We have received several questions related to billing insurance companies recently, including the following two inquiries.
Q: I have left a social service agency to start a private practice. I have been accepted by a few insurance and managed care companies as a provider. But, with all the recent changes in billing these companies, I am at a loss on how to proceed. I practice in a community where most clients need to use their insurance benefits to afford counseling.
Q: In one of your recent columns, a counselor referenced use of HCFA (Health Care Financing Administration) forms. This counselor was not on insurance panels and had clients file their own forms with their individual insurance companies. My colleague and I are in the same position and would like to offer this service to our clients. Would you please advise how to go about obtaining and using HCFA forms? What is the process? Does the counselor have to complete part of the form and/or interact with the insurance companies?
A: Congratulations on making the change to private practice. Take a breath and pat yourself on the back. If you plan to bill insurance and managed care for your clients, it pays to investigate all the options. Also, whatever path you choose now is very important, because as your practice grows, it can be a real headache to switch later. Don’t try to save a few dollars up front, as it may cost you more later on. When investigating the options, be sure to inquire about Health Insurance Portability and Accountability Act (HIPAA) compliance.
First, decide now to either purchase billing software and learn to do it yourself or hire it out to be done. Some insurance and managed care companies, such as United Behavioral Health, allow providers to bill for free through their websites. In terms of software, look at Sumtime, Ezclaim, Therapist Helper or Shrinkrapt. Each of these billing programs is fairly user-friendly, and you control the billing process. Each of the programs automatically prints out the complete insurance billing form from your computer printer. The form is called the CMS-1500 or HCFA (these forms can be ordered at www01.medicalartspress.com/catalog/browse/sku.asp?PageType=1&sku=165760).
Another option is a billing service. For a percentage of your collections, these services will handle all billing and debt collection from both the client and third-party payor. Netsource Billing (netsourcebilling.com) will do everything from insurance verification to handling denials. NaviNet (www.navinetclaims.com) is a web-based service that, for a flat yearly fee, will walk you through billing and set up and submit your claims electronically. We have links to these sites on our website, counseling-privatepractice.com.
Second, join as many insurance/managed care companies that offer a fair fee as possible. Identify the top 20 employers in your area, find out which insurance/managed care companies they use for employees and actively pursue those companies.
Billing insurance and managed care companies can add value to your practice. It might be one way to differentiate your practice from others in your area.
Another cost-effective insurance billing strategy is the superbill. “Superbill” is the term for a billing format in which the mental health clinician wants to handle billing in a simplified manner. Using this strategy allows the client to submit the bill directly to the insurance company. The superbill form is all clients need to file their own insurance. It removes the clinician from the billing loop and saves money on computer billing software and even postage. It is a particularly good choice for the new provider who is starting out on a shoestring.
A superbill is usually a single page and must contain the client’s name and date of birth, clinician’s name, the practice name and address, phone number, date and place of service, clinician’s tax ID and National Provider Identifier number, state license number, checklist of CPT (current procedural terminology) codes, a place to write Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosis codes, the charge for service and the payment, balance due and signature of the clinician.
Any local printer can make three attached pages with NCR carbonless paper. One copy goes in the client file to keep record of payment. Two copies are given to the client: One is a receipt for personal records; the other can be sent to the insurance company for reimbursement through the client’s insurance plan. With the superbill, the mental health clinician can ask for payment at the time of the session and save money by not purchasing billing software.
An example of our superbill is available in The Complete Guide to Private Practice for Licensed Mental Health Professionals. We will also send it to those who request it (e-mail firstname.lastname@example.org).
We will be presenting our workshop “Starting, Maintaining and Expanding a Successful Private Practice” on Sept. 21 in Charlotte, N.C., and on Sept. 22 in Durham. The North Carolina Counseling Association is sponsoring the workshop. For more information, contact NCCA at 888.308.NCCA (6222), or visit www.nccounseling.org.
Robert J. Walsh and Norman C. Dasenbrook are coauthors of The Complete Guide to Private Practice for Licensed Mental Health Professionals (www.counseling-privatepractice.com). ACA members can e-mail their questions to email@example.com and access a series of “Private Practice Pointers” on the ACA website atwww.counseling.org.
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