Posted by Kym Tolson, LCSW

Working Online and Traveling the World

Is your practice fully remote? If it is, you are living the dream. You provide valuable mental healthcare from home, your hotel room, from anywhere. Your clients aren’t locked into an office setting. They can receive your care from any safe and nurturing place of their choosing as well. It’s a good thing. You’re doing the work.

So, now all you have to do is bill for your services.

Not so easy? If you’re honest, the idea of sifting through the rules and parameters is likely intimidating.

Do you find yourself, hedging, procrastinating, or even outsourcing your claims to people who might not have your best interests at heart? You aren’t alone. If you find yourself held back by the thought of tackling billing on your own or tired of feeling inadequate or uninformed, you’ve come to the right source.

Working Online and Traveling the World

Step One: Communicate with the Provider

Firstly, before you do anything, you need to know who you’re working with.

While it’s true that COVID-19 has ushered in a wider range of telehealth services, communicating clearly with your patients and providers is vital to avoiding billing missteps. Foremost, it is wise to request that your patients confirm their own insurance coverage before each appointment. Then, follow up by corroborating coverage and verifying each insurance provider policy. Keep a list of telehealth eligible CPT codes from each payer.

Step Two: Be Clear About Therapy Service Location

As discussed in a previous post, POS(place of service) codes are two-digit codes reported on Form CMS-1500. These codes clarify the services performed and ensure that each claim is properly settled. As you may already know, there are two applicable POS codes at work:

1. Billing Code POS 02. This code indicates that telehealth service was administered without identifying where your patient received it.

This applies to situations where therapy services were 1) provided via telecommunication technology like Zoom and 2) where your patient is not located in their home while working with you.

2. Billing Code POS 10. This billing code is a result of COVID-19  public safety expansion. It allows for a patient’s place of residence to be the site of all mental healthcare.

Diagnosis, evaluation, and therapy can all be accomplished and billed under this code. Please note that employing POS 10 will become possible in April 2022 for most commercial insurances. At that point, CMS is still wanting us to bill 11 as the location and 95 for the telehealth modifier.

Step Three: Be Aware of Important Telehealth Distinctions

As you learn more about billing, you will also learn more about the differences in federal offerings, state providers, and private insurers. This is important to recognize in how teletherapy accommodations are administered.

For example, as it pertains to audio vs. video teletherapy, Medicare may be billed for both audio and video telehealth.  However, audio-only therapy is currently covered only for the duration of the pandemic public health emergency by other insurers. Moreover, some providers only cover video teletherapy.

Thus, as you travel and practice, it’s important to determine which codes apply and for how long. You may want to hire a qualified virtual assistant to help too if you feel it would help you stay current.

Step Four: Work with A Knowledgeable Guide and Supporter

Hopefully, you have found this info helpful and you aren’t too worried about billing to postpone your travels! Don’t worry if you have more telehealth billing questions. You aren’t alone and you have resources that travel with you! In fact, you have qualified, up-to-date telehealth billing support offered without judgment anytime.

Currently, I run a Facebook group for insurance billing for Telehealth to help you in real-time. You can talk things through with others who are looking to master telehealth on the go as well. When you are ready, link here, and join us soon to start making teletherapy billing a breeze.

New POS Code 10, Posted by Kym Tolson

The pandemic has changed us all in ways that are too numerous to count. This is the case in the therapy billing world too.

In a previous post, we discussed how much location matters when billing telehealth services. Given the greater demand for teletherapy, the Centers for Medicare & Medicaid Services (CMS)  has seen fit to amend certain billing codes in response. To keep up and bill correctly, it is crucial that you are aware of changes and modifications to the place of service codes for telehealth today.

How Have Place of Service Codes (POS) Changed?

POS codes are two-digit codes reported on Form CMS-1500 meant to help clarify those services rendered and ensure that claims are appropriately paid. As you may recall, on the HCFA 1500 form, telehealth providers were required to use the E&M CPT location code of 02 with the modifier GT or 95. Without the POS 02 code, the telehealth services would not be accepted by the payer.

The idea of the current changes is to improve the reporting of services you are offering your patients away from your office as well as the coverage of that therapy.

