Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller

Are you intimidated by out-of-network billing? Is being uncertain of what to do interfering with your income or worse, keeping you from accepting clients who would benefit from your expertise?

It’s important to remember that your client may be confused too. Take control of the situation by making clients aware that they may qualify for out-of-network benefits as early in your interaction as possible. Simply addressing payment options during the initial phone screen will give you an opportunity to address potential benefits they hadn’t considered.

The point is that you and your clients don’t have to fret over the phrase “out-of-network” anymore. Not being contracted with certain providers is not an automatic anxiety-inducing problem. With a bit of knowledge, your confidence will be boosted and your reimbursement secure. All you need is some key terminology defined and a clear path to navigate.  Below, you can find both. In addition, you’ll feel supported and less afraid to make a costly mistake.

So let’s get familiar with the basics: generally, there are two ways to bill out-of-network clients:

 

1. Submit a “Superbill” to the Client

What is a superbill exactly? How does it differ from the CMS-1500 form used to bill insurance companies?

Generally, that CMS-1500 form centers on the client’s providers who are in-network on insurance panels. Superbills are typically used when you are not contracted with your client’s insurance plan. Your client can simply pay their therapy costs out-of-pocket upfront as noted on the superbill and follow their payment with a submitted request for reimbursement to their insurance company. This affords them proof of their session with you and the specifics regarding your treatment.

What does a superbill look like?

Typically, you will generate a superbill that looks like an itemized invoice. A superbill form is easily generated through most EHR platforms. On it, the following information is clearly outlined for your client and their insurance company:

Simply put, the client will receive this bill from you, pay your full rate, and submit the superbill to the insurance company for their own reimbursement according to their benefits.

 

How often should you offer clients superbills?

It’s really up to you. Many therapists provide superbills at the end of every month. Some therapists provide a superbill every session.  Still, others generate a yearly bill.

Essentially, the beauty of the superbill is that once you provide it to your client and receive payment, your part is complete.  The client assumes responsibility for coordinating and negotiating benefits with their insurance company. Also, once you’re comfortable, you’ll likely find the method is worth your time and consideration as you can quickly and easily provide more comprehensive care options and still obtain your full fee.

Not interested in superbilling?

2. Courtesy Billing is Another Out-of-Network Option

What is courtesy billing?

This billing option meshes direct billing methods and the superbill process. Basically, your out-of-network client still pays your full fee upfront, but you will assume responsibility for submitting the reimbursement forms for them. In this case, your client isn’t burdened with the required paperwork or coordination of funds. When the bill is processed, your client receives the determined reimbursement funds from their insurance company.

Also, when submitting a courtesy bill, do note that there is a difference in how benefits are assigned that you should pay special attention to.

The term “assignment of benefits” refers to a legally binding agreement between the client and their insurance company. When you submit the form for them, it is vital that you are clear about what selecting or not selecting ” Accept Assignment” on the insurance claim means.

Courtesy Billing – Do Not Accept Assignment 

Selecting “no” on the form where it asks whether you accept assignment of benefits means that the insurance company understands you do not want anything from them. Thus, your money is still paid upfront. All insurance funds go to the client.

 

Courtesy Billing – Accept Assignment

Selecting “yes”  on the form means you will not receive upfront pay and must wait for and accept the determined insurance reimbursement. Obviously, not the right option in helping you accomplish your goal for prompt and efficient billing.

 

Check out this video tutorial: 

I walk you through Out Of Network Billing in Simple Practice Here (https://youtu.be/FpNL1YIlvD0)

 

Take the Next Step

Finally, you have the information and a way forward. Do you still need a bit of support?  You aren’t alone. I’m here to help. Please reach out now. Moreover, get started, get guidance, and get your full fee by billing Out Of Network.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller 

So, you want to take insurance payments? Or do you think you might possibly want to take insurance payments at some point down the road? 

Whether you’re sure right now or not, you’ll do yourself a favor by learning about credentialing in the clearest and least intimidating way possible. 

Not sure what that credentialing really is? Or does what you do know sound like a hassle you don’t want to take on?

To be sure, insurance panel credentialing and Medicare credentialing have their challenges. However, don’t assume that. With a little education and expert support, you will have what it takes to get the job done.

Now, to start, it’s always good to answer some basic questions first:

What is Credentialing Exactly? 

Simply put, credentialing is a process by which you establish your qualifications as a legitimate, licensed professional and submit them for assessment to health plan networks.

Why bother? Insurance plan credentialing is essential if you want to provide care for patients who are insured as an in-network provider.. In other words, if you want in-network  benefits to pay for your work, credentialing with local insurance companies matters. It is vital to generate a bill-pay process that will support your aim to create a lasting and profitable healthcare revenue cycle for your practice.

Is Credentialing Hard to Do?

It doesn’t have to be the chore it’s purported to be! Still, you need a wealth of user-friendly information and experienced guidance. Fortunately, you’ll find those here.

