What should my billing plan look like? Should I document eligibility checks? What other information do I need to check for?
In this podcast episode, Joe Sanok speaks with billing expert Jeremy Zug about what your insurance billing plan should look like from start to finish.
There are many ways to keep your practice organized, but TherapyNotes is the best. Their easy-to-use, secure platform lets you not only do your billing, scheduling, and progress notes, but also create a client portal to share documents and request signatures. Plus, they offer amazing, unlimited phone support so when you have a question you can get help FAST. To get started with the Practice Management Software Trusted by over 35,000 professionals go to TherapyNotes.com and start a free trial today. If you enter promo code JOE, they will give you two months to try it out for free.
In this podcast episode, Joe Sanok speaks with Jeremy Zug about your insurance billing plan from start to finish, with Jeremy as an example of one of Joe’s clients.
Let’s go through all the steps together.
Case Scenario: Jeremy is a client of Joe’s
Jeremy sends Joe all of his insurance information. Joe is in-network with Priority Health.
Joe does eligibility for benefits check.
Jeremy receives a text reminder/call/email that he has a co-payment of $20.
They then set up an appointment. Jeremy receives an appointment reminder, and they do intake. Joe does his notes and billing right away.
Jeremy pays $20 to Joe.
Joe submits Jeremy’s claim for date-of-service. The claim takes 14-20 days to process. Joe and Jeremy receive EoB that the claim has been denied.
Joe follows up on the claim and documents resolution. He then perhaps sends in an appeal and lets the patient know what’s happening.
The claim gets paid.
Joe makes sure that the payment and session in the electronic health record system match. Once he’s happy, he posts it and the claim then ‘falls off’ the ageing report (it shows how long a claim has been unpaid). The record of this transaction is then saved in your EHR.
Make sure you document your eligibility check and also, make sure you have a system to follow up on claim denials.
- Tech in Billing Insurance to Save Time and Money 4 of 5 with Jeremy Zug | PoP 405
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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 that are growing their income, influence, and impact on the world. Click here to explore consulting with Joe.
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[JOE]: When it comes to keeping your practice organized, you want software that’s not only simple but the best. I recommend Therapy Notes. Their platform lets you manage notes, claims, scheduling, and more. Plus, they offer amazing unlimited phone and email support so when you have a question, they’re there to help. To get two months free of Therapy Notes today, just use promo code [JOE] when you sign up for a free trial at therapynotes.com. Again, that’s promo code [JOE].
This is the Practice of the Practice podcast with Joe Sanok, session number 406. I don’t really get tired after these. I feel pretty energized.
So, where we’ve been already is, we’ve covered the biggest myths in insurance, then we went into insurance terms that you have to know. We talked then about fraud, audits, and not screwing over your business. And we then yesterday talked about tech in billing to save time and money and we are bringing it all together today. Jeremy Zug from Practice Solutions, who is also now a consultant with Practice of the Practice. Let me just start with, I’m super glad you’re on our team. And it’s funny because I was thinking about this whole DIY billing thing. You guys do billing and so for you to say, “Hey, I’m going to teach people to do something if they want to do it on their own,” is just super cool that you don’t have this sense of protectionism. [JEREMY]: Yes. I think there’s plenty of work to go around and I think that at a certain point it makes a lot of sense for providers to do their billing and then as they grow, adjust and be flexible to the needs of their business. I mean, you know, there’s, I mean you’ve gone through quite a few changes over the years, Joe, in business and in consulting. So, you know, the ability to be flexible and to know when you need to plug in vendors and when to plug out of vendors or whatever is a critical skill in the success of any business. [JOE]: Yes. So where should we start in regards to your billing plan? Like, maybe because early on we started to get there, but then I kind of said, “Let’s go, episode five, big picture, here’s the whole flow.” Take us through the general flow and then maybe we can drill into some of those. [JEREMY]: Yes. So, let’s pretend that Jeremy is a patient of Joe’s or a client of Joe’s from a billing perspective. Not from perhaps a clinical perspective, but what is my experience? Because we talked about that earlier. You know, you need to be focused on what your customer experience is from start to finish and then tie that into the backend. So, let’s say I’m going to go see Joe. So, I sent Joe all of my insurance information. Let’s say I have Priority Health, Joe is in network with Priority Health and Joe takes my insurance information and he needs to do, what we called earlier a verification of benefits or an eligibility and benefit check. So, Joe is going to take my insurance information. He’s going to contact Priority through a portal or call them and then go through that process of checking benefits. Let’s