Insurance billing…it’s something that either frightens you, frustrates you, or is something that you are constantly learning new things about. It may seem like no matter how long you are in practice, or how much you research, you never seem to really understand everything there is to know about insurance billing. And while that is often just a fact of doing business with an ever changing and evolving entity, it does not have to frustrate or frighten you as a group practice owner.
First, there are two routes you can go regarding billing. First is having your clinicians do their own billing. Second is outsourcing or having an in-house biller. Sometimes, group practices with Independent Contractors will have their clinicians do their own billing. Practices with employees fare better having an outsourced biller or in-house biller that can be in charge of the practice’s billing. Also, because employees tend to make less than Independent Contractors, the idea is that they are doing less of the non-counseling work. Another benefit of having a dedicated biller is that there aren’t a bunch of hands in the pot. Not only do you have to remember to train each clinician how to check benefits, send claims, fix denials, and take payment, you also have to check regularly that they are in fact doing these things in a timely manner. Even the best intentioned therapists don’t always focus on being organized with billing and administrative duties (unless you are a solo practitioner, of course!). Think about how often clinicians get weeks behind on doing notes! For this reason, having a dedicated biller who is accountable for all things billing makes life a bit easier.
Another important part of billing insurances for your group practice is having a system in place. Let’s do a walkthrough of the billing process and what things need to be considered and systematized. When a client calls to schedule an appointment, the intake person needs to get all pertinent demographic information in order to do a benefit check, including primary cardholder name and date of birth. Next, it’s time to actually call and get their mental health benefits and let the client know what they should expect to pay for counseling. Nothing is worse than an angry client who didn’t know their benefits and didn’t expect to pay the full contracted rate because they have a deductible. Insurance cards need to be stored, front and back. Make sure to check if a client has a secondary insurance, and if they do, ask them to do a coordination of benefits. Do you want your therapists (or whoever!) to take payment at the time of service or have clients leave a credit card on file? If payment is at the time of service, how are the clinicians notified of how much they should charge clients? Or do you have an in house biller who will take payments?
On the backend, it’s important for clinicians to do notes in a timely fashion, as most EHRs require that notes are completed before claims can be done. Having something in place, like all notes be done within 48 hours of session or by the end of each week helps clinicians have direction and accountability. If you are using an EHR, which as a group wanting to take insurance you should, it’s important to also utilize the reports available to you. Make sure to check each month for unpaid claims so that your biller can check for potential issues. Clients often terminate with their insurance or switch insurances and forget to tell us. It’s one thing when you are a solo practitioner and after a few weeks of sessions a claim comes back denied, but its a whole other beast when you have a large group practice with hundreds of clients and dozens of denials a month for one reason or another. Having systems in place that quicken insurance payment time and catch potential mistakes will be a lifesaver for your group practice.
This is a learning process. Everything about group practice ownership is a learning process. A good piece of advice is as you learn what works (i.e. what does the job in the least amount of time and with the least amount of work) and put it into a policy manual.
If you are just starting using insurance with your group practice, you may find this article helpful on paneling new clinicians in your group to insurance. You can also visit Be Your Own Biller to get insurance billing consulting.
Maureen Werrbach is a psychotherapist, group practice owner and group practice coach. Learn more about her coaching services here: LEARN MORE HERE