Everything Your Biller Wants You to Know About Insurance Billing

We’ve gone directly to the source and asked our billers for the best advice that they can give!

Know Your EHR

An EHR is a powerful tool, but only if it’s being used correctly. The more that you can familiarize yourself with the tools and features of your EHR the better! Most EHR companies have support teams or web pages with tutorials on their software. Familiarizing yourself with different features can help you to get the most out of the software, and ultimately can make your billing experience smoother.

We like TherapyNotes for their highly detailed and accessible support team. Every feature is written about in detail at support.therapynotes.com, and they have an extensive video library of tutorials. If you’re still in need of more training, you can reach a member of their team who will walk you through certain features.

E&B Checks Can Be Wrong

In spite of everyone’s best efforts, an eligibility check can provide information that is different from how the claim processes on occasion. This can be frustrating, but the best way to approach this is to be communicative with your patient as well as with the insurance company to resolve the issue. There are a variety of reasons that an E&B check could be wrong, however if you and your patient believe that a claim was processed incorrectly according to the patient’s plan, you can file an appeal to get the claim corrected.

Patient Communication is Key

Your patient (and their insurance card) has a significant amount of information about their insurance plan that is necessary for billing. It is very common that patients don’t fully understand their insurance coverage, and they may not realize that some details are extremely important to share with you as their provider. Identify common issues that you run into with collecting patient insurance information, and have conversations with your patients so that you can get the most accurate information for billing claims. We’ve compiled a list below as a starting point of things that you can clarify with your patient:

• Ask your patient if they have a secondary insurance plan, or if they provide you with two insurances ask if they know which is primary and which is secondary.

• Clarify if the patient is the policy holder, or if they are on someone else’s policy.

• In accordance with the No Surprises Act, provide your patient with a Good Faith Estimate of the cost of services.

Know How You Are Credentialed

How you are credentialed is one of the keys to successful insurance billing. The information that is submitted on the claim must match the information that the insurance company has on file for you. Knowing the NPI, tax ID, address, and the name that you are credentialed with, whether that be a practice name, your individual name, or a short form version of your name are important for claims to process.

For more information, read our article on Important Billing Identifiers for Therapists.

If you are unsure of how you are credentialed with an insurance company, it is worth taking the time to call and find out for each of the insurance companies that you are credentialed with.

Keep Your Information Up to Date

You may end up moving offices, getting married and changing your name, or you transition from an individual to a group practice. Make sure that you are communicating with the insurance companies, and updating your information with CAQH, and NPPES. CAQH requires quarterly attestations, which simply means that you need to verify that the information that they have on file is correct every quarter. We recommend that when you get the email to do your CAQH attestation you also review your information on the NPPES website.

Having your information as up to date as possible is very important in ensuring that your claims are processed correctly.

Patience is Necessary

Credentialing can take months, claim processing can take a couple of weeks, and phone calls can take hours. A great deal of patience is required throughout the insurance billing process. Follow ups are important to complete, however they don’t always speed things along. The best way to approach insurance billing is to be extremely detail oriented with collecting patient information, inputting information into your EHR, and ensuring claims have all the correct information as well. The higher the level of attention to detail prior to claims submission, the more likely it is that claims will process correctly with no further delays.

If You Don’t Know, Ask

Insurance is complicated! There are many resources available that you can use to find answers to your questions, such as provider portals, calling the insurance company directly, or by working with a third party such as a biller.

If you would like Practice Solutions to cover specific topics in future blogs, send your questions to info@practicesol.com, and be sure to subscribe to the blog to get information directly in your inbox. You can also reach out to learn more about our billing services, or get connected with a billing specialist at the aforementioned email address, or by using the contact form on our website.