This, of course, is only a good thing if you know exactly what to do and when. So let’s break this down clearly together below:

Billing Code POS 02

First, understand that this existing code has been revised. The POS 02 code,  is now described as telehealth provided other than in the patient’s home. By using this code, you are indicating that your telehealth service was administered to a client who was in a location other than their home.

This means that

  1. your therapy services and, any related services, were supplied and obtained, via telecommunication technology, such as Zoom or any such teleconferencing medium that is HIPAA compliant.
  2. your patient was not located in their home while working with you. In other words, to use the code POS 02 they can be anywhere but their own home environment.

What if they did work with you from home? There is now an entirely new code for that type of care below.

Billing Code POS 10

**NOTE: Do not use this code for Medicare.

Medicare is still requesting 11 as the location and 95 as the modifer. (April 2022)

Post-pandemic, this new billing code provides the specific distinction and soon payers will require the distinction.  This change was made to accommodate the 2021 Consolidated Appropriations Act.

This allows for a patient’s home to be the site of all care. This includes diagnosis, evaluation, and treatment for any and all mental or behavioral health conditions.

With this being the case and endorsed for public safety,  you can confidently use this code to indicate that your telehealth service was appropriately and professionally administered in your patient’s place of residence.

Before you bill, do be sure to wait until the time is right

Now, that you are fully informed, be patient. To start using this code right away will likely meet with missteps and frustration. Unfortunately, systems are still rejecting the new code. You will need to wait until April of this year (2022) to employ POS 10. At that point, CMS will fully implement the updates.

New POS Code 10
New POS Code 10

Still Feeling a Bit Unsure?

Are you ready to jump into billing or do you still have questions? It’s perfectly okay if you do. These are uncertain times. You have a lot on your plate. Maybe you wonder whether the modified POS Code 02 will be affected by the end of COVID-19? Or do you wonder how you will know how to adjust your codes when our official public health emergency (PHE) finally comes to an end? Perhaps you are feeling uncertain about the number of changes occurring in the billing world in general!

You are not alone and you don’t have to navigate it all on your own.

We are here to help you feel confident and secure as you set about properly identifying your services, meeting your client’s needs, and fairly (and legally) receiving payment.

You Have Telehealth Billing Support Available to You Right Now

It is perfectly okay if you have more telehealth billing questions! I run a Facebook group for insurance billing for telehealth to help you in real-time. Link here: http://bit.ly/2kKfZXp  and please join us soon. Let’s talk things through together with others who looking to master telehealth billing just like you.

Posted by Kym Tolson

Do you Need A Virtual Assistant? Do you need help answering the phones for your practice? Are there stacks of to-dos, half-attempted forms, and emails that need to be blasted? But you know you just don’t have the time? If so, you might consider the support of a virtual assistant. In fact, a VA may just be the help you need to free you up considerably. Then, you might not feel so frazzled and demoralized when you think about billing privately.

Not sure you what a virtual assistant is and how you would go about hiring one?

No problem! Read on:

A Virtual Assistant is that “Right Hand” Successful People Are Always Talking About

Anybody at the top of their game obtains the right support at the right time. For many therapists, that support is a person whose job is to provide that support. They have the skills to offer and willingly do so for a fee.  This support can come in a host of forms and is usually offered on a schedule you prefer on a remote basis.

The beauty of it?  Their remote location means you can find ideal candidates from anywhere, near or far. The best people, with a wealth of experience, are not out of reach as long as they can work privately, securely, and reliably online.

With a high-speed Internet connection and attention to detail, an experienced virtual assistant can be a game-changer for you and your practice.

So, What Key Skills Would a VA Bring to My Practice?

There are various kinds of virtual assistants. So, it’s important to consider your needs as you see them now, what seems to fall through the cracks and the kind of support that might be necessary for goal-setting and growing your practice. Generally, virtual assistants offer the following services, which may be very helpful:

Administrative tasks are common responsibilities for most VAs. They can help with

Personal support is also well within the skill set of many VAs.

They can maintain your social calendar or act as a personal shopper. Managing your personal errands, deliveries, and transportation would be areas they could handle as well.

Tech Support is often an area the right VA can help with routinely as well.

They are able to manage and maintain your website, often a load off a therapist’s shoulders. They can also set up efficient works systems and processes, transcribe audio files, and more.

