Too many times I’ve heard clinicians say
- “My biller didn’t tell me old claims haven’t been paid,” or
- “I have no idea where I stand with claims payments,” or
- “My biller said to bill my Medicaid client for unpaid claims,” or
- “My biller made me sign a contract that says I can’t do any of my billing. She gets a cut of everything, even the copays I collect in the office. She even expects her cut of EAP and victim witness payments that I insist on billing directly due to the clinical nature of the invoice required by EAP and victim witness,” or
- “My biller is sick so she’s behind,” or
- “My biller (insert your frustrations)…”
- “I don’t know what CPT codes my billing person is using. I just give her dates.”
Does any of this sound familiar?
For your mental health, potential liability exposure, and the health of your provider-client clinical relationships, I certainly hope not.
Unfortunately, this is all too common: A billing person who is not on top of things, doesn’t have policies and procedures for communicating vital information to the clinician, and holds all the cards.
You are ultimately responsible for the actions of your billing person, however, there’s a power differential that most of us don’t think much about until there’s a problem. Your billing person’s actions can put you at a liability or licensing risk, cause loss of revenue, or impact your clinical relationship with your clients. It is your license on the line, not hers if costly mistakes are made.
Not paying attention to what is happening with your billing can put you in risky situations.
It’s easy to think, “I need someone to handle all of that so I don’t have to think about it.” It’s tempting to think, “I need to just focus on my clients.”
The problem with this perspective is that by the time you are in a sticky situation, it may have already progressed to the point of loss of revenue, loss of trust with your client impacting the clinical relationship, or may have instigated a potential ethical or legal risk.
These can be expensive situations to navigate. Even if only in terms of your emotional expense while your liability carrier pays your monetary obligation.
If my therapist told me I had to backpay claims from months ago because she missed the timely deadline for any reason, I’d be mad, too. There’s no excuse for not communicating what is happening to the client in real-time.
Compare these potential conversation starters with your client:
“I’m sorry but we need to discuss financial things before our session starts. Your insurance denied the last two claims my biller submitted, but she is working on it.
“There is a potential situation where your insurance company doesn’t pay and I may need to collect the fee from you. I just want to make sure you are aware so you can make an informed decision about therapy.”
“I’d like to review with you my office policies that are in the documents you signed at the beginning of treatment in terms of payments, in case we run into denials we can’t resolve with your insurance. Talking about money can be uncomfortable, so please know we can process feelings about the situation anytime you’d like to during a session.”
VS
“I’m so sorry, but we need to discuss financial things before our session starts. My biller has informed me that your insurance hasn’t paid for several claims from last summer. The insurance company says she made mistakes on the claims, but it’s difficult to figure out if this is true or if the insurance company is mistaken. In any case, I can no longer expect payment from the insurance company because we are past the timely filing limit. I’m afraid I’ll need to collect payment from you. Talking about money can be uncomfortable, so please know we can process the feelings part of the situation anytime you’d like to during session.”
VS
“Before we start the session clock, I wanted to let you know that I just found out some of your claims were not paid from last summer. I can’t collect from the insurance, but I am going to write it off.”
Which one makes the most sense in terms of business and a clinical approach? Are there legal or ethical issues?
My recommendation is to always choose a billing agency with multiple employees and who provide clear information about their policies and procedures, and keep you up to date at least monthly on all claim statuses. Some timely limits are as short as 60 days. That’s not very much time to deal with problem claims. Your billing agency needs to be on the ball, professional, and communicate efficiently without excuses.
If you have ever said or thought this: “I don’t know what CPT codes my billing person is using. I just give her dates”
then,
You need to review documentation rules and regulations pronto. Those billing codes you have lumped into the “I don’t need to know” category in terms of billing must be on your progress note. If it’s not there and an insurance company requests records, guess what? You’ll receive a demand for payback (affectionately known as “clawback”) from the insurance company. Even if the client paid you directly, then they collected reimbursement from the insurance company, you received payment so it’s you who pays back the money.
Suggestions for finding a billing agency
- Ask clinicians in your area who they use and why.
- Ask the same questions on clinical forums you participate in.
- Look in the back of psychology magazines.
- Do an internet search.
- Look up “Certified Professional Coder.”
- Pick an agency that has solid experience in mental health billing.
As always, enjoy the adventure in private practice!
The 14 Concrete Steps to Private Practice 