Key Components of the Medical Billing and Collections Process

If you are new to private practice and don’t understand the billing and collections process, Practice Solutions has your back! This blog will be a good place to start to understand the overall process of billing insurance and collecting from your clients. We are aiming to help you understand your role in the process and gain clarity in Medical Billing and Collections as we know it is a common pain point for new clinicians in private practice.

Insurance

One of the most important players in the revenue cycle management process is the insurance company. In order to collect money from the insurance company you must be credentialed with the insurance company. Credentialing is the process of proving that you are qualified to provide healthcare services and receive reimbursement from the insurance company. If you intend on accepting insurance and you are not yet credentialed, we have a blog that provides you with a credentialing plan that will take you from start to finish.

Credentialing is not the only key to receiving payments from insurance companies for your sessions. There are a few more details that you will want to understand beyond the credentialing process that can ensure quick, reliable payments for claims submitted, such as which EHR you will use, how to submit claims through your EHR, and how to record payments once they are received.

An EHR is a software that you can use to track sessions, submit claims, collect from clients, manage treatment plans, and so much more. It is especially helpful as an interface between you and the insurance company. We recommend that you evaluate several EHR companies and pick the one that you feel the most comfortable with, fits within your budget, and meets all of your practice’s needs.

Knowing how to submit claims to the insurance company through your selected EHR system is important in achieving paid claims, and involves understanding how to use your EHR as well as understanding requirements from the insurance company. Some providers complete their own billing with success, and your EHR company and the insurance company may offer some training and support on how to do this. However, many providers decide to outsource insurance billing so that they do not have to spend the time learning and performing the process. Practice Solutions has removed the burden of billing from hundreds of providers with our team of experienced billers. We act as an extension of your practice to make sure that all billing functions are completed accurately in accordance with the insurance company, and you have a good understanding of your billing without consuming too much of your time.

Keeping accurate and detailed financial records is an important part of any business but especially healthcare. Recording payments from both insurance and your patients in a precise and timely manner in your EHR system is a part of this process. You will want to either set up systems that hold you accountable or outsource this part of the process to a company that will do it for you and that you trust. Practice Solutions includes insurance payment posting as a part of our billing service, and our billers have years of experience in combination with detailed processes that ensure you always have accurate payment records.

These are just the basics of getting started. There is more nuance to billing and collections with the insurance. For more detail you can look through our blog and be sure to subscribe to make sure you are educated on each element of the insurance process.

Clients

The next important player of the medical billing and collections process is clients! Clients are wonderful. They are the reason why you are in this profession to begin with and they are the end beneficiaries of the work that we all do. Sometimes clients don’t know how to navigate insurance. They don’t know what to ask, what to pay, or how to find the information that they need to utilize your services.

That is okay!

We are here to help break down the information that your client needs to have so you can make the client experience with your practice the best it can be. We even have a diagram explaining deductibles, copays and coinsurance that you can use to help your patients understand how insurance works!

To aid in the process of billing and collections, make sure your client knows to bring their insurance card with them to your office or provide a picture of the front and back of the insurance card to your practice. With that information you will look up their eligibility and benefits with the insurance company to find out if they are eligible to receive mental health benefits.

One of two things will happen. They will be eligible to receive your services and you will be paid for therapy! That is great news! Or you will find an issue with their eligibility or your credentialing. This means that you can’t start therapy and receive payment from insurance for your services without action being taken. This is also good news because it means that you are saving time and money by not starting treatment with a client that won’t be able to pay and your client has clarity about what they need to do to find the right therapist.

Either way, you will have helpful information!

You will also want to inform your client that they should come to your session with a valid payment method. Your client needs to be charged for the session either at the end or the beginning of services with you. The reason is that the moment the client walks out of your office receiving payment will be harder to accomplish. Make sure you have a process for receiving payment from your client each time they are in your office.

Finally, make sure that you inquire about any changes to your client’s insurance when they are in your office. This will help you know what to charge them and if not you will have the most up to date information available for your practice.

Following these simple steps will keep your clients on the right track.

Claims

Claims are the road to payment! Without the claim process no healthcare provider or organization would ever receive payment for their services. Claims communicate necessary information about services you provided to your patient for the insurance company to review and process payment.

Fortunately, with the advent of EHR systems, you no longer have to fill out claim forms by hand or through Adobe. However, you will need to know a few best practices in order to create the cleanest claims possible so you can manage the revenue cycle in your practice.

First, you will need the demographic information and insurance information for your clients to be accurate and regularly updated so that your patient’s information on the claim matches what the insurance company has on file. Claim rejections and denials based on incorrect information like name spellings or an incorrect address happen often. Keeping this information up to date will minimize the amount of rejections and denials you receive.

Second, you will need to know specifically how you are credentialed with the insurance companies that you work with so that your identifying information on the claim matches what the insurance company has on file. We are talking about knowing your NPI number and tax ID by heart. You will need to know if you have an NPI type 2 or not. Not sure what we’re talking about? We have a blog post all about Important Billing Identifiers for Therapists. You will also need to know your contracted rates, and we provide 3 Reasons Why You NEED to Know Your Contracted Rates in this blog post. We know this sounds scary and intimidating but we promise that we are here to help you. You can call us to discuss how you can learn more about what all this means.

Finally, you will need to be mindful of when you are submitting claims and when you are recording subsequent payment. It is not enough to simply deposit money and move on. You need to record where that money should have gone and be organized with the financial information in your practice so you can avoid audits by the insurance company.

Payment

Speaking of payment, we believe that receiving payment from the insurance company or the client is the best compliment you could receive. As your billing company, we would strive to shower you with compliments (AKA, get you paid!) It means that you have successfully navigated all levels of insurance and are the proprietor of a successful private practice. Whether you do it on your own or by outsourcing billing, it is still a mark of accomplishment!

For the third and final time (it’s that important) once you receive payment make sure you are diligent to accurately record that payment in your EHR system. It helps keep your clients up to date on what they have paid and it helps you to know which claims require follow-up.

If you have outstanding claims in your practice, your biller can be the best leverage you have to receive that payment and fix any systemic issues within your practice. Regular follow up is the best way to resolve outstanding claims, and we include aging follow up and regular reporting as part of our billing service. The goal of managing outstanding claims is to keep your practice moving in the right direction and to make sure that you are paid for all the services that you should be paid for.

Conclusion

We hope this blog sets you up for success in the future of your practice by providing you with the basics that you need for medical billing and collections. Private practice is rewarding and can be lucrative for you and your clients. We want to help you maintain and sustain the best practices you can when working with insurance and with clients. If you found this blog helpful let us know so that we can continue to serve you better, and if you have any questions about medical billing and collections feel free to reach out to us and we would be happy to point you in the right direction.