say I have a $20 copay. So, I come into the office, see Joe, or maybe let’s back up a little bit. Maybe I got a text reminder where super fancy. And the text [crosstalk], [JOE]: [crosstalk]. medical practice. [JEREMY]: Yes, there you go. Or a call or an email or something. [JOE]: Well, I don’t know about Priority Health, knowing what their rates are. [JEREMY]: Yes, right. So yes. So, Joe takes benefits, I owe 20 bucks, he emails me back. I’m like, “Great, I can pay 20 bucks. Let’s schedule an appointment. I get an appointment reminder, we have our intake, Joe does his notes and billing right away. So, one of the problems that I think everybody has run into at some level is delay in doing notes. And if you’re using Therapy Notes, it won’t let you generate a claim until you complete a note, which is actually like a HIPAA-compliance issue and an ethical issue as well. So, from a billing perspective, it’s very, very important that you do your note as close to the session as possible because electronic health records are getting smart where they won’t let you submit a claim unless that note is done. And then if you’re a practice owner, you know how critical that is to your cash cashflow and keeping the lights on. So, let’s back up. So, Joe does his notes and billing right away and then he takes my credit card and I pay my $20. Or maybe he saves it on his HIPAA-compliant processing system and I don’t have — [JOE]: Do you do that in Therapy Notes or do you need to do the saving on the credit card? [JEREMY]: So, you can do it through Therapy Notes which I would recommend, but I mean there are obviously other systems that you can save credit card information. But let’s say that I’m a good patient and I give Joe my credit card information and he runs my card every time I see him. [JOE]: Yes. One policy that, just yesterday in a Q&A that we were doing with our membership community, someone was saying, “A lot of my clients don’t want to save their credit card information.” And so, we talked about this kind of selling it as a time saver. You know, you’re going to get two extra minutes of therapy while I can be running it at the end and that’s one way to do it or having it in your policy instead of requiring it after the first no-show. So, if you no-show on an appointment or late cancel, I need to have a credit card on file after that. You do have to have a credit card on file, which I think was good. We came up with at least some options there. [JEREMY]: Yes, that’s really smart. Yes, that’s really helpful. I’m going to file that away. So, then let’s say that Joe submits my claim for the data service that we saw and that claim takes probably 14 to 20 days to process on average, and then Joe gets an EOB. And let’s say for the sake of this example, and I as the patient I’m seeing this on my side because I got an EOB too, that they denied my claim. [JOE]: And you probably have three sessions at that point. [JEREMY]: Yes, that’s right. I probably have three or four sessions and so all of my claims are denying. So that can be a pretty jarring experience especially from the patient perspective, but also from the clinician perspective. So, from the practice perspective, you need to be watching your EOBs (explanation of benefits) or your ERAs on a regular basis, like weekly or biweekly, just keeping tabs on where your claims are in the process. So, you say that they denied and now you have a system. You’re going to call, you’re going to follow up on those claims, you’re going to document somehow that conversation and what the resolution is, and then you’re going to follow up with the patient. And maybe it’s necessarily that you submit an appeal and you follow up on that process too. And then those claims get paid because you’ve spent two hours on the phone with priority trying to figure out three sessions, or your admin has.
And then let’s say those claims pay and you need to now process those payments. So, far we’ve gone through an eligibility check, an appointment reminder, you’ve submitted the claim because you’ve done your notes on time and now you need, you’ve gotten a payment from the insurance company and now you need to make sure that the payment and the session in your electronic health record match. So, you enter that payment in and all looks great, and then you post that. That claim then should fall off of your aging report, which we’ve talked about before. But the aging report is how long a claim has been unpaid, essentially. So after [crosstalk], [JOE]: [crosstalk] says, pay directly into the electronic health records so that you don’t have to manually say that? [JEREMY]: It’s a really good question. They don’t. No, there’s no way to automate that process yet. [JOE]: That is the future of AI technology. [JEREMY]: Yes. Actually, that’s not untrue. So I know that big, big multibillion-dollar consultancy named Accenture actually tried to obsolete the medical billing industry and they essentially said, their chief technology officer came out with a big statement and said, “You can’t obsolete the entire process or the need for a human being in the entire process, but there are steps in the process that you can automate and should automate honestly because it would make everybody’s lives a lot more.” It would just make everybody’s lives better, but at any rate for now, you have to do that physically. So, you’d reconcile those payments and then those claims would be closed out and the record would be saved in your electronic health record system.