With an open mind and commitment, you’ll soon organize and obtain the credentials necessary. Moreover, you’ll have the skills required to build a revenue cycle that brings you peace of mind and the profits you deserve.

You should know: 

 1) Just as license requirements vary from state to state, so do credentialing requirements from one health plan to another. Some have paper forms to return some have an online process to adhere to. 

2) Attention to health plan constraints and guidelines is paramount. Knowing your client base well is vital. This will help you accurately pair your own services and the health plan’s reimbursement offerings. Also, being clear about which local insurance companies cover mental healthcare and are most popular is crucial.

Is There Anything I Can Do to Make Insurance Plan Credentialing Less Overwhelming?

Yes! The best course of early action is to get your documentation ducks in a row. You want to be ready and able to provide whatever the company requests. A quick-start guide can make things so much easier and insurance panel requirements much less intimidating. Fortunately, we have such a guide. Our list of actions suggests the following

Insurance panel credentialing can take quite a while. Even if you do it all correctly, an initial application’s road to acceptance is often 50-180 business days!  You’ll need to be mentally prepared and patient as you may find you need to appeal or reapply depending on your situation.

What If the Insurance Panel I Apply for is Full?

It’s important to keep trying, particularly if the company is a key provider for the community you serve. In addition to your license and resume, a short bio attached to your application can help make your case. The quick-start guide outlines this approach but most important is to create a succinct, compelling at-a-glance picture of your qualifications including:

Finally, just know that the benefit to your practice and your client community is worth the extra effort. The idea here is to stay the course and remain focused. A clear plan and personal resilience will ensure you can effectively offer your services to a host of insured clients.

You can do this; we’re here to help. Check out this bundle I have for sale on this topic: Credentialing 101. Please reach out soon and we’ll tackle this important step together!If you don’t want to do the credentialing yourself, check out YourVAFinder.com for a qualified credentialing specialist.

(cruise Icy Straights, Glacier Bay, Ketchikan)

👫 About

I went with my mom for 10 days. Two days in Seattle and 8 days on a Norwegian Cruise through Alaska. 

This hotel in Seattle was one block from Pike Market. Our room overlooked Puget Sound.  The location was amazing.  We could walk everywhere and had a lot of fun exploring Seattle.

The cruise was pretty great as well. We had a balcony suite and woke up to beautiful scenery every morning. We saw dolphins, whales, otters, bears and crabs. We stopped at Icy Straights, Glacier Bay, and Ketchikan. The weather was perfect. 60 degrees everyday. We had rain one day for 20 minutes. Apparently this is unheard of. Ketchikan measures rain in feet and not inches. 😱

The hotel in Seattle was an inspirato.com trip and we stayed at https://www.thompsonhotels.com/.../seattle/thompson-seattle

If you want to talk to inspirato and learn more, here is my referral link. http://inspirato.com/invite/KymTolson

💻 Internet

Seattle: The hotel internet was great. I was able to stream movies from their wifi. 

Alaska:  I splurged and bought the hi-speed internet package on the cruise. I've never had luck with the internet on a cruise. This was excellent. I was able to livestream into my Facebook groups and use Facetime. I was connected the whole time and able to work on business tasks while traveling.

👨‍💻 Work

I didn't see clients or have any coaching calls while I was on this trip. Took a little break 🙂  I did work on my VA billing course and directory for Virtual Assistants and billers which is being released in the next few weeks.

📝 Licensing Issues

Not an issue this trip, but, I did do my due diligence and checked with both states, just in case.

Alaska (for LCSW)

While in Alaska you will still be able to provide services to your Virginia clients via telehealth. You are not required to obtain licensure in Alaska to provide services to Virginians. If you became an Alaska resident, wanted to begin treating Alaska residents, or began employment as a licensed Social Worker in Alaska, you would need to become fully licensed in Alaska at that point.

Washington (for LCSW)

No there are no restrictions to this. Care occurs under the jurisdiction of where the patient is located not the provider.

🍱 Restaurant Recommendations

We found quite a few great restaurants by using my Find Me Gluten Free app (due to my celiac disease). I would recommend The Virginia Inn, Cinnamon Works, The Crab Pot in Seattle.

Norweigan cruise lines were excellent. Each meal was three courses and they took my Celiac, no dairy, no eggs very seriously.  I did not get sick on this trip and the food was excellent!!

🚲 Highlights

~Pike’s Place Market

~Glacier Bay!!! OMG 💕

~Whale Watching

~ Nugget Falls

🚙 Lowlights

The COVID testing before we got on the cruise. It was nerve-wracking waiting on the results.

I scheduled an event in my insurance Billing Facebook Group accidentally in Pacific time instead of Eastern. I had the event Monday night (SEO for your private practice)  https://coursecraft.net/courses/Bbhc2/a/cpmYFEvhv

💰 Tips and tricks.

Get the wifi cruise upgrade! So worth it!!

Book your excursions once on the cruise because you get onboard credit.

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