Why Should Private Practice Owners Have a Billing Education?

Learning about the insurance billing process is often not something that is taught as part of your schooling, but it is an important part of running a private practice if you are planning on accepting insurance. At Practice Solutions, part of our mission is to educate providers around best revenue cycle management practices. Even if you are not planning on doing the billing yourself, there is merit to having a basic understanding of the billing process so that you can have a better understanding of how your practice is doing financially, you can communicate effectively with your insurance biller and your patients, and you can have confidence in choosing the right biller for your practice. You don’t need to be an expert in medical billing codes by any means; a basic education on billing should be enough for any private practice owner to be successful!

Use Billing Knowledge to Analyze the Financial Health of Your Practice

Know Your Fee Schedule

Your fee schedule is one of the best tools to use in predicting income for your practice from the insurance company. Knowing what payment to expect for each session type, and from each insurance company you’re credentialed with can help you structure your appointment schedule in a way that meets your financial goals. If you think of your fee schedule in terms of an hourly wage, you can use that information as a benchmark for how many patients you should be seeing daily. It can also help you evaluate if you want to be seeing a mix of private pay and insurance clients, since your private pay rate is set by you and the fee schedule is set by the insurance company.

Understand Your Aging Report

An aging report is a summary of all open claims yet to be paid by the insurance company, and is another good tool to use to help you understand the financial health of your practice. It is not a perfect representation of how much money you should expect to receive from the insurance company. This is because claims are often submitted using your full private pay rate, but will be paid according to the fee schedule (typically less than your private pay rate). It is also important to note that some claims represent a mixture of insurance payment and patient payment. Even though the aging report is not an exact representation of payments that will be collected, it can at least serve as a benchmark for the number of unpaid claims, and how old each of those claims is.

As a rule of thumb the older the claim is, the less likely it is that you will receive payment. That being said, Practice Solutions has helped clients collect thousands of dollars in outstanding aging claims with patience, diligence, and billing know-how. If you can look at your aging report and see that there are a large number of outstanding claims over 90 days yet you are feeling like there is no time to follow up on those claims, it may be time to consider outsourcing your billing.

Use Billing Knowledge to Communicate Effectively

Communicating With Your Biller

As a private practice owner, you can think of your billing knowledge like learning a foreign language before traveling to another country. You want to know enough to get by, understand key phrases and not confuse poisson (French for fish) with poison (French for poison!) Your biller is fluent in all things billing, and you just need to know enough to be able to communicate your needs, and understand key points that they are communicating to you.

Since billing is closely tied to the finances of your practice, working with a biller involves a good amount of trust. Without good communication trust is nearly impossible to build. Developing a basic understanding of billing will help you to be able to build better relationships with your biller and allow you to rest easily knowing that your practice is being cared for by someone competent.

Communicating With Your Patients

Speaking of trust, your patients have trust in you as their healthcare provider to inform them of what they need to pay you. Having a basic understanding of insurance billing allows you to communicate directly and openly with your patients about paying for your services. Understanding insurance can be hard for patients. The more that you are able to explain copays, coinsurance and deductibles to your patients, the more likely you are to solidify a good relationship, as well as collect payment from that patient.

Select the Best Biller for Your Needs

Basic billing knowledge can help you ask the right questions of any potential biller candidates, such as how they manage eligibility and benefit checks, whether or not they perform claim follow ups, or if they will work on resolving outstanding aging claims. It can also help you decide if your current biller might not be working out for you by recognizing red flags (i.e. your aging report just keeps getting higher and higher rather than lower and lower).

Whatever your needs may be, Practice Solutions has options for you! If you are ready to bulk up your basic insurance knowledge, subscribe to our blog so that you get notified of new posts. If you are feeling like you know enough about billing to know that you don’t want to do it anymore, reach out to us through the contact form on our website.