Whether you’re a seasoned behavioral health professional that just opened a private practice or a biller that just landed your first job at a facility, you have to figure out how to bill insurance companies for counseling services.
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Unfortunately, caring for clients is only half of the responsibilities you have on your plate. The other half is dealing with and reporting to insurance companies so that you get paid for your services.
If you don't lock down a solid process for billing within your organization, you’ll have no choice but to eventually close your doors for good.
So the solution to what I’m saying is easy then, right? Come up with a process for billing with your staff, implement it and you can sleep well at night assuming that all your organization’s revenue is in good shape.
It’s not that easy.
Two statistics help paint the dismal picture that is billing insurance companies.
First, 80% of medical bills contain errors. In other words, even if you spend weeks with your team perfecting the billing process for your organization, the industry averages aren’t on your side.
Second, insurance claim denial rates are well over 11%. So, even if there aren’t any errors on the medical bills you send to your patients, their insurance companies still might not compensate you on the back end.
Yes, I’ve painted a grim picture. But there’s still hope.
The first step is the credentialing process. Billing can’t happen without credentialing.
Basically, insurance companies came up with the process of credentialing to ensure that you’re qualified for their panels. To put it more simply, they want to make sure that they can trust you.
Once you’re credentialed with an insurance company, they’ll likely list you and/or your on their website.
Although each insurance’s credentialing process is different, there are preliminary steps you should take to ensure that you’re prepared before the specifics…First, acquire a tax ID for your organization that’s separate from your SSN. Second, Seek and obtain malpractice insurance (use the separate tax ID received in step 1). Third, obtain a National Provider Identification (NPI) number. Fourth, ensure that you’re licensed in the state you’re providing service. Fifth, understand your NUCC grouping. Sixth, if you’re going to be a Medicare or Medicaid provider, look up and know your taxonomy code. Seventh, apply for a DEA Number if you plan on prescribing clients. Eighth, finalize the location and address of your private practice (PO Box # address suffice). Ninth, familiarize yourself with CAQH.org and create an account. Tenth and finally, conduct research and make a list of insurance organizations.
That preliminary process is essentially all of the information that’s required for your CAQH application. You see, CAQH is so important because it’s an industry-accepted database that many insurance companies use as their credentialing database.
Of course, once you create a user and submit it to the CAQH database, you need to keep the information updated. It’s especially important to ensure that you update the information within this database when your license and/or malpractice insurance renews every year.
The second step to billing insurance companies for counseling is credential applications. The application and contracting phase of the insurance credentialing process looks like this…First, before contacting any organization, determine whether you’re credentialing as a group or as an individual. Second, iIf you have multiple locations, have the addresses ready to provide. Third, contact each of the insurance companies on your list and ask for their provider relations department. Fourth, ask the provider relations department for a credentialing application. Fifth, review the credentialing application before signing…understand documentation and claim submission requirements, appeals processes, reimbursable diagnosis codes, modifier codes and timely filing limits. Sixth, once signed, keep a record of the contract in a safe place. Seventh, once credentialed, the insurance organization will give you access to the provider portion of its website. Eighth, visit that website, create a login and familiarize yourself with the website. Ninth, add all of the contact information to the master list you created earlier.
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