Three Questions to Ask About Counseling Medical Billing

medical billerMedical Billing, for counseling practices, is either a strength and a huge asset that helps to shoot your practice to the next level–or it is a frustrating albatross that could lead to the demise of your practice. There is rarely an in between! The following article looks at important questions to ask your medical billing staff or company about how your receivables are measuring up.

Question Number One: Are you receiving payment for your claims?

Obviously, the point of medical billing is to get paid for your work. But what is reasonable to expect?

A: You are doing well if you receive between 96 to 99 percent of claims, or better said, percentage of money from claims. I make this distinction because if you’re billing for different services, and you’re getting paid on your small claims, but not your high-fee claims, you could potentially have a high percentage of claims paid, but a lower percentage of total money in the door.

A quick note: having 100% of claims paid is always what you’re aiming for–that would be ideal. But in the imperfect system you’re working with (healthcare), be satisfied if you’re receiving 98%.

Consider it a Red Flag is you’re receiving under 95%

If you’re at 94%, don’t panic, but its time to look closely at your reports, and determine where you’re losing 6%, so that you can make changes.

If you are under 90%, now it’s time to hit the panic button. It is time to seriously evaluate what’s going wrong.

The thing is, many practices collect less than 90% of what’s owed to them, and don’t even know it because they don’t have reliable reporting. Being able to run reports, to determine where your money stands, is a must—even for a small practice.

This leads us into question number two:

Question Two: Do you know what has been paid or not paid, and why?

Counselor Medical Billing: Read On

Medical Billing for Counselors: 17 Reasons Why Claims are Denied (intro)

17 Reasons Why Insurance Companies Deny Claims

Medical billing is a frustrating process for counselors who are often juggling lots of business tasks, as well as trying to provide excellent clinical care. In fact, many counseling practices collect less than 80% of the monies that they’re rightly owed from insurance companies. However, with good planning, and a smart billing staff, your practice can reasonably expect to collect between 96-99% of claims.

Look out for these pitfalls. There are many reasons that claims can go unpaid, including: –to view, See our blog at !

Mental Health Medical Billing: Why Claims are Denied (reason 17 of 17)

The Patient Has an Unmet Deductible

Even if the patient’s insurance card says that their copay is $10, if he or she has not met their deductible, you might receive $0 from the insurance company when you file your claim. In addition, be on high alert in January, when deductibles often reset!

Mental Health Medical Billing: Why Claims are Denied (reason 16 of 17)

The Patient has an Out of State Insurance Plan

If your patient has an out of spate insurance plan, even if the company is a company that you work with (such as Blue Cross Blue Shield), you might find that your reimbursement rate is less, and (depending on the patient’s specific plan) your claims can even be denied.

Mental Health Medical Billing: Why Claims are Denied (reason 15 of 17)

The Service was Already Rendered

With Behavioral health, insurance often covers an intake appointment (90801) only once per 3 month period.  If your clients went to see a therapist prior to you, and the previous therapist billed a 90801, your claim could be denied.

Medical Billing: Why Claims are Denied (reason 14 of 17)

The client’s Out-of-network Benefits Differ from In-network Benefits

Out of network benefits often differ from in-network benefits. For example, with out-of-network benefits, insurance companies often place a greater amount of the payment responsibility on the patient, including the potential for additional deductibles that need to be met. Fail to identify the actual amount owed by the patient for out-of-network services, and you may never retrieve payment for services.

Therapy Insurance Billing: Why Claims are Denied (reason 13 of 17)

Services Rendered at the Wrong Location

When a counselor is paneled with an insurance company, they list one (or multiple) practice addresses. It is important to make sure that providers have all the places they serve patients registered with all the insurance companies they work with. Provide services at an unregistered location, and the claim could be denied.

Therapy Billing Insurance: Why Claims are Denied (reason 12 of 17)

The Provider isn’t Paneled

If a provider sees a patient, but isn’t a paneled provider with the patient’s insurance company, the claim will be denied. This sounds like common sense, but with insurance companies changing names and merging, this happens somewhat frequently. Also, if a provider was working for a larger clinic, he or she might think that he is a paneled provider, when really he was working under his employer’s contract with the insurance company.

Medical Billing for Therapists: Why Claims are Denied (reason 11 of 17)

The Medical Biller sends the Claim to the Wrong Managing Company

Insurance companies often delegate the management of some of their plans, or some services within plans (such as behavioral health) to other companies. Fail to realize this, and send a claim to anyone other that the managing company, and your claim could be denied.

Counseling Insurance Billing: Why Claims Are Denied (reason 10 of 17)

The Patient was Late to pay Their COBRA

COBRA is a government program where individuals can keep their health insurance after losing their job. However, those individuals need to pay 100 percent of the policy principle (a lot of money for someone out of work!). If a patient is behind on their COBRA payments, your claim will be denied.