Practitioner Resources
Helping you, help others.
Hi all! As a fellow CNS (Certified Nutrition Specialist), trust me when I say I know how hard it can be to break out to make a name for yourself. I believe knowledge should be share and have provided some resources that I have created & put together for you in hopes that my experiences can benefit others. Additionally, I have also credited some of my colleagues/peers who are doing amazing things, so please show them some love & check their pages out as well!
CNS Candidates
What paperwork do I need for the BCNS exam? It'‘ll vary by school, but in my time, this was the list of all the classes that I could consider taking before sitting for the exam.
What internship should I do?
In-person or Online mentorships are available
Look for an internship program that are well structured to guide you every step of the way to prepare you for the CNS exam and set you for success in completing your hours (e.g. Clinician’s Incubator, Nutrition & Herbal Collective) - NOTE: I am not affiliated with any of these, they’re just other MUIH alumni that I’d like to support & have heard great things about!
You can also find supervised internships from nutrition practitioners who have been practicing for at least 3 years (these can range from $0 to $1K+ for 6 months). I did two internships, one in private practice for $0 and another as part of my school’s Experiential program for $1,200. Some peers reached out to former professors who were practicing and were charged $1K for 6 months of supervision. It just depends on who you ask!
Practice Makes Perfect.
Congrats! You just passed the CNS exam & have your LDN to start clinical practice … now what?
There are many career paths you can go from here since nutrition is pretty flexible amongst healthcare fields, and based on the state you’re in, it can be smooth sailing or quite a bumpy ride. Here’s my experience for both:
I’m not going to sugar coat it. California is not an easy state to start a nutrition practice (the CA tax alone is $800/yr)! I applied to dozenS of jobs, but all they wanted was an RD - which is understandable as they are the only ones with title protection here, and in many other states. If you’re in a state that licenses both, CNS and RDs, under the same LDN license like Maryland does, it’ll be much easier to find a job. It wasn’t until I earned my DCN degree that I really stood out from the crowd and demonstrated that I had earned the highest level of knowledge and skills a school could offer to be a nutrition professional. Once here, I was able to branch into:
Teaching - I started off as an adjunct professor in anatomy and physiology and the transitioned into facilitating courses within the master’s and doctoral nutrition program at various schools.
Biotech Lab - I heard through a Nutrition Facebook group that there was a job opening at a functional lab company. Now I help practitioners like you interpret conventional and functional lab tests!
Private Practice - Once you’ve determined your niche, you can starting honing your skills here! See next column on how to get started.
Things I Wish I Knew When I Started My Private Practice
Unless you’re extremely business savvy, I highly recommended enrolling in a business building class! (I did mine with a former professor, Camille Freeman, who is the absolute sweetest)! From there you can look into:
Company Name - if you’re in CA, check here to see if it’s already taken.
Making a Logo - you can either pay someone to do it or if you’re like me, you can doodle something and create it in Adobe Photoshop/Canva!
Forming an LLC/S-Corp - I definitely wanted to make sure I got all the correct paperwork done so I had a business lawyer help me out and explain the advantages of S-Corp vs LLC!
Professional Liability Insurance - I chose TRMS for the low annual fee and services covered (again, not affiliated, just sharing what I’ve done).
Hiring a CPA - Optional, but it really helps if you don’t want to deal with calculating all of of the taxes yourself!
How to Determine a Fee Schedule - Determining a fee schedule will vary by area and expertise. I recommend checking what other nutrition professionals in your area are charging & either match theirs or adjust your price based on how much you think your skills, knowledge, and services should be valued at.
Disclaimer: This post is not to be interpreted as legal advice (since I’m not a lawyer) but to help those in California know what their scope of practice is in regard to MNT, insurance, and ordering lab tests.
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California Code, Business and Professions Code – BPC § 2585
(a)(1) Notwithstanding any other law, a registered dietitian or other nutritional professional meeting the qualifications set forth in subdivision (e) of Section 2585 may, upon referral by a healthcare provider authorized to prescribe dietary treatments, provide:
Nutritional and dietary counseling
Nutritional and dietary assessments
Development and recommendation of nutritional and dietary treatments, including therapeutic diets
This applies to individuals or groups of patients in licensed institutional facilities or private office settings.
The referral for medical nutrition therapy (MNT) must be accompanied by a written prescription signed by the healthcare provider, detailing:
The patient’s diagnosis
Either a statement of the desired objective of dietary treatment or a diet order
The registered dietitian (or qualified nutrition professional) may:
Perform nutritional assessments
Initiate nutritional interventions within the parameters of the prescribed diet order
Individualize the patient’s nutritional or dietary treatment when necessary by modifying the distribution, type, or quantity of food and nutrients—as long as it stays within the diet order
All modifications and their rationale must be documented in the patient’s record for review by the prescribing practitioner or another licensed healthcare professional responsible for the patient’s care.
