have, like mental health is, I guess, pretty simple when it comes to billing because we just have like a couple of codes that Uhhuh get used, right?

[00:11:33]  Maureen Werrbach:  Mm-hmm. Like an intake CPT code and like the hourly code for the most part. Yeah. There aren’t many modifiers or, you know, other secondary codes that we’re using for the most part, right? Like med management does. You can, you know, you, you build sometimes. Two different CPT codes for like an add-on code on top of the main one, but that’s as complicated as it really gets.

[00:11:55]  Maureen Werrbach:  What does it look like for like, I guess, a standard, I don’t know, a standard 

[00:11:59]  Jamie Magdic:  [00:12:00] Yeah. Session for you. Right. So for each practice it’s gonna be a, you’re going to have to find your systems again based on. What your insurance looks like and what coverage looks like, specifically where you’re at. And I think that’s a big part of it.

[00:12:16]  Jamie Magdic:  And as far as, and I’m not sure with how it works for billing for therapy and how across the board it is for, if you have this insurance, you’re gonna have the coverage under different plans for insurance, for medical. Certain diagnoses are covered. Medical nutrition therapy might not be covered under certain plans.

[00:12:35]  Jamie Magdic:  So every plan is so different. So what we’ve found that has been challenging. So there’s a few things I wrote down that I think are important to note. Um, hopefully this helps answer your question. Um, but we, you know, checking benefits for us has been something we wanna, of course do for clients to help.

[00:12:53]  Jamie Magdic:  Educate them, but because we also as providers and the billing team doesn’t know [00:13:00] what’s gonna happen with their plan. We’ve, it’s been an experimentation over six years and it’ll continue to be as things change and, and as they do so we’ve checked benefits for a long time and had to stop because clients come back to us and they say, that’s not what insurance told us.

[00:13:16]  Jamie Magdic:  And we get that so often, and then it hurts the relationship. They have with side by side. So ultimately we had to let go of that and it can also be pretty time consuming. This is important to note for, you know, if you have a billing team, you need to expand your billing team or, or like have a larger package or for expense wise, um, for billing nutrition because of course that experimentation time to see what exactly you’re going to experience in the location and with the major insurance companies you utilize.

[00:13:46]  Jamie Magdic:  It’s also a lot of rebuilding and fighting for the client to get services. We try and be really creative and we rebuild as often as possible. That’s also gonna change your policies. In regards to [00:14:00] when do you put this on the client? How much leeway is there going to be? How much are you going to do as a practice?

[00:14:07]  Jamie Magdic:  What works for you to keep those good boundaries for you as a practice and also gets them coverage? I might sound all over the place. But that’s kind of describing the experience that we have had with billing over the years. So yes, it’s hard and I, it would be really nice to have my biller here to chime in.

[00:14:26]  Jamie Magdic:  Um, but uh, she’s had an experience over the years billing with us and has learned a lot. I can imagine. So 

[00:14:33]  Maureen Werrbach:  like for mental health it is. The easy part is. I would say is that our CPT codes are always pretty much the same, right? Yes. Our diagnosis codes will be different depending on the person, but we have like standard CPT codes for mm-hmm.

[00:14:47]  Maureen Werrbach:  Like a 30 minute or an hour counseling. Yeah. We also do get to denials ’cause certain insurance companies might cover family sessions while others don’t. Or certain like insurances [00:15:00] might cover only a certain amount of sessions where others. Don’t have, uh Right. You know, that limitation. Right. Um, so there is some amount of, uh, it doesn’t sound like as much as what you guys have, but there is, you know, working through denials and insurance companies saying that something is covered when it ends up not being covered.

[00:15:18]  Maureen Werrbach:  Right, right, right. On us having to like creatively. Shift our billing to be able to have that client sessions covered. But the act of billing itself is easy in that. Mm-hmm. It’s, you know, as long as the therapist has a diagnosis and puts like the CPT code in, then there’s, you know, this is as much as you gotta really do.

[00:15:40]  Jamie Magdic:  Right, right, right. Yeah. I mean, I, I’m sure there’s overlap and from, and I’ve never billed for therapy, but speaking with other dieticians, speaking with multiple billers and their experience with medical versus therapy, it’s a lot less straightforward. There’s a lot more experimentation. There’s, it’s, uh, I feel like it is, uh, [00:16:00] you know, things are changing so.

[00:16:03]  Jamie Magdic:  For the CPT codes, yes, we do use specific CPT codes and a few different ones for different insurances. But then also, you know, we do, for a lot of those insurances, we need a medical diagnosis. And I think that’s where sometimes it gets complicated as far as, you know, we can’t, as dieticians diagnose, we work with therapists and doctors to get that diagnosis, but we need that diagnosis in order to bill.

[00:16:24]  Jamie Magdic:  Right. So people have different protocols of, of obtaining that diagnosis and proof of diagnosis. In addition, sometimes the, the insurance plan, a lot of times the insurance plan will, um, you know, say we have medical nutrition therapy, so we know we can use those CPT codes, but they require medical diagnosis, and it’s if those medical diagnoses fall under the umbrella of, of what they support.

