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New Practice Billing Toolbox Series 1 of 4: Billing Basics


Main Points

  • Be sure to know your credentialing status with each insurance company

  • Put a financial policy in place for your patient's cost-share amounts

  • Start to map out your key business processes

Starting our practice is a very exciting venture because you have finally reached a point where you can do where you what you want to do. But running a practice is complex especially if you're going to take insurance.

Here are our top tips and tricks to ensure that you are billing processes run smoothly.

Be sure to know your credentialing status with the insurance company. One of the biggest reasons that we see claim denials and provider is not paid in a timely manner by the insurance company is because the practice owner or the biller is unclear on the provider's credentialing status.

One way to keep the credentialing status of a provider in a clear way is to maintain a spreadsheet of all the insurance companies that you are in network with and document what NPI and tax ID they are in network with. This document can be a guiding map for the biller and practice owner when dealing with the insurance company.

It is important to navigate this part of the process with as much detail as possible. Claims will not get paid according to the client or the provider's expectation if the credentialing status is unclear.

Put a financial policy in place for your patient's cost-share amounts. Part of seeing patients that have insurance is collecting what they owe. for some practices it can be difficult to collect the patient amount because of the relationship in therapy. However, if a practice fails to collect the patient amount they are at risk of violating their contract and they are at risk of hurting their business.

It is important to manage the patient and the clinician's expectations for payment. keeping a financial policy that outlines when payment is owed and what the patient owes is key to success in collecting a patient balance.

Map out your key business processes. It might sound a little backward, but you will want to document your processes before you are even done them. this helps to give some guidance and a framework to how the practice should run in case you hire someone or in case you get audited.

Maintaining clear documentation around business operations, particularly billing, will be key to your success in the future. Knowing how the business runs is just as important as the business running itself. Some key processes to think about documenting would include payment posting, claim submission, eligibility, and denial follow up.


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