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Ah, Push It - Push It REAL Good

OMG! Don't be a perv! I'm talking about pushing claims through! I know, it seems like I was just talking about claims the other day, but here we go again.


The reason this whole process will be a recurring theme is that one of THE major pain points (among nearly all my private practice clients) is dealing with insurance claims. Submitting them correctly, following up if they aren't processed (paid) in a timely fashion, and disputing denials when/if they arise...that can all be very time consuming. Not necessarily difficult or complicated...just time consuming. And time is money. Especially when your business is based on set schedules and appointment times. You can either see (and bill) 7-8 clients a day OR you can see 5-6 clients a day and stay caught up on collecting fees and submitting claims. I promise paying someone else to handle the claims/billing will more than pay for itself if you can see a few extra clients every day/week.



These days, a lot of EHR (electronic health record) systems are integrated with claims/billing and scheduling software. That can be a HUGE benefit to a smaller practice where you may have just one (or none!) admin around to handle the little things like making sure you get paid by insurance companies.


Setting up your system correctly can make or break your entire billing process. Overlooking something minor - like including a 95 modifier as a default - can throw entire batches of claims into suspended or denied status. Fortunately, you can often set up the correct CPT code, modifier, and fee for service on the front end, saving literal hours of time on the back end. Taking the time to onboard so that you can submit claims electronically (and get paid electronically!) means you're not stuck waiting around for ERAs to arrive via carrier snail so you can post payments and keep your clients' accounts current.


Pay Me What You Owe Me

There's nothing clients love more than being charged incorrectly. It totally instills a sense of trust and confidence to be told they will owe a certain amount for your services, only to get a big old bill in the mail 6-8-12 months down the road.


Even if you can't always provide an accurate quote, it's crucial to catch billing discrepancies as soon as you can so that your client knows you're taking their financial health as seriously as their physical or mental health. That means, keeping them in the loop and being an advocate (when possible) so they know who to call and what questions to ask when/if something "interesting" happens with their claims.


Just this week the client of a client emailed me to say that her insurance company confirmed that they incorrectly processed her claims. What had happened was....I told her she had a $25 copay...because that's what the insurance company indicated when I verified her benefits. Then, when several of her claims processed, they (insurance) said her deductible applied so she owed us several HUNDRED more dollars. I reached out to the company and was told "that was how the claims were processed, there was nothing they could (would) be able to do"....so I let the client know exactly who to call and what questions to ask...and all of a sudden she did only owe that $25 copay!!!!


I'm not trying to say anyone was up to anything sneaky. There are real live humans processing thousands of claims every day, and mistakes happen. That's where knowing how to correctly review benefit info with (and for) your clients comes in handy. I knew something was off when the insurance payment came through, and worked with the client so that she could continue to afford the care she wanted (and was paying for with her insurance premiums!)


Bill Me Once...

And get paid forever. If you're noticing a lot of lag time between when you submit claims, and get paid (if at all), give me a call. I might be able to spend an hour or two and tweak the settings in your system so those automated claims actually, ya know...automate. It's definitely worth a small (and temporary) investment to get ahead of lapsed claims to avoid late filing penalties and lost income that you ALREADY EARNED.


This is doubly important if you're running into discrepancies between what you've collected from clients and what insurance reimburses. Specifically, if you thought they had a nice neat $25 copay and insurance has determined the (unmet) deductible applies so you're missing out on a substantial portion of your covered service fees. Not only that, clients may not be able to afford continued care if their weekly expense goes from $25 to $135.


If you're at a place where you avoid looking at your client balances (if you even know where to find them), and have a big old list of claims that have been sitting for more than a week or two, reach out so I can help! Either by tackling the mountain myself, or by recommending a more efficient and effective system so you can get caught up and stay caught up!

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