YES – it is possible to be successful billing for yourself.
Last time, I discussed the complexities involved in identifying a billing service that would be a good fit for your practice.
Now, in Part 3, let’s examine the opposite choice.
What does it take to be successful if you bill for yourself?
In Part 1 of this series, I introduced the concept of Revenue Cycle Management (RCM). Take a minute to go back and review RCM, because…
Successful billers do MORE than just submit claims. Much more.
So, what does it take? Well, time, obviously. But assuming you have enough time, then what?
I hear the following multiple times each day:
“I could never do what you do!”
“I’d be in a padded cell if I had to talk to insurance companies all day long!”
“Your job must be so stressful!”
Still sane after 25 years (at least, I think I am!), I’ve concluded that there are 3 things that contribute to success in billing:
- Personality traits (which you either have or you don’t)
- Knowledge (which can be taught/learned)
- Tools (anyone can buy tools and learn to use them)
Let’s break it down…
PERSONALITY TRAITS
I identified a few of these in the first part of this blog series. Now, I’m going to explain why each of these is important to success as a biller.
Frustration tolerance
Submitting claims is easy enough, but what about some of the other RCM functions?
When it comes to talking to payers…even I reach my limit, some days.
There is no doubt in my mind that the system is designed to be mind-bogglingly obtuse. When trying to fix a denial, things can be almost as bad:
- Long hold times.
- Representatives that can only read from a script in a foreign accent.
- Representatives that can only read from a script in a foreign accent.
- Transfers that result in putting you back at the end of the line, where you have to re-enter all the same data to get to a second (third, fourth) unhelpful representative.
- Reps that promise to fix the issue, and you wait 30-40 days only to find that nothing was done.
- Denial codes that are vague and don’t explain WHY you were denied.
I could list dozens of examples. I find a sick sense of humor helps too!
Patience
The payers’ shenanigans are bad enough. But it also takes time to get your billing on the right track. This can be especially stressful when you first start out – of course, right when you most need the income!
There is so much to learn and do – especially if you’re new to private practice.
- Credentialing & contracting. The total turnaround time for new commercial payer enrollments:
- 60-90 days – if you’re lucky
- 90-180 days – average
- 180+ days, sometimes. (longest I’ve seen: over 365 days!)
- Credentialing & contracting. The total turnaround time for new commercial payer enrollments:
- Learn your software and the basics of billing
- CPT codes
- Where do all those numbers go on claims?
- What does it all mean? – let’s face it, no one taught you this in grad school!
- Learn your software and the basics of billing
- Correct errors then wait for the results. Then try again. And again.
- EDI enrollments (signing up for electronic claims, remits, and portals)
- Set up RCM workflows; find an organized method that works for you.
I recommend that before attempting full-time private practice taking insurance, you save at least 4-6 months’ worth of income. You will need it!
And try to take as many cash clients as possible to tide you over until you are contracted (if you decide to accept insurance).
Organized
Billing is like this! Multiple problems, all at once.
If you allow yourself to become easily distracted and lose focus, it’s tempting to avoid doing what you need to do. Which results in NOT GETTING PAID!
RCM tasks are like laundry, cleaning house, or mowing the yard – never really done! But oh so easy to put off…
Timeframes are important, so a good workflow is a must.
If you think it’s only timely filing you have to worry about…think again. Appeals, disputes, and correcting claims all have time limits as well.
It isn’t just interactions with the insurance payers. Charging client credit cards, and sending statements, are best done on a regular cycle:
- Charge credit cards: Daily or every other day is best. Once a week at a minimum.
- Sending out bills: Every 28-30 days
It’s very important not to let client balances build until they become overwhelming! In fact, you should never have “outstanding balances” at all, if possible. This is not good for either you or the client! In “Those Darn Deductibles – Part 2” I talk a little about this…. But be watching for a dedicated blog on this topic.
Even benefit verification has a “sweet spot.”
Inquire too early, and the accumulators (deductible; out of pocket max) could change significantly. The client could cancel. It’s best to verify no more than 5 days ahead for new psychotherapy clients. But for the love of getting paid… don’t wait until AFTER you see the client. Benefit verification can sometimes reveal nasty little surprises.
Check rejections daily. At a minimum, weekly.
Review outstanding claims at least every 30 days, follow up on claims that are outstanding too long (30+ days), and fix errors.