[00:16:48]  Maureen Werrbach:  Yep. 

[00:16:48]  Jamie Magdic:  As well. 

[00:16:49]  Maureen Werrbach:  That makes a lot of 

[00:16:49]  Jamie Magdic:  sense. 

[00:16:50]  Maureen Werrbach:  And makes it so that it seems like you guys need to do a lot more collaborating mm-hmm. With other provider types [00:17:00] than maybe what a therapist mm-hmm. In a therapist group practice might need to, like, of course collaboration is helpful and we should be doing this, but it’s not ne necessarily necessary for a therapist too, because we can make a diagnosis and then bill.

[00:17:14]  Maureen Werrbach:  Mm-hmm. So it would be maybe something else to be thinking about as a. Practice owner. Um, like what process will you have in place to make sure that anyone that you have. That isn’t someone who can provide a diagnosis, how are you ensuring that you’re giving them the tools for success in, in order to be able to get like what they need to do their work?

[00:17:35]  Maureen Werrbach:  Mm-hmm. Like the ability to collaborate with other medical or mental health providers. 

[00:17:39]  Jamie Magdic:  Right? Yeah, absolutely. I think that, you know, as far as advice to your listeners, it would be, you know, if considering bringing on a dietician and, and taking insurance. Speaking with the dietician in the area as to as far as like how the coverage is, what insurances to start with, how.

[00:17:58]  Jamie Magdic:  Easy it is to navigate those different [00:18:00] insurances. What insurances to maybe stay away from, and then also to, to make that, those decisions there. But then also to maybe get ahead of the process and the system of onboarding to make sure your clients are really informed about what to expect as well in that process.

[00:18:16]  Jamie Magdic:  And bring out a dietician and you know, you have your therapist, how they’re going to work together to. Find that diagnosis and communicate with the client about what that looks like for their insurance coverage as well would be, you know, important things to consider. 

[00:18:29]  Maureen Werrbach:  So it brings me to, I think will be my last question.

[00:18:33]  Maureen Werrbach:  Yeah. Given all of this, how can therapists and dieticians work together to provide holistic care if we think about it from the lens of like they’re all working under one roof? 

[00:18:43]  Jamie Magdic:  Yeah, absolutely. I mean, I am. I, I love our therapists. I work with, I love having that holistic treatment. I think that specifically, so mental health impacts nutrition and physical health, and physical health impacts mental health, and there’s a lot of [00:19:00] overlap with relationship with food, relationship with, with, with body image relationship to, to, you know, what health is.

[00:19:07]  Jamie Magdic:  And so I think that, you know, having that well-rounded team addressing. Emotional, cognitive behavioral aspects and how they impact each other is super supportive to the client. It’s also super supportive to the clinician. I mean, we are, I’m gonna bring families in in here when we’re working with families and children and FBT and doing that tough work.

[00:19:29]  Jamie Magdic:  We’re so happy to have that therapist to be providing, you know, that overlap, that support of the dietician, and to provide that support of the therapist to help create like a stronger team to push. And move the client forward in the way that we feel is best and to collaborate and say, Hey, I’m worried about this client.

[00:19:48]  Jamie Magdic:  We’re doing X, Y, and Z. This feels maybe a little bit like we’re not moving things along. I’m starting to feel a little bit apprehensive about the treatment plan. What do you think, you know, and constantly [00:20:00] assessing, because really we need to do that with eating disorders and disordered eating all the time, is how do you feel they’re at now?

[00:20:05]  Jamie Magdic:  How do you feel like. It is best to do like next steps. So I think that overlap is super supportive and it creates a really strong foundation and support for the client and also for the clinicians as well. So yeah, there’s so many perks that hopefully that that describes a few. 

[00:20:24]  Maureen Werrbach:  If there are practice owners that are looking into bringing on a dietician or are struggling, do you support them?

[00:20:31]  Maureen Werrbach:  And if so, how can they find you? 

[00:20:33]  Jamie Magdic:  Yeah, absolutely. So I’m, I’m really passionate about helping therapists and dieticians. With group practice and all that comes with that leadership, bringing on additional, you know, clinicians and while maintaining their, you know, values and mental health and all that. So I love doing that kind of supportive work.

[00:20:53]  Jamie Magdic:  So people can find [email protected]. I also, you know, can check out my website side by side [00:21:00] or group practice, side by side nutrition. 

[00:21:02]  Maureen Werrbach:  Yeah. 

[00:21:02]  Jamie Magdic:  I can provide you some of that information as well. Sure. 

[00:21:05]  Maureen Werrbach:  Awesome. Well, I appreciate you coming on and taking the time to chat about what this process looks like and the opportunities and obstacles that come with bringing on a different provider type.

[00:21:17]  Maureen Werrbach:  I. What mental health practice owners might be themselves, so I appreciate it. Yeah, absolutely. Thank you for having me. Yeah, thank you. Thanks for listening. Give us five stars on whatever podcast streaming service you use, and I’ll see you next week.