Collaboration requirement: The nutrition professional shall collaborate with a multidisciplinary team, including the treating physician and registered nurse, in developing the patient’s nutrition care plan.
Limitations:
This law does not authorize a registered dietitian or qualified nutrition professional to order or administer central or peripheral vein nutrition.
Take-home message
A qualified CNS or RD can provide Medical Nutrition Therapy (MNT) in California only if there is a referral from a licensed healthcare provider.
Outside of a physician’s referral, nutrition professionals may provide general nutrition guidance and counseling, but this cannot be billed as MNT or framed as treatment for a diagnosed condition.
Even if a patient pays out-of-pocket and insurance is not involved, providing services intended as MNT without a physician referral is outside the legal scope of practice.
Always follow the diet order and collaborate with the healthcare team when providing MNT in institutional or clinical settings.
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Under current CMS MNT Credentialing requirements, § 410.134 Provider qualifications, Certified Nutrition Specialists CAN take insurance [x].
For Medicare Part B coverage of MNT, only a registered dietitian or nutrition professional may provide the services. “Registered dietitian or nutrition professional”means an individual who, on or after December 22, 2000:
(a) Holds a bachelor's or higher degree granted by a regionally accredited college or university in the United States (or an equivalent foreign degree) with completion of the academic requirements of a program in nutrition or dietetics accredited by an appropriate national accreditation organization recognized for this purpose.
(b) Has completed at least 900 hours of supervised dietetics practice under the supervision of a registered dietitian or nutrition professional.
(c) Is licensed or certified as a dietitian or nutrition professional by the State in which the services are performed. In a state that does not provide for licensure or certification, the individual will be deemed to have met this requirement if he or she is recognized as a “registered dietitian” by the Commission on Dietetic Registration or its successor organization, or meets the requirements of paragraphs (a) and (b) of this section.
NOTE: At Starberrie Nutrition, I don’t accept insurance, but I can give you a “superbill” form to submit to your insurer for possible reimbursement.
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Direct Access Testing: 1246.5
Notwithstanding any other provision of law, any person may request, and any licensed clinical laboratory or public health laboratory may perform, the laboratory tests specified in this section. A registered clinical laboratory may perform the laboratory tests specified in this section if the test is subject to a certificate of waiver under CLIA and the laboratory has registered with the department under paragraph (2) of subdivision (a) of Section 1265. A program for nondiagnostic general health assessment that includes a laboratory test specified in this section shall comply with the provisions of Section 1244. The results from any test may be provided directly to the person requesting the test if the test is on or for his or her own body. These test results shall be provided in a manner that presents clear information and that identifies results indicating the need for referral to a physician and surgeon.
The tests that may be conducted pursuant to this section are: pregnancy, glucose level, cholesterol, occult blood, and any other test for which there is a test for a particular analyte approved by the federal Food and Drug Administration for sale to the public without a prescription in the form of an over-the-counter test kit. A test approved only as an over-the-counter collection device may not be conducted pursuant to this section.
While you may practice nutrition consultation as it pertains to food, nutrition intake, meal planning, grocery list, and recipe creation and nutritional assessment, you may not:
…practice medicine or to undertake the diagnosis, prevention, treatment, or cure of any disease, pain, deformity, injury, or physical or mental condition and specifically does not authorize any person other than one who is a licensed health practitioner to state that any product might cure any disease, disorder, or condition.
– California Code, Business and Professions Code – BPC § 2068
California’s nutrition law can be found in the California Business and Professions Code, sections 2585, 2586, 2586.2, 2586.4, 2586.6, 2586.8, 2053.6, and 2068.
Take-home message
In California, it depends on what test is ordered and who the test is being ordered through:
Anyone (including nutrition professionals) may request a very small set of Direct Access Tests: pregnancy, glucose, cholesterol, occult blood, and FDA-approved OTC analyte tests.
Nutrition professionals cannot independently order more complex labs, which require either a licensed provider’s order or the use of a functional lab platform that provides physician/licensed provider sign-off (e.g. Rupa Health, Ulta Labs, Vibrant, DUTCH, etc.)
Nutrition professionals may provide nutrition counseling but must avoid diagnosing, treating, or claiming to cure disease and work within their scope of practice.
Want to learn more about CNS pathways?
Feel free to reach out to me!