In this episode of the Practice of Therapy Podcast, Gordon talks with Jeremy Zug from Practice Solutions about his medical billing in private practice. The two discuss the advantages and disadvantages of using insurance panels versus private pay. Jeremy also brings up the fact that most providers disregard the option to do out-of-network billing and goes into detail on how to provide this service. Later they talk about insurance credentialing and Jeremey gives some helpful tips and tricks to make the process easier. Lastly, we find out why using Practice Solutions can make being on insurance panels easier and how you will never have to deal with an insurance claim again.
Meet Jeremy Zug
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. 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
Insurance Panels vs. Private Pay
Jeremy and Gordon start the podcast by discussing the advantages and disadvantages of insurance panels versus private pay. Jeremy asserts that private pay is definitely easier. However, the bigger the business gets, the more expenses it will generate. This will, in turn, shrink your profit margin.
While on the other hand, the benefits of being on an insurance panel include marketing and keeping the cost of therapy affordable for patients. Jeremy then touches on the fact that some insurance panels are just hard to work with. He suggests looking at the number of patient referrals for each insurance company, the ease of interaction, and their reimbursements in order to decide which company to continue working with.
Out-of-network billing is an option most people forget about. It lets the payment go directly to the patient and you still submit the claim, allowing the practice to still make your cash rate. Jeremy suggests collecting your cash rate up front and determining the out-of-network benefits for that patient. Chances are, their out of network benefits are pretty decent.
Jeremy reveals in certain instances, patients only paid a few dollars more than they normally would and his practice made their full rate. Gordon’s practice offers a sliding scale for patients who do not have insurance or do not wish to use their insurance. His practice still makes the money it would if they went through the insurance company.
Gordon brings up the fact that credentialing can seem like an intimidating process. Jeremy suggests being organized with your license documentation, resume, previous work experience, and certifications. Credentialing boils down to being who you say you are. The only way to prove this is with your documentation, so it needs to be organized!
It is very important to create a filing system that makes sense and keeps all documentation in a row. Next, you need to ensure there is a consistent follow-up with the insurance companies. Lastly, you need to prove your modalities of treatment work.
Jeremey discusses opening Practice Solutions and how it was only meant for five therapists in Montana. With his business, they were able to save therapists eight to ten hours a week. Therapists no longer have to waste their time calling insurance companies and dealing with the billing. With this time saved, therapists are able to see more patients and essentially pay for the cost of this outsourcing. Another solution to getting this work done would be to hire an admin. As long as the expense is covered, it will be worth the price.
Insurance claims can be time-consuming and overwhelming when in a solo practice. Practice Solutions takes all of this off their plates. Practice Solutions will post payments, follow-up with the insurance company on rejected claims, send out patient statements, and do the credentialing. All of these items are now 100% the responsibility of Practice Solutions.
Meet Gordon Brewer, MEd, LMFT
Gordon is the person behind The Practice of Therapy Podcast & Blog.He is also President and Founder of Kingsport Counseling Associates, PLLC. He is a therapist, consultant, business mentor, trainer, and writer. PLEASE Subscribe to The Practice of Therapy Podcast on iTunes, Stitcher and Google Play. Follow us on Twitter @therapistlearn and Pinterest “Like” us on Facebook.