• Practice Solutions

If You Want To Successfully Bill Insurance Don't...



Main Points


  • Don't take on more insurances than you are comfortable with

  • Don't have expectations that will set you up for failure in the long-run

  • Don't fly higher than you are willing to fall


Starting out in private practice is an exciting process. Most clinicians get into the field to help people and have a sense of if they are going to take insurance or if they are going the private pay route. If you are a therapist that takes insurance and is planning on billing insurance, then there are things that you will need to keep in mind as you grow your practice and take on the insurance industry.


While there are a lot of tips and tricks that you can use to navigate insurance, there are a few don'ts that we need to go over so that your practice has a strong position when it first gets going.



The first "don't" that we need to address is taking on more insurances than you are comfortable with. One insurance myth that is prevalent in the private practice industry is that in order to grow and scale a private practice you need to take on as many insurances as possible.


This simply isn't true!


What is better is if you can make smart, data-driven decisions around which insurance companies that you are going to accept and which ones you aren't.


Here are some guiding data-driven questions to help make the best decision:


  • Is there an insurance panel that pays well AND can supply enough demand that I can stay in business?

  • What are the main companies in my area and what is the insurance that they offer?

  • How many people in my area have insurance and what type of insurance do they have?

  • What percentage of colleagues are working with a certain insurance and why are they doing that?

Often times, therapists get into the mindset of taking as many insurances as they possibly can, but that only limits the amount of time that you are spending in your business.


Let's say you open a practice and you want to take on 10 insurances. That seems like a lot but it happens far more often than you realize.


Here are the factors that you will be managing for each of those 10 insurances:


  • Applications

  • Denials

  • Rejections

  • Payment records

  • EFT set up

  • CAQH requests

  • Patient inquiries


The list could go on and on, but if you take 1 insurance, then you are only handling 1 set of all of the pieces of information listed above, allowing you to spend the most time on your business and not in your business.


Remember, time is the one thing you can't buy or get back. Do you want to spend your very limited resources of time worrying about CAQH and denials? Or would you rather spend your time focused on other important factors like the clients themselves?


Don't have expectations that will set you up for failure in the long-run.


One of the biggest challenges in running a private practice (or any business) is the expectation setting and management at whatever stage of business you are in. For a clinician that has always done clinical work and loved working with patients that are now thrust into the world of business and running a practice, it is difficult to manage your expectations.


When it comes to working with large insurance companies, billing, or credentialing your expectations have to be adjusted to account for a few assumptions. Those assumptions are:


  • You are working with a large insurance company Since you are working with large companies, you have to understand that things get done differently at large companies. And by "differently" we mean slow and steady. Therefore, if you think that you are going to be credentialed overnight, paid overnight, or receive clear and constant communication, think again. You will need a certain amount of patience when dealing with large insurance companies when it comes to billing

  • Mistakes Happen You are dealing with a trillion-dollar healthcare industry and mistakes are bound to happen. The claims processing technology is imperfect because of the multiple levels that claims have to go through in order to process for payment. This means that you will need to forensic when it comes to claims processing. Your best bet is to set up systems and methods that allow you to catch mistakes naturally as claims go through the process and then be dogged in your follow-up of those claims.


Don't fly higher than you are willing to fall.


This is a really good piece of business advice. If you are okay with building a multi-six figure or even seven-figure practice, you ought to be willing to fall from that level. If you are not willing to take that risk, then don't.


The same principle applies to billing and credentialing. Are you ready to take the risks associated with being in-network? Are you open to claims audits? Are you willing to be flexible to changing reimbursement rates? Are you open to changing legislation and policies? Are you prepared to still yourself when those changes occur and make difficult decisions when those changes occur?


These are really important questions that you must ask yourself before taking on insurance and credentialing if you are going to be successful!


The flip side of the conversation is if you are willing to take on insurance and roll with the punches, you will have been successful in building a business that will employ individuals, serve patients, solve social and cultural issues, and expand access to high-quality mental healthcare.


If you are successful at doing those things, then why not do it?


There might be a lot of don'ts in the insurance and billing world, but one thing is certain, we DO need more mental health care and better access to care. Taking insurance will help to accomplish that goal and will assist in helping individuals, families, and communities.


If you need help with your billing or credentialing, or would like to speak to one of our consultants about your practice feel free to reach out to us via the contact page and we would be happy to speak with you about your need.

© 2017 PRACTICE SOLUTIONS, LLC