Creative help is also available if you find the right VA for you.

Website and social media design and content creation may be areas they can help you with. Graphic design, marketing, and direct mail campaigns might also receive a boost and consistent attention with a VAs assistance.

Hiring a virtual assistant is a wise decision if your expectations are clear.

It’s important to be realistic and open to change if you do decide to hire a virtual assistant. They aren’t miracle workers and a good deal of communication will enhance your ability to effectively delegate. This person will represent your private therapy practice to your customers.

Also, be sure you can balance handing over the reins in certain areas while feeling comfortable with your role as the primary director of your practice. You’d want to hire someone who understands your communication style and with whom you can interact comfortably online, over Zoom, etc.

All told, hiring a virtual assistant with the right skills for you and your practice can provide the time you need to rest, do lots of things you haven’t felt free to do, and grow in ways you can’t without support. Why keep yourself stretched thin?

Where Do I Find A Virtual Assistant?

I created a directory for trusted Vetted billers for therapists. Here's the list. I have interviewed them and checked their references. All are highly recommended billers and virtual assistants. Message them and inquire about how they can help you with your private practice!

Group Therapy Billing Posted by Kym Tolson

Do you offer group therapy sessions that deal with distinct mental health concerns, skills, and solutions for issues like anxiety, depression, grief, substance abuse, etc? Are you confused about how to bill for it? Not to worry, you can still feel good about offering a place for your clients to meet with like-minded people seeking treatment and support. Below, you’ll simply find the information and support you need to bill appropriately and routinely.

Let’s Start with a Point of Clarification:  Psychoeducation vs. Psychotherapy

To bill correctly, you need to know the difference between psychoeducation and psychotherapy. Why? There is a significant difference between group psychotherapy and group psychoeducational services in the billing world. Legally, you can only bill for psychotherapy sessions. Otherwise, you can charge a self-pay rate for the group and dispense with using insurance at all.

To get a clear idea of what your practice is offering with regards to group work, let’s look at the differences:

Group psychotherapy treats mental health problems via an assessment of some type. That assessment defines both the problem and the treatment goals you specified to help the group progress. The goals are specifically related to the mental health issue that has been identified. Group psychotherapy providers may include a licensed mental health therapist, such as a psychologist, social worker, counselor, etc.

Group psychoeducation is education provided to a person with mental health challenges and the loved ones available to help manage their condition best. The mental health assessment, in this case, does not need to be performed by the psychoeducation provider. Group psychoeducation may educate members regarding a variety of topics, including mental health, communication skills. Psychoeducation is helpful guidance, not particular treatment, The group leader may be a wide variety of experts not just a licensed mental health professional.

Be Sure To Use the Correct CPT Codes

Defining 90849 and 90853

Your practice’s group offerings will use one of two billing codes: 90849  or 90853. They are the codes used when treating clients with similar issues together, in a group format. To qualify for use of those codes,  the session must employ psychotherapy within the group.

So, you might wonder, “which code is used at what time?” Good question. The two group therapy codes are distinguished by patient type.

Group Therapy Billing
group therapy billing

What Does the Group Therapy Billing Process Include?

Reimbursement for group psychotherapy is insurance-dependent, varying by the plan and your region, so be sure to check with payers to determine if they cover code 90853. Because many insurers don’t cover group psychotherapy, it’s a good idea to make your clients aware as early as possible. You may want to establish a policy alerting clients that they are responsible for all uncovered charges on their consent forms to ensure you receive payment.

Also, be aware that the members in your group psychotherapy sessions need individual documentation. Describing each session and the way it contributed to treatment goals is important.

Medicare policies require that sessions do not exceed 10 participants and do not allow for the following services under CPT Code 90853:

One unit per day may be billed for CPT code 90853.

**Special Note: If you are teaching these above-listed services. This is considered a psychoeducation group and you can charge a self-pay rate for the group. Have your clients sign an insurance opt-out form just to be safe. Email me if you would like a copy of my opt-out template.

More 90849 or 90853 Coding guidelines to keep in mind

Now, Let’s Take the Next Step

You know the value of group therapy. Hopefully, you also recognize now that you can offer it and get the fair compensation you deserve. If you find you still need a bit of support, don’t worry. I’m here to help and to connect you with other therapists who are improving their billing knowledge too. Please reach out now. Get started now to get the guidance you need.

