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  • Practice Solutions

Overcome Falling Reimbursement Rates


Main Points

Regain control of your business

Predict billing for prospective clients

Private insurance companies are doing to the mental health industry what they have done to the rest of the medical field - cutting reimbursement rates, deny claims, and raise the bar on getting paid. This year we have seen psychological testing rate go down due to the change in CPT codes and some insurance companies continue to fluctuate rates, with the exception of an increase and positive change from Optum.

Navigating reimbursement policies while attempting to maintain healthy margins has become difficult for mental health providers in private practice, but there is hope!

Regain control of your business. The best way to regain control of your business is to know your reimbursement rates from the insurance company. In a previous blogs and future blogs, we will discuss in more detail the importance of knowing your fee schedule.

Knowing what the insurance company will pay for your services is sacrosanct to controlling your business!

However, there are a few other factors that are important in regaining control of your business. Here are some ideas for how you can better know and work on your business:

  • Develop some key performance indicators so your clinical staff stays on track

  • Know your finances (net revenue, net profit, gross profit, gross margin, etc.)

  • Track your expenses and know them intimately

  • Do the arithmetic on hiring and staffing

If you develop numbers around these key issues, you will regain control of your business and be able to control your growth!

Predict billing for prospective clients. Did you know there are ways of predicting your claims chances of paying and/or your client's ability to pay? By completing thorough eligibility checks and by knowing their insurance you can better prepare for how your claims will pay.

One way to this is to limit the amount of insurance companies you are in-network with. If you are in-network with 10 insurance companies and each of those has 10 insurance plans, you will be doing a lot of administrative work to know every plan

However, if you are in network with 2 insurance plans and each of those has 10 plans, then you have reduced your work by 80%.

You will want to pay attention to how your claims are processing for each insurance plan and company so you can better prepare and plan for the risk that your company is absorbing.

Common insurance companies to work with are:

  • BCBS

  • Optum/United Healthcare

  • Aetna

  • Cigna

  • Magellan

  • Beacon

  • Kaiser

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