Insurance Billing Secrets No One Tells You

There is little doubt that insurance billing can be the source of much frustration when owning and running a private practice. Insurance billing can even be a source of frustration for staff when it comes to payment or acquiring clients when starting out. It takes time and expertise (as well as a lot of patience) to master everything there is to know about insurance. This is why we exist! We know that you did not take a class in your masters program about insurance or private practice, and we know that you have a lot of questions in order to stay on top of the ever shifting landscape of insurance billing. We are here to answer those questions and give you the inside track into the world of insurance. Our clients receive exclusive content on insurance changes and best practices, but we will do our best to give you excellent and actionable content on our blog every week. In this blog we will give you some of the insurance billing secrets no one tells you, but they should.

You Don’t Need To Be Credentialed with Every Insurance Company To Be Successful

The first insurance billing secret that no one tells you is that you do not need to be credentialed with every insurance company to be successful. In fact, it is often the opposite that distinguishes successful private practices from private practices that are drowning in administrative work and losing money from insurance billing. We will explain how being credentialed with fewer insurance companies can lead to greater success in private practice.

First, by limiting the number of insurance companies you are credentialed with means that you have narrowed down who your ideal client is and you have determined which insurance company is going to be the better partner in your success long-term. Let’s break this down step-by-step.

Not every insurance company caters to every individual in your area. There are some insurance companies that are specialized for specific subcategories of the population. You can determine whether to work with those subcategories or not. Some therapists determine that they want to work with veterans or active duty military. This is a decision that they make on the clinical side that impacts the business side. Therefore, that particular therapist would be in network with TRICARE. However, if you are a therapist that does not want to work with veterans or active duty military then you would not be in network with TRICARE. This means that depending on the insurance company you need to make a decision about whether they are a good partner in your growth or not. By eliminating insurance companies that are not good partners for your growth you determine which ones are.

Oftentimes the clinicians that have the most clarity around their specific audience are those clinicians that grow their practice with more velocity because they know where to spend their time and resources.

There are some specific actions that you can take to determine which Insurance companies to be credentialed with. First, you can look at which insurance companies in your area dominate the market. You may want to look at major employers in your area and ask what insurance they offer their employees or if there is a college in your town you may want to find out what the college plan is and determine if you want to be on that plan as a provider. The other option that you have is to talk to colleagues in and around your area to find out which insurance companies have been the best to work with and have good clients. It is important for your practice to have the best quality clients so that you can continually have good referrals.

Many of the clients that we work with only take one or two insurances and this helps them with their administrative work. One of the biggest limiting factors to your growth in private practice is going to be administrative work. When you think about the administrative work that business ownership offers it can become overwhelming quickly; You can have accounting tasks to do, Notes to finish, 90 day and annual reviews,, and billing work to do. The nature of insurance billing is complicated. There are a lot of ways in which billing can be affected by fast work that is not detailed. Often, billing is neglected or done poorly as a function of a task list that is large.

Reducing the amount of insurances that you are credentialed with limits the administrative work that you have exponentially. One of the first clients that we worked with accepted almost every insurance company that they could. This led to a lot of frustration on their part because the administrative work grew exponentially instead of steadily. They found themselves drowning in more insurance related tasks than they could handle.

Overtime we were able to narrow down the list of insurances that they accepted and things improved. Not only did their profit margin grow but their stress levels were reduced and the clinicians on staff were paid much faster. If that wasn’t enough they found themselves with more time to focus on growing their practice instead of wrestling with insurance.

It is this secret that can greatly assist in your development of your private practice and help you to provide the best quality care to your clients as possible. We know that it can feel scary to eliminate possible referral sources, but over time we have seen that the practices that accept fewer insurances tend to have a better growth trajectory and happier staff overall.

We want to encourage you that it is possible to have a thriving private practice and only take the insurances that are going to help you and your clients in the long term. We know this can take a lot of patience and can feel like a lack of growth. Overtime we trust that the strategy of limiting the insurance that you accept will be the right choice.

Your EHR Skills Are Your Greatest Ally

One of the best lessons that we have learned over the course of billing for thousands of therapists is that a baseline knowledge of your EHR tool is critical. We also know that your business associates need to be intimately familiar with the capabilities and limitations of your EHR tool.

First, there are several EHR companies that exist for the behavioral health industry. They are all different and they all serve different purposes for different kinds of practices. A thorough examination is needed when you are selecting an EHR tool. There are a few basic considerations that need to be made before selecting an EHR tool.

