“A bad system will beat a good person every time” – W. Edwards Deming
The importance of building a rock-solid billing system is critical if you are planning on taking insurance or using a hybrid model (i.e. insurance/self-pay). Right at the beginning stages of private practice, it may be beneficial to do your billing yourself to maintain lower expenses. If you’re in this stage of private practice or do your billing yourself then here is what you will need in order to build your billing systems:
In order to have effective billing systems, you’ll need to know your credentialing status with each insurance company inside out and backward. It is imperative to know how you are credentialed and with what information (i.e. which tax ID, which NPI, what address). If you don’t know this information start compiling a list of payers and how you are credentialed with them.
If you’re brand new to credentialing then you’ll need to allow yourself 60-120 days before you’re considered in-network. And then another 30 days before you start receiving funds. Managing your expectations around the timeline will be important so you are not put in financial hardship.
Once you are credentialed save your contracts, fee schedules, and all other relevant documentation in a folder or filing system for reference. You will need this information frequently when you do your own billing.
Make sure that payments from the insurance company and the patient are assigned to the correct date of service in your EHR. This is best done on a schedule. In other words, you will have payment from insurance companies and patients on a rolling basis. It’s more efficient to post all your payments in one sitting. This way you will know the status of all of your claims.
This will allow you to document any denials or rejections that have come through. A denial or rejection is simply an unpaid claim. And documenting those in one sitting is much easier to track than documenting daily.
Once payments are reconciled and the denials and rejections are documented, you’re ready to follow-up on any aging claims or any denials and rejections.
At this point, you are on your way to establishing great billing systems and processes. It is crucial that you know how you are credentialed. This first step is the foundation upon which your billing systems will thrive. If you are organized and allow ample time to get in-network you shouldn’t have a problem. If issues should arise, be sure you have all your relevant documentation and continue to follow-up with the insurance companies.
There is no one correct way to approach these elements of billing systems. But once you have them established they will allow you to grow and scale your practice to your liking.
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.