Creating a Insurance Billing System | Billing 101: An eBook by TheraNest
Chapter 4: Insurance Billing and Your Employees
Now that you are comfortable with the basics of billing, how do you pass on this information to your staff? Your employees need to know how to properly handle billing tasks, including medical coding. Sure, they may know HIPAA, but do they know the difference between downcoding and upcoding? Do they understand your payment policy? Are they able to answer your clients’ most common billing questions without putting them on hold and shuffling through paperwork?
If you said no to any of those questions, or if there is a doubt in your mind, this section will help you create a plan of action to put your worries to rest. We will discuss how to educate your staff on the basics of billing so your practice can succeed without financial (or legal) mishap.
Understand the Code
Your staff should be well versed on Current Procedural Terminology (CPT) and International Classical of Diseases (ICD-10). ICD-10 is much more specific than its predecessor ICD-9, so make sure you educate the responsible staff members on the new changes.
Create a cheat sheet for your office of the top mental health billing codes you use on a consistent basis. This reference page or booklet can be a lifesaver until you have memorized your most frequently used codes.
Teach Your Staff How to Use the Software
First, choose the best software available (we are partial to TheraNest, but encourage you to look around until you find a software that best fits your practice’s needs). Next, make sure every staff member who works with this software feels comfortable navigating around it. Your staff should understand how to operate the software to properly invoice clients, create and download intake forms, and schedule client sessions. At TheraNest, our client portal makes collecting intake forms easier and even allows you to build custom forms to suit your needs. Functionalities such as these are ones that you should consider when deciding on a software.
Create a Standard Check In Procedure
Do you have a set check in procedure? Going beyond signing in a client and asking them to fill out the necessary paperwork, does your front office follow a standard set of practices for billing? This is the process that should happen during every client check in:
Insurance verification should happen on (and better yet before) each office visit. Because a client may change insurance at any time, you should always verify that the client has active coverage.
There are two ways to do this: over the phone and online. Over the phone is definitely more time consuming but it may be the best way to verify insurance. Many insurance companies make it possible to verify coverage via their website. If you are a contracted provider, you will have access to their website, including coverage information.
Check the client’s coinsurance, copay, and/or deductible
What fee, if any, will the client need to pay on this office visit? Has the client already paid a portion of the deductible? Billing copayments, coinsurance, and deductibles via invoice highly decreases the chances of receiving timely payments in comparison to when these charges are collected at the time of service.
Coverages differ wildly depending on the insurance plan. While you may have two clients who work at the same place and use the same insurance provider, the services covered for one may not be covered for the other.
It is crucial to check for coverage because if you do a procedure that is not covered by the insurance plan, the insurance company will deny your claim and you will either have to pass on the balance to your client (bad) or eat the charge yourself (worse).
But this situation can all be avoided by having a standard procedure for checking coverage along with insurance verification.
Check benefits cap
You have checked coverage and you are good to go — but have you checked the benefits limit? This limit is usually reset annually, and it can dictate how much you are able to offer your clients.
Check for authorization notices
The insurance company may require advance notification before you perform a service. Find out during the verification process if you need to pre-authorize services with the insurance company. Otherwise, your claim may be rejected (though some insurance companies will authorize a service retroactively) or even denied.
Make a copy of the insurance card
On an initial visit (and any time your client changes insurance providers), create a copy of the insurance card front and back. Keep it on file for reference.
Explain How to Handle Self-Pay
It may seem easy to deal with self-pay clients. Without a doubt, there are less hoops to jump through. However, you should commit to streamlining your front office payment policies and procedures. Here are a few strategies:
Create a written payment policy
In your payment policy, set clear expectations for your practice and your clients. Discuss when payment is due (typically before receiving a service). Explain what your policy is for no shows and late appointments. Detail how much you charge for checks that are returned due to insufficient funds. Provide all the payment options you accept.
Attach your written payment policy to your check in forms. Ask that your clients sign this form to verify agreement and make sure to give them a copy to take home with them.
However, do not stop there. Ensure your front office staff understand exactly what your payment policy is and can recite it with their eyes closed. When everyone is on the same page, it creates a consistent and better client experience.
Verify payment for each visit
For repeat clients, you may have a credit card on file. However, get your client’s permission to charge this card during every visit.
Plan for all types of payments
Train your front office staff on how to accept and process each payment type you allow. Your staff should be adept at processing credit and debit card transactions. They should understand how to handle personal or cashier’s checks. Also, they should feel comfortable providing change back to those who pay with cash.
Training your staff on how to handle billing offers its own reward. The more they understand and comply with your billing procedures, the greater your chances of creating a seamless check in (and check out) process.