What You Need To Know About Hiring A Billing Professional

After several of you asked for more information about whether or not to hire a billing professional, I spoke with Jill Osborne, EDS, LPC in Georgia.  She graciously offered to go after some of the answers to your questions by interviewing her favorite billing professional, Barbara Ifill.  Below you will find their interview in Jill’s first guest post here.

(If you are interested in writing a guest post, check out the guidelines here.)

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A Guest Post by Jill Osborne, EDS, LPC

When I was attempting to open a private practice by myself I assumed I was going to do all the billing myself. It will save money right? Then I don’t have to pay someone else; I’m on a budget. All I need is some good billing software.

Then, I joined Eagles Landing Christian Counseling Center and met billing professional Barbara Ifill. I can’t tell you how much I have learned from her about the billing process, and how much more complicated and time consuming the process is than I thought.

Here is my interview with Barbara about common pitfalls therapists make when we do our own billing and whether or not hiring a billing professional is for you . . . .

Jill: How did you get into insurance billing?

Barbara: I started billing in 2007 when I lost my job due to downsizing. I had been in the medical field for over 25 years and had a basic foundation of understanding in regards to insurance and billing. A doctor approached me and asked if I would be interested in taking over the billing in his office. I took classes at Clayton State University and earned a Certificate in Billing and Coding.

Jill: What can a billing professional do for therapists in private practice?

Barbara: A biller can and should keep the revenue cycle going. Claims need to be filed timely. This brings the revenue in as well and identifies any potential problems. If there is a problem with the insurance claim,  then it is important to identify that as soon as possible. It may be an easy fix or it could be that the client will owe the clinician money (or in some cases may have a credit owed to them).

A claim generally takes 15 to 20 days to process. Therapists generally see their clients once a week. If there is an insurance problem such as not having mental health coverage, being in a waiting period, or the co-pay being more than was collected, the therapist needs to know that before they have had numerous sessions.

Jill: Why should a therapist in private practice hire a billing professional?

Barbara: Hiring a billing professional will ensure that your claims are filed correctly. The biller also will monitor the EOB’s (Explanation of Benefits) to make sure the clinician was paid according to contract guidelines. If the claim was not processed correctly, then the biller will take the appropriate action to get the claim paid, as it should. This may require a few phone calls or writing a letter of appeal to the insurance company.

The biller will also keep track of outstanding claims making sure they are processed in a timely manner. It is the responsibility of the biller to keep the clinician informed of any issues that arise during this process such as co-pays changing, a deductible that was reached, any adjustment made that results in the deductible having to be met again, billing or reimbursement mistakes that result in money being recouped, or money being sent and an adjustment being made in the client’s favor.

I also keep a tickler file on all of the claims that have been sent back due to errors by the insurance company. I pull that file weekly to track the progress of a claim. Right now for example, I have an insurance company that paid fifty-eight dollars on a claim that should have paid sixty-five dollars. I spoke to the insurance company who has sent the claim back for review. I should have a response within 15 days of the call. I will pull my file on Monday and look at all claims under review and ones I should have heard from. Many times it takes a follow up call to find out what the hold up is.

Jill: When should a therapist consider doing his or her own billing?

Barbara: A therapist who is doing private pay only or who bills one or two insurance companies and who has the time to track claims would be the only one I would consider who may want to do their own billing.

Jill: What are the top common mistakes therapists make when billing on their own?

Barbara: The mistake that stands out the most is the therapist does not know the specific guidelines/regulations that insurance companies have concerning billing. Each insurance company has specific requirements that must be followed when filing a claim. By having someone do your billing, you avoid costly mistakes as well as valuable time trying to figure out what the mistakes were and how to correct them. Also, many therapists try to save money by doing the billing on their own but end up losing money in the long run by not getting paid or paid incorrectly for the work they have done.

Jill: What about therapists who don’t take insurance?

Barbara: Therapists who don’t take insurance often will have someone handling the client base in some type of software system that allows them to track payments as well as generate statements.

Jill: How much does it cost to hire a billing professional?

Barbara: The cost of a biller varies. Most charge a percentage of what is collected from insurance. Some may charge an hourly fee, but that can be difficult to track.

Jill: What do you like about your job?

Barbara: I like the challenge of the job. It is something different every day. I also like making sure our therapists get all the money they have coming to them. They have done the work and they need to get paid for it.

Jill: What is your biggest headache?

Barbara: Often times when insurance companies make mistakes it can be handled with one or two phone calls. There are times however when the insurance companies insist they are right when they are not. Those times involve lots of phone calls, letter writing and documentation to get the claim paid. Sometimes it involves calling the provider rep to help settle a matter. These can be very time consuming and frustrating.

Jill: Advice for therapists who want to bill on their own?

Barbara: Get a software system that allows you to bill electronically, know all insurance guidelines BEFORE you start sending claims. Make sure you do a thorough job of understanding the benefits up front. Know everything about that particular plan and what they require on their claims.

Jill: Where can therapists go to research potential billing professionals?

Barbara: The best place to research billers is to ask other therapists who are using a biller. You want someone who will be dedicated to making sure you get all of the money you have coming to you. They will be aggressive in getting your claims paid in a timely manner.

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About the Author: Jill Osborner, EDS, LPC is a writer and psychotherapist in private practice and Barbara Ifill is a certified billing specialist at Eagles Landing Christian Counseling Center in the Greater Atlanta, Georgia area. You can learn more about Jill at Jill’s Writing and Play Therapy page.