With all of this to do, it’s no wonder that being organized is a must!
Detail-focused
I can’t stress enough how essential being DETAILED is when billing. It can make the difference between being PAID – or being FRUSTRATED!
For example…yes, it DOES make a difference if you type 90834 vs 90833. So BEFORE you hit that submit button, review your details one last time.
Claims are usually auto-adjudicated. Meaning no human ever looks at them.
Computers don’t have the ability to look at your claim and decide, “Well, the provider most likely meant 90834.” In fact, your electronic claim wouldn’t even make it to the payer in this instance, since 90833 isn’t a code that can be billed 1) by itself; and/or 2) by a non-prescribing clinician.
One wrong number and you don’t get paid – and there are a LOT of numbers involved in claims!
- Insurance ID
- Insurance ID
- Diagnosis
- CPT code
- Date of Birth
- Tax ID
- NPI
- Place of service
- Date of service
- Modifiers
Tedious? Yep. If you don’t tolerate attention to picky details, it’s best not to bill for yourself.
Analytical / Problem Solver
There’s a certain level of detective work to a claim when something goes wrong.
Billing can be relatively straightforward once your system is set up, you enter claims, and they come back paid (or even applied to the deductible).
But there are always “problem-child” claims.
If there weren’t, insurance companies wouldn’t be making millions, if not billions, of dollars every quarter. (and I’d be unemployed…)
Regardless of the reason for the denials, it’s important to take the time to research and solve claims problems. No one can afford, these days, to work for only a fraction of the income they rightfully are owed.
If you would like more information about how to challenge denials successfully, sign up for our mailing list!
Tenacious
Along with the problem-solving mindset when faced with a denial, tenacity helps!
Sometimes it’s just a question of finding someone at the insurance company who will listen. But that takes persistence.
Do you have it? And the time?
If you don’t, there’s no shame, but you might be better off paying a biller.
KNOWLEDGE
Technical/billing
No, you don’t have to get a degree in billing and/or coding. You can learn billing any number of ways. But what’s important is that you DO learn at least enough to get by.
Why?
- A claim is a legal document. You don’t want to make an error on legal documents!
- It’s easier to get training than to wing it to fix complex problems! Probably cheaper, and definitely less stressful.
- Your income will suffer if you don’t get paid due to a lack of education about billing.
- Even if you stay out of network, your clients might not be reimbursed if you don’t provide correct documentation for them.
Ask your colleagues? Maybe. Depending on specialty, geography, license level, payer, and even software platform, your colleagues’ advice may (or may not) be accurate FOR YOU.
At a minimum, you absolutely have to understand: the proper use of CPT codes, how to diagnose correctly, use of modifiers (as needed), and what goes where on the claim form. Get training in documentation that will stand up to audits (even out of network clinicians can be audited!!!). Be sure you understand the basics of your EMR/billing platform.
You can do this! And, worst case scenario, if you get stuck on something, Your Billing Buddy is here for you!
Understanding how RCM functions fit together to ensure profitability
It bears repeating: JUST SUBMITTING CLAIMS WILL NOT MAKE A PRACTICE PROFITABLE!
If only, right?
In Part 1, I listed the main tasks involved in Revenue Cycle Management.
How does it cause the profitability of a practice to fail if you skip some of these tasks?
Let’s look at an example.
Sometimes, clinicians doing their own billing put off posting payments (either from the insurance and/or the client).
Why? Maybe it’s…
Tedious
Time-consuming
You don’t understand why it’s necessary
(or all of the above…!)
What happens when you don’t post? Well…
- You won’t know if insurance is paying ALL your claims
- You might time out on appealing denials
- You won’t know if your claims are getting paid correctly
- How will you know how much to collect from your clients?
- What if you don’t post a payment from a client and then you try to bill that client again? (you will have one angry client!)
It all cycles back in on itself.
Revenue can be lost in many different places, not just if the insurer denies your claims.
TOOLS
The most important tool, without a doubt, is your software platform/clearinghouse. This is critical regardless of who the biller is.
There is so much involved in choosing the solution that is best for you!
As with choosing a billing service, selecting a technology solution depends on more – far more – than just the price.
If price is your only focus, you may miss out on options that could be useful to you – and even save you money on the back end.
Because it’s so involved, the final part of this series will be devoted to evaluating billing software.
Don’t miss out on our final blog of the series – Part 4 – How to evaluate billing software.