By and large, that is the narrative of how billing should work from the patient end and from the practice end. Your patients should have very little to do with following up with insurance, if anything. Hopefully, they just get an EOB, they know what they need to pay you, you charge their card, you get that cash and everything is reconciled at the end. If everything goes very poorly, let’s say that your credentialing perhaps got screwed up, and all of your claims are denying, you’ve got no payments coming in, that’s where it would be valuable to either spend a day just working on that or finding a consultant or billing company to come in and run with that from that perspective, because that could take anywhere from like 20 to a hundred hours to sort out. So, you want to be very cognizant of that. But if your credentialing is set, if you have your technology in place and your processes on the back end are structured so that the client experience is smooth, you should be able to run that system for a very long time. [JOE]: Awesome. You know, hearing that compared to you like day one and two when it was like, “Oh, I’m so overwhelmed,” and like checking out, like when I just hear that process, I’m like, “Once it’s set up, ideally it kind of clicks along,” and then there’s just a few kind of anomalies that pop out of it and you’re like, “Oh, okay.” [JEREMY]: Yes, I mean anomalies are much easier managed if you have a framework that you operate out of. But if you’re sort of absentminded and you don’t have an organized framework, those anomalies can be detrimental because then you have no idea which way up is and then you’re lost. So, that is generally the billing process from start to finish. There’s a little bit more nuance in there as far as how that, how the nuts and bolts actually work, but by and large, that should be the framework they will use to guide your billing plan really. [JOE]: So, give us a few of those nuances that you think we should drill into. [JEREMY]: Yes. How do you document eligibility checks? That’d be like the first thing. Or do you document them? One way that I would recommend doing it is either keeping a spreadsheet or in your electronic health record, you just put it there. You have a pre-filled out form or some kind of template that you use that when you do an eligibility check, you just run through that checklist and you just plug and play the information or you use an email back to the client as your housing for that information. Couple of things are the eligibility checks. Are you going to document the number that you called, are you going to document who you spoke with, are you going to document the reference number? What information are you going to check for? [crosstalk] copays?
So, when you look at eligibility check, it could get more complicated. It doesn’t necessarily need to be, but there are certain things that you should think about. Where am I going to put this? Where’s my admin going to put it? Can I train my clinicians on it? Can I scale with this process or is it something that just lives in my brain? All right, and another example would be like following up on claim denials. How are you going to know from one week to another what you did, who you spoke with, what the resolution was. So, you know, when you look at those, that’s really a place where a consultant could help you build those processes out and look at, what’s the best method for your practice to build up these systems. We have a general billing framework, but how does each main process interact with each other or what’s the result of each process that you want? And then how do you get? [JOE]: Yes, when it’s big picture like that, like here’s how the flow is supposed to be, I think, I don’t know how the listeners feel but I feel like way less like, “Okay, this would be totally doable. I was just starting out.” [JEREMY]: Yes. And I hope it would be right. So, if you’re just starting out, I mean, just sit down perhaps with that whiteboard, I love whiteboards or a piece of paper and just [crosstalk]. There you go. You just write down what the process should look like or what you want, and then revise it. It’s so much easier to edit your processes than just start writing them. So, if you just sit down, just start writing them out, start documenting them, you’re going to revise them later. I mean, you’re not writing the 10 commandments or something. You’re just going to document them on a piece of paper and you’ll revise them later. [JOE]: Yes. And I think for people that want that help, that’s something that you’ll walk them through in the consulting to be able to say, “Okay, here’s how it should be,” and then they can say, “Oh, let’s change this and this.” So, awesome. Well, this series has been killer. We covered so much ground in regards to billing and insurance and if you’re watching this on YouTube you know, head on over to practiceofthepractice.com and you’ll see this whole series. We have all the show notes, all the resources, all of that there. We have a couple resources for you. So, if it’s before November 6th that’s when Jeremy and I are doing our billing webinar.
So, you can head on over to practiceofthepractice.com/billingwebinar and you’ll get access to that. It’s totally free. We’re going to be chatting all about billing, insurance, answering a bunch of Q&A questions. So, that’s November 6th at three o’clock Eastern, two o’clock central, one o’clock mountain, and noon Pacific. Also, if you’re starting that credentialing process or doing the DIY billing, or if you’re a larger organization that wants to have people trained by Jeremy Zug, you’ve done, what’s, you said how many millions of dollars of collections you’ve done? Like, do you know what you guys are at this point? [JEREMY]: Well, yes. It’s well over a hundred million at this point. [JOE]: That is insane. [JEREMY]: That’s between patient and insurance, but it’s a fair bit of revenue. [JOE]: Yes. So, you know what you’re doing. And so, head on over to practiceofthepractice.com/Jeremy if you want to work with him. One shout out I didn’t tell Jeremy I was going to do is if you do want to work with Practice Solutions you can go to practiceofthepractice.com/fun, because they are the most fun billing company I’ve ever met, and then that’ll redirect you to their page. I am an affiliate, I do get a small commission for that, but it’s a way that we keep doing kind of the podcast and this sort of stuff by having these relationships with people. So, Jeremy Zug thanks so much for being a part of the series. [JEREMY]: Thanks Joe. I really appreciate it. It’s been fun. [JOE]: All right, talk to you soon. [JEREMY]: Yup. Bye. [JOE]: This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one. And thank you to the band Silence is Sexy for your intro music. We really like it.