This post has been authored by Samara Stone as part of our guest post series. Learn more about Samara at the bottom of this post.
Understanding Common Insurance Mistakes
Are you tired of fussing and fighting with insurance companies? Frustrated with not getting paid for the work you do?
Well, I am here to tell you there is light at the end of the insurance tunnel. If you are willing to take a few moments to review some office procedures in your practice, I can guarantee you will find a few ways you can improve operations and help things move forward more smoothly inside your practice.
Pay close enough attention and you will see a few trends begin to emerge. Trends on why those insurance claims are being denied. In my experience, there are five basic avoidable problems that stand in the way of getting your private practice claims reimbursed.
Take a look and let me know which one sums up the problems you have been having:
It’s the little things that count when it comes to gathering the right information to bill for mental health services. Correct demographics, policy information and even insurance company information is essential in making sure your claim is attached to the right person, the right policy and going to the right place. Any discrepancies here and those claims will be denied.
The good news: it’s a denial that you can correct. If the claim comes back denied, update the form with the correct information and re-submit to the insurance company. Your claim should be processed with no problem.
My goal is to save you the frustration and headache of having to manage denials at all by teaching you how to set up a solid intake process. This process starts with making sure you know the right questions to ask new clients and double-checking to be sure you have accurate answers.
Use this Insurance Verification Guide to avoid making those pesky information errors.
Just because your client was eligible for services at the beginning of your work together doesn’t mean that they will continue to be eligible a few months down the line. There are tons of life events that can change someone’s health insurance status: new employer, a lapse of payment, annual renewals, employer changing insurance plans…on and on. We cannot rely on our clients to know when they need to update us. They may not understand that those changes require attention on your part so that claims are not denied and you are able to get paid.
I recommend that you verify eligibility before every visit. I highly recommend taking the time to quickly visit the insurance company’s website to check eligibility. Trust me, it is WORTH it to do this ahead of time. Putting in time initially means and not having to manage denials on the other side.
Some insurance policies require that you have authorization in place in order to bill for services for a client. This means going online or calling ahead of time to request that authorization from the insurance company to ensure that you will receive reimbursement.
Securing the authorization is the first step, but to avoid authorization issues you will also have to track how it’s being used. For example, you may be authorized for 20 sessions in a six-month time frame. Be sure to monitor how you use them so you don’t run out of sessions or run out of time.
Good News…practice management systems will often provide you with a simple and easy way to track your efforts. TheraNest, for example, not only lets you track authorizations, but they also send an alert to the assigned staff member when the patient has run out of authorizations. Be sure to inquire with your practice management customer service if you’re not using TheraNest to see if you can properly track your authorizations. One other word of advice on this one: create a pattern of requesting a new authorization when you have about 4-6 remaining. It makes it easier to keep things flowing without stress.
Billing errors cover a pretty wide category and the truth is, they happen from time to time (even in the best-run practices). It could be something as simple as not knowing exactly where to send the claim or accidentally submitting a duplicate claim or even entering a code in incorrectly.
My best advice is to learn to love those mistakes and use them wisely. Each error actually points to a new area where you can strengthen the systems you are creating to keep your practice strong and healthy. Think of it as a real-world training ground where you are learning the strategies essential to maximize the income in your practice. There are a few suitable nuances that are particular to different insurance companies, but the patterns will become clear if you approach each one with a healthy dose of curiosity and solutions focused thinking.
Sometimes a more complex issue like coordination of benefits might come up and you will have to navigate billing to secondary insurance. Generally, all of these are solvable problems, something that can be fixed once you understand what has to happen.
I see this one often when people are new to private practice. Maybe they start seeing clients before they have a billing solution in place. Without a clean way to submit the claims…they wait…and wait…and wait until they have waited so long they run into something called Timely Filing. Timely filing means there is a window of time where an insurance company will accept a claim for payment. After that, they are going to deny your claim simply because you took too long to submit it! This is extremely avoidable. Don’t let this one happen to you. Before seeing clients, think through how you are going to submit those claims. Don’t let them sit unprocessed for 6 months or more.
Listen, I know it is tempting to opt-out of something when we don’t get the results we want. But with a few infrastructure updates, most of the problems private practices are having with insurance companies can be solved. Do yourself and your clients the favor of building solid systems in your practice.
I feel saddened when I see that people have had such frustrating experiences with insurance billing and I know that it doesn’t have to be that way.
If you are struggling to get paid for your work or feeling overwhelmed, get the mentoring and support you need to build the practice you want. Perfected Practice’s Mentorship Program along with a solid practice management software, like TheraNest, can help you make your pro-insurance practice one that is business savvy and set up for success!
P.S- Don’t forget to grab your Insurance Verification Guide so you can avoid making those information errors and get paid sooner!
Samara is a Sunny California native with a bright infectious smile. Her natural ability to connect with people and her strong entrepreneurial spirit led her to start her first business in college at Hampton University and has carried over to her unique career in social work.
After a decade of building The Stone Foundation a pro-insurance group practice in Maryland, Samara launched Perfected Practice in 2013. Through her mentorship programs and live events, she has become known for her wealth of knowledge and dynamic presentation style encouraging mental health professionals to build practices that make money and make a difference…without the frustration and the guesswork.
Visit www.PerfectedPractice.com for more information.