Common Mistakes New Practice Owners Make With Billing

By Danielle Kepler, LCPC. Visit her website at: Be Your Own Biller, LLC

You did it, you’re in-network with an insurance company! Congratulations! Now the fun begins. Unfortunately, insurance companies tell mental health clinicians very little (ok, hardly anything) about how to go about billing once we become in-network. We also do not get taught this in graduate school. Left to our own devices, we have to wing it, reach out to our colleagues, or find resources. Throughout my years of billing for my practice and consulting with other clinicians on how to bill insurance, I’ve seen many of the same first-time billing mistakes made by new practice owners.

Here are some common mistakes I have seen and some proposed solutions:

Not Knowing How to Submit Claims

Mistake: Finally getting credentialed, only to not know how you will bill the insurance company.

Solution: Fortunately, there are many different ways to submit claims electronically and you have to figure out which way works for you and your practice.

  • Electronic Health Record (EHR)
    • Many offer claim submissions (usually costs extra).
      • Have insurance billing, client accounts, notes, and client paperwork in one place.
      • Can track claims and client accounts easily
  • Insurance Provider Portals
    • Many major insurance companies have provider portals where you can submit claims directly to the insurance company.
      •  No cost.
    • Usually requires more data entry each time you submit a claim (the portal does not store client information)
      • You will have to figure out another way to track claims
  • Clearinghouse (two popular ones are Availity and Office Ally)
    •  Like a provider portal, many insurance companies use. preferred clearinghouses and you can submit claims.
    • Many clearinghouses store client information for ease of claim submission.
      • Some do charge a fee.

Not Knowing What Information to Collect from Clients

Mistake: A client wants to use their insurance, but you do not know what information you need to bill their insurance company.

Solution: Here is the main information you need to gather:

  • Insurance card
    • Make note of the insurance company name, member ID, group ID, and member name (if different than what the client gives you).
      • Getting a copy of their insurance card (front and back) and putting it in their chart is always helpful.
  •  Client demographics (birthday, address)
  • Subscriber demographics (if not the client) (relationship to client, name, birthday, address)

Failing to Verify Insurance Information

Mistake: This is a topic that is debated often. I am always in camp ‘verify before first appointment.’ Not verifying insurance leaves the clinician taking a gamble on if they are in-network with the client’s plan if the client has a deductible to pay and thus owes the full contracted rate, or even if the client’s plan is active during the time of service.  The client could also be long gone once their claim gets processed and not pay their bill.

Solution: Many of these issues can often be avoided by taking the time to check the client’s benefits before their first session.

Ways to verify insurance benefits:

  • Insurance company portals
  • Availity and other preferred portals
  • Calling the insurance company

Neglecting to Educate Clients About Their Benefits

Mistake: Clients often misunderstand and are confused by their insurance benefits. This leads to poor client retention and unpaid client bills. 

Solution: Set up a system where you educate the client their estimated benefits.

  • Many clients want to know the cost of their therapy sessions (even if it’s just an estimate). Checking benefits for them can take some of the stress off of them to call their insurance themselves.
  • It might even make them more likely to schedule a first appointment and can improve client satisfaction and payment rates.
  • It’s good customer service and shows your investment in their care even before the first session.

Not Knowing What to Charge the Insurance Company

Mistake: Clinicians don’t know what fees to charge insurance companies and often set their rates too low.

Solution: If you do not get a fee schedule with your contract, request one from the insurance company so you know your in-network rates. These schedules are broken up by CPT code (procedure codes we use to bill).

  • Once you get your fee schedule, set your rates a bit higher than your in-network rate (maybe even more than a bit). This will ensure you are not under-billing an insurance company and get your full in-network rate.
  • The insurance company will adjust your fee so you get paid the contracted in-network rate.

Overlooking the Importance of Tracking Claim Status & Payments

Mistake: Once you have submitted many claims, many clinicians fail to track the status and payments, leaving claims not looked into and clients may end up not paying if they are not notified promptly of claim denials. This can jeopardize your practice’s financial health.

Solution: Once you file claims, you need a system in place where you can track the status of the claim, the insurance payment, and what the client owes.

  • Make it a habit to check and follow up on all of your unpaid claims at least monthly. If you have a claim that is outstanding for more than a month, look on the insurance portal for the status. If the claim is denied and you are unsure of the reason, call the insurance company to inquire.
  • Many EHRs track claim status for you automatically (set-up required).
  • I have seen many clinicians keep track on a spreadsheet, which works too.

By addressing these common billing mistakes, new clinicians can ensure smoother insurance billing operations, better practice financial health, and improved client satisfaction with the administrative process of their practices. This might also reduce clinician frustration with insurance. I hope that if these common billing mistakes are avoided, clinicians will remain in-network creating more client access to affordable mental health services.

Danielle Kepler, LCPC

About the Author

Danielle Kepler, LCPC

Visit her website at: Be Your Own Biller, LLC

Danielle Kepler is the founder and “head insurance guru” at Be Your Own Biller, LLC, where she offers consultation to business owners, solo practitioners, and nonprofits local to Chicago and across the nation. Be Your Own Biller’s mission is to empower clinicians and demystify the insurance credentialing and billing world so they do not need to hire a long-term credentialing or billing service. She has recently launched a membership site that includes loads of content as well as monthly QAs and runs a Facebook group dedicated to insurance credentialing and billing. In addition to consulting, she is a clinical therapist, Certified Gottman Therapist, trained in EMDR, and owns a group practice, DK Therapy, in downtown Chicago. DK Therapy treats adult individuals and couples utilizing Gottman Method, EMDR, ACT and other evidence-based therapy. DK Therapy is paneled with over 45 insurance and EAP companies and Danielle continues to do all of her group’s credentialing.