Is your private practice insurance-based? Should you credential your group with an NPI1 or an NPI2? What are some important mistakes to avoid when you take insurance pay?
In this podcast episode, Alison Pidgeon speaks with Kym Tolson about how therapists can successfully bill insurance.
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Meet Kym Tolson
Kym Tolson is an LCSW in an insurance-based, online, private practice and a digital nomad. Kym had a terrible experience with billers in her private practice and after they fired her, long story, she decided to teach herself everything there is to know about insurance billing in private practice.
It’s become Kym’s passion to help therapists live their dreams and have a successful insurance-based private practice. As a result, she created, a 3-part “Boss Biller System” to get your insurance based private-practice up and running.
Join her free Facebook group.
In This Podcast
- Billing insurance for a solo practice versus a group practice
- Troubleshoot your insurance billing
- Billing telehealth basics and mistakes to avoid
Billing insurance for a solo practice versus a group practice
For a solo practice:
- If you own a solo practice you can do an NPI1 which is essentially your name and an NPI number.
- You can also have an NPI2 which is more connected to your practice or organization. With your NPI2 you can credential with insurance companies as a group practice and be a group of one, or a group of clinicians under your NPI2.
Therefore, if you see yourself moving from a solo practice into a group practice, consider working with an NPI2 immediately when you contract with the insurance companies.
You can also redo your NPI1 to an NPI2 if you ever decide to make the switch, it is not a once-off decision.
Troubleshoot your insurance billing
If you have any issues with billing insurance, navigate your insurance’s homepage to check up on their recent COVID-19 information because some insurance companies keep extending their end dates.
Many insurance companies are still covering telehealth as an accepted billable service due to the public health crisis at the moment, so keep an eye on the trend to see if and when this changes so that you can edit your insurance to adapt to this potential change.
Billing telehealth basics and mistakes to avoid
- Be sure of your location code. This is 02 and if you are in a brick-and-mortar office the location code is 11, so if you are billing telehealth choose 02.
- Modifier: This is when you notify the insurance companies that there is something different going on in the sessions. The two modifiers that insurance companies want the most at the moment are GT and 95.
- Call if you can:
Just call and ask them if it’s covered because a lot of the times if you ever give your EHR to give you a cover to report it almost never includes the telehealth information so I would definitely recommend, if you have the time, call and actually get a confirmation that the telehealth is covered. (Kym Tolson)
- For most therapy businesses, the bigger they get the more likely they are to outsource their insurance billing so make sure that you trust the company you are outsourcing to.
- You might not need to know everything but know enough to know that it is being done correctly.
- You need to verify benefits before consultation and make sure they have been cleared to receive treatment.
- Make sure you document the time of the consultation and the location of the client whenever a therapy session is carried out because this is information that the insurance companies may need.
Make sure you have a measurable treatment plan goals and objectives and that the treatment plan ties into the progress note and the progress note and the treatment plan tie into the diagnosis. If you can make it all interconnected like that, the chance of an audit or having to pay money back is going to be a lot less. (Kym Tolson)
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Meet Alison Pidgeon
Alison is a serial entrepreneur with four businesses, one of which is a 15 clinician group practice. She’s also a mom to three boys, wife, coffee drinker, and loves to travel. She started her practice in 2015 and, four years later, has two locations. With a specialization in women’s issues, the practices have made a positive impact on the community by offering different types of specialties not being offered anywhere else in the area.
Alison has been working with Practice of the Practice since 2016. She has helped over 70 therapist entrepreneurs start and grow their businesses, through mastermind groups and individual consulting.
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