“Incident To” "Supervisory" Billing Confusion

Posted by  Kym Tolson, Billing Expert, Traveling Therapist

Are you confused about the rules governing your ability to bill under the license of another professional?

You aren’t alone. The fear of mistakenly committing fraud keeps many therapists from tapping into their income potential. However, if you can define the terms, clearly, obtain some up-to-date information, and learn the ropes from a trustworthy guide, you might feel differently.

Let’s explore “incident to” billing together.

“Incident To”…What Are We Really Talking About?

Typically, the phrase “incident to” refers to the relationship between a conditionally licensed person and their fully licensed supervisor.

Let’s say you want to provide sessions that are covered by a client’s insurance. How can you do this if you work under a supervisor’s umbrella?

Essentially, if you meet the appropriate requirements you can legally meet with clients and get paid to do so. Still, context is important for getting things right on your claims. Below, we break down what’s legitimately allowable for you to bill and how to do so.

As the supervisee, incident-to billing allows you to:

Incident to billing
Incident To Billing

Investigate the Insurer… Are You Sure You Are Cleared to Claim?

This is important. To successfully bill, you must take time to be sure you know the incident-to billing parameters of your location.

Your state and insurance carrier matter greatly. Why? Each plan operates differently in each state. Cigna is the only insurer that has a blanket policy that allows for national application.

So, to be clear, Medicare often permits incident-to billing. Unfortunately, many private plans don’t. Figuring out whether you can bill under your supervisor’s credentials is best accomplished by reaching out directly.

First, contact each insurance panel. Then discuss with the appropriate parties which incidental, supervised services are permitted under their policy. From there, you can determine if you are eligible for this type of billing and which requirements hold true for you and your state.

Pro tip: Go to Psychology Today, look up limited licensed providers in your area, see what insurances they take. That will help pinpoint some insurance plans that allow provisionally licensed providers to bill under their supervisor. Unlikely to falsely advertise, they have already done the research that will point you in the right direction.

Take On The Billing Process…What Do You Actually Do?

Okay, so what does billing look like?  First, remember that your supervisor (the attending provider) must see the patient first( though not on every visit). They provide oversight, engagement as needed. With that understood, you are fine to meet with the client.

After seeing the client, you will enter the appropriate billing codes and sign the form appropriately for the plan. Your supervisor will then review your submission and approve it and submit it to the billing department for review.

As requirements vary state to state and payer to payer, you are responsible for ensuring the submission of correctly formatted claims. For example, some policies will ask that your name be provided along with your supervisor’s credentials. Others will require your supervisor’s name and credentials instead. Here is a list we are compiling in my Facebook group, "Insurance Billing For Telehealth Providers"

Don’t Bill Alone

With good information and support, you can do this and feel confident about moving forward. Soon, sustaining your income legitimately without concerns about fraud will be entirely possible. Any fear of creating problems for you or a supervising professional will also no longer worry you. Let’s talk soon and put our heads together. I’m here to assist in making worries about incident-to billing a thing of the past.

Posted by Kym Tolson, LCSW, Boss Biller, World Traveler

Okay, so you’ve decided that you need help from a Virtual Assistant. That’s good and actually half the battle.

You realize you’re buried in tasks and appointments. You recognize that follow-up and follow-through are getting more and more difficult to manage. You’re clear that you need support so you can focus on billing well and learning new ways to optimize your practice.

All told, outsourcing seems like a godsend. Now, if you can just find the right virtual assistant, reining things in and restoring your peace of mind is possible. Ideally, you want to free yourself up to maximize the time devoted to clients, passion projects, and income building. Thus, it’s vital that you clearly determine what exactly “outsourcing” means to you.

Understanding Your Priorities: Know which practice activities you want to outsource to a Virtual Assistant

Will you hand over general office duties and admin tasks? Or will you need someone more experienced with the ins and outs of private therapy practice? Answering these questions honestly and clearly makes a big difference in the type of help you hire.

Take time to look closely at your activities and your business to calculate what you believe needs your personal attention and what someone else could perform competently. Then, you need to figure out which of the latter should be transferred to a VA and how.

