Are you at your wits’ end with trying to bill insurance? Have you struggled to find the right company to work with when it comes to billing insurance and filing claims? What are the things you should know when hiring a new billing company?
In this podcast episode, Andrew Burdette speaks about why having a billing pro is the wise choice with Victoria Benson.
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Meet Victoria Benson
Victoria is the owner of Victory MH Consulting (VMHC). Before the creation of her business, her background was in Finance and Profitability for large worldwide corporations. She developed a love of making companies profitable and more efficient but found that the global companies were so massive in size, that she couldn’t see how her efforts helped transform individual lives.
VMHC began in 2013 with a lot of faith, few clients, humble beginnings, and a passion for helping small businesses grow and function efficiently on a more personal level. She focused her skill set on a field she is passionate about: Mental Health, as she believes in and knows the importance of what practitioners do. She has since had the honor of meeting mental health clinicians from all over the US and she enjoys watching their practices grow and become profitable. VMHC offers full-service billing services, insurance paneling services, and new practice consultations.
In this Podcast
- The difference between being paneled and credentialed
- Your NPI number in insurance
- Why hire someone to do your credentialing
- Offering telehealth therapy with insurance
- Victoria’s advice to therapists who handle insurance solo
- How to hire a biller
The difference between being paneled and credentialed
A lot of people use the words paneled, credentialed, and contracted interchangeably, but they do mean different things.
For example, being credentialed means that a provider has gone through a process where their credentials have been checked along with some other required items like liability coverage and education requirements.
Once they go through the credentialing process, if the insurance company has enrolment to join as an in-network provider, you can then request a participating contract to provide in-network services to their members. That would be paneled or contracted. (Victoria Benson)
So you can be credentialed with an insurance company, but not necessarily paneled or contracted unless you take further steps.
Additionally, a therapist can be paneled and contracted with multiple insurance groups.
Your NPI number in insurance
The NPI number is the national provider identification number, and there are two types:
- Type 1 is assigned to an individual provider. This number will be associated with a taxonomy code that belongs to your classification and your specialty.
As an example, [there’s] a nurse practitioner classification but maybe their specialty is psychiatric mental health, and there’s a taxonomy code for that. (Victoria Benson)
You can have more than one taxonomy code since you can have more than one specialty.
- Type 2 is assigned to an organization, group, or sports facility. You want to get a taxonomy code that is aligned with the highest level of specialization within the group.
A physician or nurse practitioner is at a higher level, so have the primary taxonomy code link with them.
Why hire someone to do your credentialing
If you decide to hire a company or consultant to do your credentialing for you, some questions you could ask them may include:
- Are they familiar with your particular insurance company? Since each insurance company may have different stipulations and regulations.
- Ask them to follow up with you on any questions, but most of them will do so anyway as a standard practice.
You definitely want somebody that’s keeping track, making sure that nothing is needed, it’s not being held up for whatever reason, that the analyst that has it is doing their job, that you escalate it once you get past their initial required days of waiting. (Victoria Benson)
- As soon as the required days of waiting are up, be sure to follow up with them to escalate your process.
Even though working with a company to get credentialed can be easier and a little stress-free, you may lose some autonomy since your contract remains with them if you decide to go elsewhere.
You don’t own the contract so you don’t have any say in what they do with it, what happens with it, and if you ever wanted to leave, you’d have to have something in place. (Victoria Benson)
Offering telehealth therapy with insurance
Whether or not telehealth is covered is plan-specific.
If you’re going to provide telehealth services to your clients, you definitely want to make sure that your client has checked to see what their coverage is, and if it is covered, is there a platform requirement? (Victoria Benson)
Certain insurance companies will only allow telehealth therapy on specific platforms, so the provider needs to be set up on that specific platform.
Before the pandemic, most insurance companies paid therapists less for telehealth services. However, that has shifted and been updated since the pandemic and now many insurance companies pay the same amount for telehealth therapy and in-office.
However, not all insurance companies have adopted that shift, so you need to check the amount first as well.
Victoria’s advice to therapists who handle insurance solo
- If the denial reason for payment is not explicit on the form, you have to call them. Make time to call and figure out what is going on.
- Many ERAs will tell you why the payment might have been denied, so be sure to read it before making the call.
- Don’t write claims off when you become frustrated! There are ways to resolve issues.
How to hire a biller
Victoria’s advice is that if you want to hire a billing company, set up a meeting with them and make sure that before the meeting you have a clear outline of the kind of service you want.
What is important to you? Receiving benefit information? Do they charge fees? Also, make sure there is a monthly minimum in place and a fee schedule that you need to hit.
Make sure to ask what their policy is in terms of billing timelines and how long you can expect claims to return once they have been submitted.
If you’re going to be providing services, you don’t have time to do that, so it’s really about where your time is [needed]. If you’re going to be doing your own billing, make sure that you schedule in some time to be able to get on the phone. (Victoria Benson)
Billing can be tough, but it is doable! And there are teams of experienced people around who are more than willing to assist you.
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Meet Joe Sanok
Joe Sanok helps counselors to create thriving practices that are the envy of other counselors. He has helped counselors to grow their businesses by 50-500% and is proud of all the private practice owners who are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.
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