“How to I get paid more?” is a question that I am asked on a weekly basis by clinicians from all over the country. While there are a couple of ways to get paid more, most of them involve working harder. But what if there were a way to get paid more for the same sessions? I would like to address the various scenarios in which this could be an option, especially if you are working with insurance clients.
Go Out of Network
Providers have three options when it comes to insurance; 1) don’t take any insurance, 2) accept insurance as an in-network provider, or 3) be an approved out-of-network provider. The term “in-network” means that a provider has agreed to see patients at a specific rate for their services based on a contract. The term “out-of-network” means that the insurance company will pay out approved out of network costs without a contract.
There are many pros to being an out-of-network provider. For one, you can bill the patient for your full-rate at the time of service. This increases cash flow and reduces accounts receivable amounts. Also, you can submit claims on the patient’s behalf and have payment mailed directly to the patient.
This can be a great way to increase your revenue without doing any more work. For example, I worked with a group practice who was in-network with an insurance company who was paying around $60.00 a session. We decided to go out of network with that insurance company and now they pay on average $120.00 a session. That is a 100% increase in payment for the same time spent!
Refer to this article to learn how to bill out of network.
Request A Rate Increase
If you believe that being in-network with an insurance company is the right thing for your practice, but you find the practice needs to make more as you scale, you can request a rate increase. This process can take a long time, so it is important to get your ducks in a row.
First, you will want to pull and analyze a bunch of data. Ask yourself; how many patients do I have with this insurance? How do the reimbursements for these patients compare to other insurance companies? What does the outcome data for these patients show?
Then, you will want to take a look at the value that you bring to those patients. For example, we found for another practice that they were in-network with Cigna and they requested a rate increase. Along the way, we found that there was a high percentage of patients with eating disorders in their area. Cigna approved the rate increase because that practice specialized in eating disorders and could treat that population. This was incredibly valuable for both Cigna and the practice.
Increase Your Rates
Finally, you can increase your rates. This seems like a simple solution, but increasing your rates based on cost to run a practice, profit goals for the business, and compared to other clinicians is best practice. Additionally, the fall is a great time to make this change because patients will have time to plan for the added expense.
Listen to this podcast on how to determine your rates.
If you are an insurance based practice, then there are several ways to increase your revenue without working harder. You can go out-of-network, request a rate increase, or increase our private pay fees. In either case, be confident that your services are worth it! You provide great services to whomever you are working with and ought to be compensated for those great services.
Jeremy grew up in the Pacific Northwest where he discovered his passion for people. He decided to go to college in Chicago to further develop his skills working with people and pursue a degree in counseling. While in Chicago he worked for a group practice as a practice biller and marketing manager. This initiated his desire to pursue learning about the business of Private Practice, particularly medical billing. Jeremy’s website: https://www.practicesol.com/
He now lives in Michigan with his wife of 3 years. They both are pursuing their passion of helping helpers maintain sustainable and compliant billing practices. In his free time, Jeremy loves reading, fishing, biking, hiking, and camping.