How to Find Viable Candidates, Interview, and Hire the VA for You

Finding Candidates via Virtual Assistant Companies and  Job Postings

A simple web search will lead you to a host of virtual assistant companies promising help. Upon closer inspection, you’ll see that some offer American-based assistants with specialized backgrounds. Others will offer competent, English-speaking assistants with less specific training. Who you choose depends on how you wish to use their skills and your budget.

Why YourVAFinder.com is the only Search Aid You Need

Find Your VA for Private Practice
Find Your VA for Private Practice

While agencies and job boards can offer a wide variety of options, such large pools of Virtual Assistants can be overwhelming. That’s why I developed a site dedicated to supporting therapists with private practice. Better yet, my site provides VA’s who understand the unique nature of your business, billing standards, and what it takes to manage a growing practice. This significantly streamlines your search for support.

At YourVAFinder you can one-stop-shop for help. You’ll be able to

1. Search candidate specialty or location.

2. Compare candidate rates, reviews, and profiles.

3. Connect with candidates for additional info.

Executing an Interview

To get the best sense of who you’re dealing with, perform an interview via Zoom, Google Hangouts, Duo, etc. Face-to-face interaction is key. Beyond the way they read on paper, you need to read temperament and whether they truly have a workable Internet connection. Feel free to let candidates know they are being recorded, and compare recordings later to gauge who you like best.

Need ideas for what to ask during interviews? Try these:

Most of all, your interviews should determine several factors beyond the basics of their past experience. Your work together would be fluid and require prompt, attentive action. Thus, you need to clearly ascertain how they cope with specific situations.  Try to ask specific questions about situations, how they would contribute, and what they would do if specific issues arose.  Take the time to get a clear idea of their ability to organize, problem-solve, and take responsibility.

Keep Communication a Top Priority

As you narrow down your options, the need for a high level of communication is key. A virtual assistant is relying on their ability to serve you via technology. You need to work well, exchange ideas, provide feedback, and receive updates seamlessly. Your online interview and discussion of rates and working conditions reveal a lot about how comfortable you’ll be in a working relationship.

Finally, congratulations! You are on the way to making your practice more efficient and your life less stressful. Let YourVAFinder find you a professional able to understand and support your business. Soon, the right selection will anticipate your needs and help you transform, your business optimally.

The No Surprises Act 2022 & Good Faith Estimates as of 12-29-2021

The Good Faith Estimate (GFE) relates to a new law that will go into effect on 1/1/2022. Here is a detailed summary of The No Surprises Act (NSA).  I currently have all insurance-based clients so I haven't been too rushed to hop on this, but I'm sure it's coming soon for all client types.

Facts
:

-This absolutely applies to therapists in private practice. There seems to be some confusion around what type of provider needs to provide a Good Faith Estimate. At first, it seemed it was only for MD's and emergency providers.

-Currently, this only applies to our out-of-network clients and our self-pay clients, but if you charge other fees you need to include them in your good faith estimate. 

-This is expected to be expanded to in-network clients later in 2022. It looks like insurance providers will soon have to provide these as well. I'm hearing in the Spring.

- Your safest bet is to consult a lawyer to discuss your specific practice and the rules of the NSA and GFE. I called my liability insurance (CPH & Associates) and they "do not offer legal advice related to billing." They suggested I call a local business attorney to get advice. 

Opinion: 

I believe it's best practice to go ahead and implement this in your practice for all clients because you still need to give estimates about no-show fees. I really need to get on that! The expert billers in my Bill Like A Boss membership are already doing this for all of their providers.

Templates: 

Check out these templates to help guide your paperwork. I would recommend creating your own and having a business attorney that specialized in healthcare and mental health law review them.

Template for client disclosure statements.
CMS's Template for a Good Faith Estimate. 

Megan Smith Gunnel of The Thriving Therapist FB group shared her Template for her practice.

A member of my Insurance Billing for Telehealth Practitioners shared this template.

The major EHR's are starting to add templates to their paperwork.  Simple Practice created a form that we can fill out and send to our clients. Here's a free trial if you aren't already a member. 

