Whether you’re thinking about starting a private practice or you’ve already taken the leap, you’ve recognized there’s a lot that goes into establishing a practice. Finding office space, determining/setting up the legal status of your practice, marketing and deciding how your billing to insurance will get done are just a few of the many tasks you’ll be involved in.

As a Business Manager and Billing Manager specializing in Mental Health practices,
I have found that an important document a practice should have – which is often missing and overlooked – is the Financial Policies & Procedures. Taking the time to create this document can benefit your practice in a number of ways.

The purpose of this document is two-fold:

For the patient: It provides essential information to your clients about the day-to-day issues that may arise for a patient in your practice, including the various fees the patient may be financially responsible for.

For you, the therapist: The process of writing this document is quite valuable. It gives you the opportunity to think about the many administrative and financial variables that could arise day-to-day in your practice, and determine how they will be handled.

I have found that patients who have insurance are often unenlightened or misinformed about the benefits their insurance policy provides for Mental Health services. So let’s look at some of the key issues that the Financial Policies & Procedures document should cover.

1) If the patient has insurance, suggest that s/he learn the benefit details of their policy. For copays and co-insurance, inform the patient when those payments are due. Will it be at the time the service is rendered? Monthly?

2) Will your office verify insurance benefits for new patients – and when? If authorization is needed, determine whether the therapist or the patient is responsible for obtaining it, and let the patient know. If your office will not verify insurance benefits, recommend that the patient inquire about this.

3) Let the patient know that s/he is responsible for any payments not covered by insurance that are considered billable to the patient. When insurance is expected to pay but doesn’t, due to deductibles or other issues, first decide what your policy will be, then let the patient know, taking into consideration the following:

> Does your practice offer a payment plan?
> How soon will your office notify the patient of the amount due?
> What method will be used to notify the patient? Invoice? Email?
> Will your practice expect payment-in-full within a certain amount of time?

4) What is your cancellation policy? Will there be a fee for appointments that are cancelled (or rescheduled) with less than, for example, 24 hours notice?

5) Will patients be responsible for a missed appointment fee? Remind patients that insurance does not pay for missed appointments.

6) When there is any change to a patient’s insurance policy (new policy, new ID # for the policy currently in use, new address for patient, name change, etc.) let the patient know that the change needs to be reported to the practice within a time frame that you determine. Patients are usually unaware of the ‘timely filing’ rule for submitting claims to insurance. If your office is notified of a change to a patient’s medical insurance policy beyond the ‘timely filing’ time frame, and thus the session(s) will not be paid for by insurance for this reason, decide if you will charge the patient, or what your policy will be; then let the patient know.

7) If a patient will pay for services out-of-pocket (not using insurance), let him/her know when payment is expected. Will it be at the time the service is rendered? Monthly?

Once your Financial Policies & Procedures document is complete, make sure to display it in your waiting room, as well as provide a copy to each of your new clients and your current clients – especially if these policies are new or amended from your previous policies. Consider whether you feel it’s appropriate to have each patient sign a copy for you to keep in your files.

Hopefully, the Financial Policies & Procedures document will provide noteworthy information to your patients and prevent any financial misunderstandings from arising. With your consistent implementation, it should also help keep your practice’s bottom line in good financial health.

Whether your practice is already established or you’re just starting out, doing your own medical billing might seem appealing. It can’t be that difficult, you ponder, and it will save money — that’s a good thing, right?? Well ……… let’s delve a little deeper to see what medical billing entails, and if processing your own billing really does benefit your practice.

Initially third-party billing may seem fairly simple, but it’s not. Medical billing can be complex. Filling out the claim form and submitting it to the insurance company is the easy part. There is a lot that may need your time and attention after that.

There are many steps to the billing process, so it’s possible for insurance reimbursement to “fall through the cracks” at any point. If you’re not paying close attention, it could easily be overlooked. Being diligent and following up is essential – not only to getting the claim processed but also to your bottom line.

Let’s look at what it takes to do third-party medical billing well:

◆ ARE YOU ORGANIZED?
You will need to gather a great deal of information to do the billing: patient information, insurance company information, electronic payer ID#, authorization # (if needed), diagnosis code, dates of service, procedure codes, etc. You’ll also need to stay on top of any changes to a patient’s insurance coverage OR if the patient has a new/different insurance policy.

◆ ARE YOU DISCIPLINED?
Will you be able to do your billing in a timely manner, on a regular basis, to keep your cash flow flowing – as well as complying with the timely filing rule?

◆ ARE YOU WILLING TO LEARN ABOUT MEDICAL BILLING?
Will you first need to spend time learning how to do medical billing, along with all the ins and outs?

◆ DO YOU HAVE THE TIME?
Your time is limited. Will you have enough time, on an on-going basis, to devote to managing and following-up on all aspects of the billing process, as follows:

➔ Will you have time to log insurance payments and patient payments to the appropriate accounts to keep things accurate?

➔ Will you have time to review all of your EOBs (electronic and paper) to determine if the claim processed properly, and if not, contact the insurance company for the claim to be re-submitted/ re-processed?

➔ Will you have time to follow-up with an insurance company when payment for a claim is denied to determine if the denial is accurate?

➔ Will you have time to stay on top of tracking authorizations in a timely manner so you’ll know when filing a new authorization request is needed?

➔ Will you have time to track patient accounts/accounts receivables and send bills to your patients for deductibles, copays or co- insurance?

◆ WHAT ABOUT BEING ABLE TO ACCOMMODATE EVERYTHING ELSE PERTAINING TO YOUR PRACTICE?

✓ Cultivating referral sources
✓ Developing Financial Policies and Procedures
✓ Clinical Documentation
✓”In-between” phone calls from patients
✓ Marketing (including social media, blogging, etc.)
✓ Scheduling
✓ Credentialing/Re-credentialing
✓ Etc.

Other than the clinical therapy service you provide, processing medical billing efficiently is top priority for operating your practice and keeping it financially sound. Investing in resources that will benefit the daily operations of your practice is an important choice. Choose wisely when deciding who the right billing administrator is for your practice.

~ Nadene Vigoda ~
DOLLARS & SEN$E
Medical Billing & Bookkeeping
….. helping you manage your day-to-day finances …..