This guide is designed for psychiatrists, mental health nurse practitioners, and therapists who are thinking about hiring a (new) biller, and want to get it right. There’s more to billing than just submitting claims and hoping you get paid.
Working with an excellent billing service can help you make more money and serve your ideal clients with peace of mind. A bad biller can sink your business, reducing your revenue and increasing your stress. Therefore, it’s an important decision to make; one worth deliberation.
MindEase Billing is a billing and consulting company in Portland, OR. We’ve seen the pain and loss that comes from choosing the wrong biller. Many of our clients found us after first enduring a bad experience.
We developed this guide from their misfortunes to help you avoid one or all three of the mistakes they made with previous billers:
- Not Knowing What You Need or Want
- Basing the Decision on Price Alone
- Staying in a Bad Relationship Too Long
Mistake #1: Not Knowing What You Want or Need
Before interviewing and comparing billing services, conduct a Needs Assessment by reflecting on your current state versus your goals.
Then when you talk with prospective billers you can determine how they can help you bridge the gap from where you are to where you want to be. This is the first step in managing your own expectations. Here are some things to consider…
- Current vs goal revenue.
- Current vs ideal # of clients/sessions.
- Why are you looking for a billing service? What pain or frustrations are you having that make you think a (new) biller could help you with?
- What expectations do you have of a billing service? How do you want your biller to help you?
- What concerns do you have about working with a (new) biller?
- What deal breakers are you watching for?
Within the mistake of Not Knowing What You Need and Want is making the assumption that all billers are created equal. Billing services are not a commodity, like gas or sugar. Instead, each biller decides what services to provide, who they service, how to charge, and what values are important in guiding their practice. Understanding this can help you avoid Mistake #2.
Mistake #2: Basing the Decision on Price Alone
What’s the number one question providers have for billers? Yep, “What do you charge?” But now that you understand what you need, you can reframe the question into “What do I get for what you charge?”
While basing your decision on price alone is a mistake, cost is a part of the equation. It’s important to know what you get for the price and how you’ll be invoiced. So, let’s look at The Service and The Invoice below.
The Service
The main purpose of a billing service is to submit claims. But if claim submission is all the billing service does, don’t expect a high level of practice advocacy. On the other hand, you shouldn’t expect to pay much, either.
A billing service can give you so much more than just claim submission. At MindEase we think these 5 components are worth consideration when interviewing prospective billers:
- Benefit Verification
- Claim Submission
- Getting You Paid
- Reporting
- Communication
Let’s look at each in more detail below.
Benefit Verification. Does the biller verify benefits routinely or only on request? Does the biller calculate the patient’s financial responsibility (PR)? Does the biller make the benefits and PR estimates available to you? Do they make them available to your patients?
Claim Submission. This is the obvious thing a biller does and frankly this is the easiest part. But you should still understand how your biller manages this step.
How does the biller get your session information and the amount of money you collected from the patient? Do you fill out a digital log? Does the biller dip into your EHR? Does the biller look for errors you’ve made and ask for clarification before submitting claims? How often are claims submitted?
Getting You Paid. A billing service should be able to track the money coming into your practice. They should be committed to not only making sure you get paid, but making sure you get paid correctly and in a timely fashion. How does your prospective biller do this?
Reports. Billers are a vital link to your cash flow and reports are a crucial source of information that reflects the health of your practice. Your biller should use a variety of reports to help manage your practice and you should have access to (and encouraged to review) reports on a routine basis so you can make informed decisions.
Communication. During the interview, does the biller seem genuinely interested in working with you? Do they seem to care about the health and goals of your practice? Do they seem easy to communicate with or is it like pulling teeth to have a conversation? We recommend steering clear of anyone who seems annoyed to have to answer your questions.
As a client, when and how do you communicate with them? Do they talk to your clients?
The Invoice
There are 4 main structures billing services use when invoicing their clients:
- Hourly Rate
- Percentage
- Per Session
- Per Patient
The structure the biller employs is the core of your invoice. Whatever structure the biller uses, it’s important to understand which service components are covered in this structure and what might be charged separately. For example, are these included in the core invoice structure:
- practice set up
- monthly minimum
- sending/receiving faxes
- database charges
- postage (mailing patient bills, etc)
- claims appeals
- dunning (soft collections)
- practice advice/consultation
- communicating with patients
- cleaning up patient accounts that you or your previous biller might have messed up
Mistake #3: Staying in a Bad Relationship Too Long
We love psychiatrists, mental health nurse practitioners, and therapists. They have big hearts and giving spirits. They help others find the best in themselves. They’re also pretty forgiving – perhaps to a fault. This is what can cause them to get stuck in a painful or dysfunctional professional relationship too long.
This section is designed to help you recognize when or whether you’re in a bad billing situation and to help you avoid one if you’re not. You’ll need a few benchmarks or metrics to monitor.
Cash Flow. Your primary metric is your cash flow. Have you noticed a drastic and/or consistent decrease in cash flow without a decrease in your volume? Don’t let this persist.
Your Experience. Your secondary metric is your experience. Are you treated kindly and professionally when you have a question or concern? Does the biller acknowledge and fix their mistakes (often before you even notice)? Are they proactive and communicative about industry changes? Or are they rude, indifferent, uninformed or chronically unavailable?
Patient Experience. Patient interactions matter, too. Ask a cross-section of clients about their experience when dealing with the biller. Are they getting their questions and concerns addressed with respect and empathy?
Other Red Flags. Is the biller taking increased time off due to illness or a pending retirement? Does the biller complain about their own stress? Is the biller looking for a job? Does the biller hint at increasing their client load, but isn’t making improvements in processes or adding staff? Does the biller complain about or disparage their employees?
If the biller is mature, they want your honest feedback so they can clear up any misunderstanding and/or improve their service. But if the biller is not interested in your feedback or makes unsustained efforts to improve the service, you really don’t need to stay.
It’s easy for MindEase to say “just get out” of the relationship, but frankly that’s our advice. Your practice is too important to let incompetence or indifference be responsible for your cash flow and a chunk of your success.
Conclusion
This guide was born out of the pain our providers experienced prior to coming to MindEase. Most of the billers we have cleaned up behind are not bad people, they were simply sloppy, poor communicators.
If it’s time for a (new) biller, take some time to do a Needs Assessment, then diligently interview prospective billers who meet your needs. Don’t settle. We want you to have high expectations from your billing service, because your practice depends on it.
If you’re a psychiatrist, mental health nurse practitioner, or therapist in solo private practice and want to see if MindEase is a good fit, click the Request A Discovery button below. To learn more about us in general, head to the MindEase Home Page.