Find it in SimplePractice Under Settings, then Notes and Forms, then Assessments, then "Good Faith Estimate for Health Care Items and Services". Update: Simple practice has just released a new feature that allows e-signatures on all documents. This is going to make implementing the GFE even easier.

I've heard therapy notes, therapy appointments, and some other EHR's have also added these templates for us to use.  

Some therapists are just putting the notice on their websites:

"You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.  Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.  You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services. 
You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service. 
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises

Please contact our office at (xxx)xxx-xxx if you’d like to request a Good Faith Estimate".


Resources:


I've put together a list of resources to help guide you through this in my Facebook group, Insurance Billing for Telehealth Practitioners here. 

Here are a few of the most helpful: 
FB group dedicated to this topic

New Billing Disclosure Act

No Surprises Act - Ethics CEU's available 

What MFT's Need To Know

No Surprises Act: New Billing Disclosures Going Into Effect

What You Need To Know About The No Surprise Act



I hope this helps!!

I will keep you updated, especially when it applies fully to In-Network insurance providers. 


Warmly, Kym
info@kymtolson.com
8046157945
Grow and Scale With Me:

Join me on Facebook at  Insurance Billing for Telehealth Practitioners

Join our exclusive billing membership at Bill Like A Boss

Need a course that walks you through DIY Insurance Billing In Your Private Practice? Join here

Out of Network Billing 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.

***Please note: If you do offer a superbill you will be at risk of an audit and potential clawbacks from the insurance company. Many clinicians do not understand if you are dealing with the insurance company, you are eligible to be subjected to audits and the repercussions of those audits.

 

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 the guidance, and get your full fee by billing Out Of Network.

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

Your practice deserves the right care and attention and Electronic Health Records are a game-changer in private practice.

Compared to other types of practices, mental and/or behavioral health practices, in general, are special. Your everyday needs are special too. Therefore, to build a successful, thriving therapy practice, you’ll benefit greatly from the use of software that helps you manage the necessary tasks for growth and proper maintenance.

In addition to the basics, you’ll need to consider the type of guidance, support, and ongoing updates required to use your software optimally. Your specialized needs as a mental healthcare professional will likely cover anything from patient scheduling to insurance billing.

Electronic Health Record
Which EHR is right for my practice?

General Features of Electronic Health Records for Mental Health Providers

Firstly, it’s important to know that, mental health software is actually a network of software systems. Combined, the idea is that these individual systems will cover all of your business bases. To be most effective, therapists usually need software platforms systems that address the following:

Electronic health records (EHRs)

Accounting & Billing

Patient scheduling

Patient portal

Telemedicine

Overall Management

Essentially, it comes down to this: you want software systems for improved efficiency, accuracy, and effectiveness of patient care. Simultaneously, you also want to support the effectiveness of administrative jobs, especially account management and insurance billing.

So…where do you start to find the best options for billing software?

You definitely aren’t alone if finding the best platforms for coding and billing seems like a big ask, especially when you’ve already got so much going on.

It’s true too, that there are lots of options on the market. But they aren’t all equal when it comes to features and ease of use. Wouldn’t it be helpful to have a clear comparison of the best programs?

Look no further. Below you’ll find a features breakdown of three major software platforms:

Mental Health Billing: Comparing the Features of Three Major Software Platforms (EHR’s) 

Simple Practice

When it comes to ease of use, popularity among therapists, and customer support. Simple Practice is well regarded and highly rated. 

Features

Grab your free trial with $50 off here

Therapy Notes

This platform is intuitive and user-friendly with features that allow you to get up and running quickly.

Features

iTherapy

This platform permits you to put together all the tools you need, with the option to add services as needed.

Features

Code:  Kym 

Use the code above when enrolling and you will receive 50% off the first two months!

Need Some More Help?

Now, just because these platforms offer so many features, support, and options doesn’t mean you know what to do when and how to tackle billing tasks optimally right out of the gate! Still, it’s good to know that you won’t be poring over a calculator, the DSM, and a pile of undecipherable forms, pulling your hair out.

With good information, a therapist with the know-how to help you along, and electronic tools you can ease the way. Soon bolstering your practice’s income will seem entirely possible. I’m here to help. Let’s get together and get billing firmly added to your skill set.

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.

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