Some of those considerations are:

• How much does the EHR cost?

• How much does it cost to submit a claim?

• Is there an additional cost per provider?

• Does the EHR company meet requirements to house HIPAA compliant protected health information?

• What are the customer service processes like?

• Who owns the EHR company?

• What clearinghouse does the EHR company use?

• What reports are readily available to help the practice owner run the company?

Once you select the appropriate EHR for your company you will need to become familiar with how that EHR tool will be used across your organization. Once you have decided on an EHR tool, you don’t have to decide where that tool will fit into your work processes across the organization. You can use the tool to communicate credentialing information, fee schedules, contracted rates, eligibility and benefits checks, claims issues, and a host of other kinds of information. Like anything a tool is only useful if you know how to skillfully use it. In this case you’ll have to think critically about how this tool will fit within your practice and how your team will be trained to use it.

One pitfall that we see a lot of practices fall into is that they hire a biller that claims that they can work with any EHR tool but they are not experts on that particular tool. This can go sideways really quick. It is important to find professionals who either know your tool or are very quick to learn the software implications of any tool that you decide to use within your practice.

The Long Way is the Short Way and the Short Way is the Long Way

When working with third-party payers it is important to bear in mind that you will need to have a tremendous amount of patience when dealing with the bureaucratic nature of large organizations. Some of our readers launch into private practice from large organizations and understand the pain points that come along with working with behemoth companies. However, if you are not familiar with working with large organizations there are a few tips that will help when Credentialing or fighting to get Claims paid.

First, large organizations depend on paperwork and administrative time to get anything done. Oftentimes when Credentialing practices practice owners will become impatient or frustrated because the applications to those insurance panels are taking a long time to complete. Additionally, Practice owners become upset when insurance companies lose applications or have incorrect information loaded into the system.

Obviously those are difficult situations to deal with but they are commonplace when working with insurance companies. Many practice owners launch into their private practice with the expectation that things will function quickly. They will get clients quickly. They will get payment quickly. They will hire quickly. They will get credentialed quickly.

This is not always the case.

When working with insurance a good principle to lay down ahead of time is to know that the long way is the shorter way and the short way is the long way. This means that if you take a shortcut it ultimately leads to more work for your practice that you could have circumvented by doing the hard work upfront.

For example, when filling out credentialing applications for insurance companies it is easy to become impatient with the process and overwhelmed with the amount of administrative burden that is laid on the private practice owner. The overwhelming feeling can cause the private practice owner to rush the process. Therefore, by rushing the process mistakes are made and applications are not processed as quickly as they could have been. By taking your time, and focusing on the details you actually save time on the back end by providing the insurance company with an accurately filled out application.

This principle holds true in a lot of areas in private practice and business. It is better to slow down and focus on the details and do things correctly than to rush things and get caught in a web of disorganization. It is important to focus on doing things the proper way and then learning how to scale those processes instead of rushing to results.

Expect Payment From Insurance to Take Longer than You Think

Once you are credentialed with an insurance company it is important to manage your own expectations about how long payment from the insurance company will take. It is also important not to plan any critical expenses around this revenue. Like most things this is easier said than done but believe us when we say we have seen practices use their aging report as revenue to count on and they end up missing payroll or critical expenses.

When planning your practice around the revenue for an insurance claim, it is important to know that payment could take 30 to 120 days to receive. Some insurance companies are faster than others but we believe that it is better to give a very conservative estimate in terms of when you can expect to receive payment from the insurance company.

The reason why we give a conservative estimate in terms of payment from the insurance company is so that you can balance your expenses and expectations around when you’ll receive money.

If payment takes a significant amount of time to get to you from the insurance company then you will need to make certain adjustments to your payroll and other critical business expenses in order to calculate a profitable practice. At some point the revenue coming in from the insurance company will be enough to cash flow your expenses. However, right off the bat it can be difficult to balance expenses when insurance revenue is inconsistent.

The other benefit of managing your expectations when it comes to insurance payment is to know that these are companies with their own struggles and expenses to balance. Knowing that your revenue is dependent on another organization can help give you a more balanced view to the risk that you take on when billing insurance claims.

In conclusion, we hope that these tips help you to run a profitable and successful private practice in your area. We know that you are doing work that is helping individuals, families and communities. We want to do everything we can to help you do that work as efficiently and effectively as possible. By giving you the inside track on billing tips that no one tells you we hope that you can use those to avoid pitfalls that we have seen helping lots of practices.