The Role of a Mental Health Billing Company in Your Private Practice
Running a practice requires managing a wide variety of responsibilities from treating patients, upkeeping an office, marketing your practice, to managing insurance billing. When a practice grows, additional responsibilities get added such as managing payroll, scheduling, and communicating processes. All of these responsibilities can get overwhelming, which is why we aim to take some of that responsibility off your shoulders. Hiring a mental health billing company to manage all aspects of your insurance billing means that you have one less thing to worry about, but what role does a billing company actually play in your practice? We will shed some light on successful relationships between Practice Solutions and the providers that we work with, highlighting the role that we play in successful practice management.
What Practice Solutions Billers Do
Many providers know that they need a biller, but they do not have a comprehensive understanding of what a biller's responsibilities are. This could be because they’ve worked within a practice where the “biller” was performing multiple responsibilities, or because they have never worked with a biller before. We designed our billing services to provide all of the necessary functions of insurance billing at a fair price, while maintaining realistic workload expectations for our billers. In this article, we will cover all of the responsibilities that we feel are integral to the role of a mental health billing company within your private practice, and a few of the other roles that you may want to consider hiring within your practice.
Claim Submission and Follow Up
Claim submission is the main thing that people think about when they think about insurance billing. Claim submission entails generating a CMS-1500 paper claim, or an electronically generated EDI claim utilizing both information from the patient and the provider to communicate services to the insurance company for reimbursement. For claim submission, it’s all about the details! Our billers are familiar with the claim submission process which varies by insurance company, and they also are experienced in identifying the areas of claims where issues most often occur. Your biller can help identify correct payer IDs for insurance companies to ensure that claims are routed to the correct place for processing. Billers review all information on claims before submitting to ensure the highest chance of a clean claim, which is a claim that processes on the first submission.
When it comes to coding sessions with CPT or ICD-10 codes, this is something that you should be responsible for as the provider. Billers have the knowledge to provide guidance on codes and modifiers, however there are limitations on what a biller can do in terms of coding due to HIPAA requirements. Even though your biller cannot code sessions for you, they are definitely a wealth of knowledge that you can depend on for guidance in coding, or for guidance in finding answers from the insurance company.
Claim follow up is one of the most time consuming aspects of insurance billing, and is where a lot of providers feel stress when they manage their own billing. Your biller not only has the time to perform follow ups, they also have the experience of knowing which departments to call, how to navigate the portals for each insurance company, and the right questions to ask to get the answers that you need. Follow up includes managing denials and rejections, and performing any necessary actions to resolve these issues, as well as checking on the status of any outstanding claims and checking on claims that have not yet been processed.
Keeping an accurate record of payments within your EHR is important. It helps you to have an understanding of outstanding money that is owed to you, and can be used as an indicator - not an exact representation - of cash flow. Many providers rely solely on their EHR to record finances, which we do not recommend. Your EHR should be utilized in tandem with your accounting system, such as Quickbooks, to manage the finances of your practice.
Our billers manage payment posting exclusively in your EHR system, not within your accounting system. They utilize information provided by the insurance company to match and post payments within your EHR. This information can be provided in multiple formats, such as an ERA (Electronic Remittance Advice) or an EOB which is the paper version of an ERA. In most cases, your biller will be able to receive and manage ERAs directly, but paper EOBs that get delivered to you would need to be forwarded to your biller for posting.
Eligibility and Benefits
Another time consuming part of the billing process, eligibility and benefit checks provide information about the patients benefits and insurance coverage according to their plan. This information is obtained directly from the insurance company by your biller. Upon request, our billers can provide benefit information within 24-48 hours. We always remind providers that while our billers know exactly what questions to ask to get the most accurate benefit information as possible, there is always a chance for inaccurate information largely due to the insurance company, and the timing of claims processing against a patient’s insurance plan. Eligibility and benefit checks should always be looked at as an estimate rather than a hard fact, but having the estimate is better than no information at all.
The greatest strength of working with a biller is the knowledge and experience that they have. We encourage our providers to ask questions of their billers. Even if it is something that falls out of your biller’s scope of responsibility, your biller will do their best to point you in the right direction or provide you with resources. Ultimately we see ourselves as an extension of your practice, and want to see your practice succeed! We will do what we can to help you, but there are a few things that our billers don’t have the authorization or expertise to do. In the following instances we suggest that you connect with another professional who is better equipped to handle these tasks.
Outside of the Scope of Billing
Credentialing and Updates to Practice Information
Practice Solutions has credentialing partners that we will recommend you to if you need credentialing services. The credentialing process is long, and requires a different set of knowledge than is required for insurance billing. We find that it is best to work with a company that solely focuses on credentialing for the best results, and then to have your biller connect with your credentialer to get the information they need to submit claims correctly.
If you make any updates to your practice, such as a change of address or change of name to your practice, you will need to make those updates with the insurance company directly. This is most often a requirement of the insurance company that the provider whose name is on the contract must be making these updates as an added security measure to your account.
In a similar vein, your biller cannot set up electronic funds transfers due to the secure nature of such information. Practice solutions will only manage EFT setup if it is required as part of the ERA setup process, as ERAs are critical to billing success. Even so, our setup specialists may need you to complete some steps of the process. Your biller may be able to provide direction on how to set up an EFT payment, but you will need to complete the steps yourself.
As we mentioned previously, you should have an accounting software separate from your EHR. Your biller will manage all insurance payments and post them to your EHR when claims are shown as processed, but an accounting software is better equipped to actually manage and track the receipt of those checks and payments. An accounting software also is capable of managing expenses for your practice where an EHR does not have this functionality. We strongly recommend utilizing an accountant to help you manage your practice finances, especially around tax season! Accounting and taxes are not within the realm of your billers expertise, but we recommend Green Oak Accounting. They are an accounting firm that specializes in helping mental health clinicians, and they offer a free consultation.
Obtaining Prior Authorizations and Getting SCAs
This is another area in which our billers can provide some guidance based on their experience, but Prior Authorizations and Single Case Agreements are ultimately the responsibility of the provider as it is closely tied to HIPAA protected information.
Scheduling and General Office Administration
Many clinicians benefit from having an office admin, who manages patient intakes, scheduling of appointments, and coordination of paperwork. They can also help manage updates to your practice, both with the insurance company and with any portals or external accounts such as CAQH as a member within your practice rather than a third party biller. This can be a part time role, or tailored to your needs within your practice.
Deciding if a Mental Health Biller is Right for You
Practice Solutions offers a free consultation for anyone who is interested in learning more about what a Mental Health Biller could do for their practice. We want to know about your business, and will provide as much information as we can about what our services entail so that you can make the best decision for your practice. If you are interested in learning more, contact us today and schedule an appointment!