If you’re at the point where you think you need a biller for your private practice, you probably do. Billing insurance can take up an exorbitant amount of time and energy. I cover this in my article: “7 Things I Wish I Knew Before Starting a Private Practice“. As a clinician, you probably want to dedicate your time to things no one else can do for you like networking, seeing clients, holding workshops etc. But how do you know where to find a good biller? You can, of course, take to Google, or ask friends and colleagues. But, are they good references? How do you know what to look for when you’re shopping around for someone to do your billing? The following tips will give you some ways to compare.
ASK YOURSELF THESE QUESTIONS BEFORE YOU COMPARE
ASK ABOUT INSURANCE
1. Before you contact a biller there are a few questions you will want to ask yourself:
- How many sessions are you billing insurance for a month?
- What are the codes you are using and approximately how many for each per month. For example, do you bill for 60 minute sessions? 45 minute sessions? Family sessions with or without the client? All of these variables mean a difference in rate and how much you get paid which will relate to how much you will pay for billing.
- What insurance companies are you contracted with?
- How do you submit claims? Paper? Electronic through a clearinghouse? Electronic through an insurance company’s online billing/claim system?
- Where do you receive your explanation of benefits? Do they go to an electronic health record or clearinghouse? Do you get them via paper in the mail?
- Where or are you posting payments? When you get paid for a claim, where or how is this being recorded? You want to know how much you are getting paid per month. If it isn’t lining up with what you are billing there may be money missing. You will also want to know this when tax time comes around.
ASK ABOUT EXPERIENCE
2. How long has the biller been in business? While being in business for 100 years doesn’t necessarily mean that they are better than someone who has been in business for one year, it gives you some idea as to whether or not they know what they’re doing because they are able to sustain a business.
3. What Insurance companies and contracts are they familiar with? Why does this matter?
A case example: In one case a therapist was told a client had a $3000 deductible. Therefore, until the client had met the deductible, the client paid the therapist out of pocket and the therapist billed the insurance company so it counted towards the deductible. The problem was, the therapist thought she could charge her regular private pay rate of $110 an hour per visit, rather than the contracted rate of $89. Twenty sessions later she learned this was an error and, as she was under contract, she could only charge the contracted rate of $89.
This meant she received $21 per session, that she shouldn’t have, and now owed the client $420. In addition, she was in violation of her contract with the insurance company and could be dropped. An experienced biller can save you from these headaches because they will know the contract rules and that will make a world of difference.
4. How many client accounts do they manage and who will you work with? Someone who has 50 different accounts and multiple people working for them may not be able to give you the personal touch that you’re looking for. They may also not be able to give you a price point that you’re looking for. Know who your contact person is, so when you have questions, you can get accurate answers.
ASK ABOUT COMMUNICATION
5. How do they communicate? Do they communicate best via email? Can you call? Can you text? Do they have secure email for specific client information? Will they come to your office and meet face to face monthly or on a schedule you prefer? How long can you expect for them to get back to you (24/48hours)?
6. How do you give them claim information and how often? Do you send the claim information via fax, email, or in an online clearing house that may be part of an electronic health record? Do they only bill monthly or biweekly? Decide how often you need to get paid. If an insurance company’s billing cycle is every two weeks and billing is submitted every two weeks, but on a different schedule than the insurance company, you need to know when you can expect to get paid.
ASK HOW THE BILLER SETS THEIR FEES
7. Do they charge by the claim? Some billers charge a flat fee per claim that may be anywhere from $5-$10 per claim. Do the math. If you see 10 clients per week x 4 weeks per month =40 claims @ $10 per claim is $400 a month.
8. Do they charge a percentage based on the total amount billed? The percentage of the total amount billed could be anywhere from 4-15%. Using the same equation above, per month, if each claim is $100 x 40 claims = $4000 @ 10% for the total amount billed = $400 per month; @15% that is $600 per month.
However, some billers do both and charge a fee per claim and a percentage of either the overall amount per month or an additional amount per claim. This can make a big difference in your bottom line.
9. Do they charge by the hour? This could be anywhere from $20-$50 per hour. You will need to know, approximately, how many hours it typically takes based on the number of sessions you have per month.
ASK ABOUT THE FINE PRINT
10. What are they actually doing for the fee? Some questions that make a big difference in time and money and knowing what you are earning a month are:
- Do they determine eligibility and benefits for new clients or clients who have a change in their insurance plan? Calling to check on and verify how many pass through visits a client gets, how many they may have used, if they have a deductible and how much has been met can save you a lot of time and money from billing errors and denials. It also saves a lot of time on the phone.
- Will they re-submit and follow up on claims that were denied?
- Do they re-check client’s deductibles to determine if it has been met?
- Will they call clients who have a balance or send letters to clients regarding balances? Will they arrange for payment plans if needed?
- Do they post payments, so you know at the end of the month how much you earned, so you can track your revenue?
- Will they audit previous records to see if you may have lost any revenue or been billed incorrectly?
Overall, when considering everything above, determine how much service you want and need. Comparing pricing can seem like simple math. However, when you consider what you are getting for the money you will know the real value of the service. Sending a bill is easy, but having an experienced private practice biller who will chase down your money can provide peace of mind and bigger bank account.
If you are interested in training or a workshop on “Everything you need to know to get started in private practice” email me at [email protected].
Tara is a licensed professional counselor, licensed alcohol and drug counselor and certified yoga teacher. She has worked in behavioral health for over 16 years and currently has a private practice in West Hartford CT. Her writing has been featured in Wallingford Connecticut Magazine, she is a contributing writer on practiceofthepractice.com and she is a regular contributing guest on Radio 103.5FM WNHH “The Culture Cocktail Hour”. Having learned from personal experience she is passionate about helping women heal the past and embrace the future. To find out more about Tara visit taratherapyct.com, http://www.facebook.com/taratherapyct/, and twitter https://twitter.com/TaraTherapyCT