You’d better learn to roll with the changes that 2013 has made, when it comes to your money!
We’re only about 6 weeks into the new year and I’ve been swamped with questions and concerns about money and private practice. Folks are noticing that some insurance reimbursements have slowed to a snail’s pace; clients are telling you that their insurance plans have changed to high deductible plans; you might even be trying to position yourself on the insurance panels that will play a big part in the new health insurance exchange programs set to debut in 2014.
There might be a huge gap between what you know about money issues in private practice, and what you need to know (to survive). I thought I’d help you by taking a look at a few of these money issues along with some of the solutions, and help you find a way to bridge that gap.
Some insurance companies are just great about reimbursing you in a timely fashion. Others… not so much. This year (more than ever) I’ve noticed and heard that insurance reimbursements are slow to trickle in. This is really frustrating and there is not much you can do about it. Here are a few tips that will allow you to take charge over that which you do have control:
- Go electronic. You’ll find that when you opt to bill electronically and to receive electronic payments (right into your checking account) you can reduce the time you’ll have to wait for processing and payment
- Know what you are owed. More than half of the people I talk to haven’t a clue as to how much money they have outstanding with any given insurance company. As a business-owner, you are your own accounts receivable department. Whether it’s a spreadsheet, a ledger book, or a fancy billing program — be sure you can quickly and easily access the numbers. You’ll be more apt to follow through on collections, and when you do — you will know exactly what you are looking for
- Use the correct billing codes. You know by now that January 1, 2013 kicked off the new CPT codes that we all must use in our billing. If you have sessions from 2012 that you’ve not yet invoiced, remember that pre-2013 codes will apply. That means if you’ve already updated your billing program to use the 2013 codes, you’ll have to modify the codes for invoices that date back to 2012. Most insurance companies will reject entire claims if even 1 date of service is billed with an incorrect CPT code.
High Deductible Insurance Plans
Many employers have opted to change the health insurance plans they offer their employees. You will likely find many more clients who now have health insurance with high deductibles (sometimes as high as $5000). That means that those folks need to pay out of pocket up until they meet their deductibles.
Because these plans can save employers big bucks, companies will often subsidize (a portion, or all of) the deductible by contributing to their employees’ health debit card (it usually has a MasterCard or Visa logo on it). Clients will present these cards for payment just as they might previously have done so to cover their co pays.
Here are a couple of things to think about, with regard to High Deductible Insurance Plans:
- Since clients must pay their deductibles before their insurance benefit will “kick in”, you may be able to offer your services to clients even though you do not participate with their insurance plan. It essentially becomes a private pay situation between you and the client. Advise clients to check that they are entitled to see their provider of choice, and discuss what will happen once the client meets deductible (if you are not participating)
- Be prepared to provide a Super Bill for clients’ to submit for proof of services rendered. Some companies are fine with the charge to the debit card; others, require submission (by the employee) of a Super Bill
Health Insurance Exchanges
Exchanges are organizations that will be set up to create a more competitive market for buying health insurance. They’ll offer a variety of different health plans, primarily for individuals buying health insurance on their own and those who own small businesses. This may trend for larger employers in the future.
Each state will establish these Exchanges and the federal government will oversee this process. The Exchanges can be government agencies, or private non-profits. Many lives will be insured by these Exchanges, and it is worth your while to find out if this market might include your niche as you’ll want to secure your spot on that provider panel.
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Given all of these changes, one of your options is to run a private pay practice. If so, be sure you become very comfortable with how you talk about money to potential clients and referral sources. The more comfortable you are, the less of an issue it will be for your clients.
Another option is for you to bill insurance companies as an out-of-network provider. This takes some time to get into a rhythm of verifying coverage, billing, and collecting co pays and co insurance from your clients. However, it can be a reasonable alternative for those clinicians who want to help clients take advantage of their benefits. The good news is that as an out-of-network provider, you will likely make more money than if you were on panel.
Choosing the “right” insurance companies you want to work with is a big decision. It’s more than just choosing the most popular one in town. Do your homework and find out if getting on panel makes sense. You’re investing your time (getting credentialed, billing, documenting, getting authorizations, etc) — make sure there is a satisfactory R.O.I (return on your investment) before signing any contract.
These nuances many give you a headache, but once you have the information and guidance you need, you should be just fine. Ultimately, it is important that you are educated and informed, so you can better educate your clients and referral sources with regard to money. The more you know and the better able you are to articulate the facts, the easier it will be to manage these money issues so you can get to work helping those who truly need you.
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