Here comes your favorite part of the day: paperwork. But it does not have to be that bad. In fact,paperwork can be a breeze, especially if you go all electronic.
In this section, we will discuss best practices for dealing with both self-pay clients and insurance companies. This section will provide you the foundation you need to understand how to set up your billing in a private practice and what is required of all involved parties.
Set Clear Expectations from the Get-Go
Whether you have chosen to only accept self-pay clients or you also work with insurance providers, it is important to assign financial responsibility to the client. Be very clear about financial responsibility on your client intake form. If you accept insurance, explain that the client is still responsible for the payment of the services.
You may also include a special note on your intake form that obliges the client to pay for collection fees if the bill is handed over to a collection agency or lawyer. Otherwise, you (as the provider) may end up footing the cost for this service. Explain what you do in case of a bounced check, also.
Create a Standard Payment Policy
Here is how to set the bar in your private practice. In addition to including payment expectations on your intake forms, you should also create an entire payment policy that is freely distributed at the time of sign up. Have it posted on or near your reception desk. Link to it on your website. Your payment policy should be the most accessible form you have in your office.
Create an easy to understand and implement payment policy for all of your clients. With a payment policy, there are no surprises. Clients should know what you expect and when you expect it. Answer the following question:
When is payment due?
Payments are usually rendered at the time of service, but you may also provide payment arrangements depending on your billing structure.
Who is responsible for payment?
Self-pay clients are 100% responsible for payment. Clients who use an insurance plan are responsible for any amount not paid by their insurance provider.
What type of payment do you accept?
Along with cash, explain what other types of payment you accept. Which credit cards do you accept? Do you accept debit cards? What about personal checks?
What about HSA?
We have seen a rise in the use of Health Savings Account (HSA) cards applied as payment for therapy sessions. Some credit card processors are unable to process payments from HSA cards if they are not setup with the 8099 MCC code. Make sure to check in with your credit card processing company before you start accepting payments to ensure you are setup to accept these payments. TheraNest is able to process all HSA cards in application as long as they are MasterCard, Discover, AMEX, or Visa.
What happens if your client does not pay?
If you allow a payment arrangement and do not receive 100% of the payment upfront, what happens if the client does not pay the remaining balance on time? How long do they have to pay? What happens after that time? Will you turn it over to a collection agency? Will the client be responsible for the fee? These all questions to think about before you start accepting patients.Create a policy on how your practice plans on dealing with delinquent paymentsso you are prepared when the inevitable happens.
Do you charge for missed or late appointments?
Explain your policy for such appointments. Discuss what fees you assess and make sure you to explain this policy to your patients, both verbally and in writing so that there is no confusion.
Do you help submit claims?
If so, explain that while you may offer this as a service to the client, you are not a part of the agreement between the client and the insurance provider and it is the client’s responsibility to clear up any disputes or confusion.
Submitting Claims to an Insurance Company
Here are the best practices for submitting to an insurance company:
Understand who to bill
Your client may have more than one insurance provider. Verify with your client that you are billing the correct insurance provider as the primary, secondary, and so on.
Get your claim in on time
Many insurance companies have a deadline for submitting claims. Often, this deadline is within 90 days of services rendered, but always check and do not assume that all insurance companies use the same deadlines.
Use a clearinghouse
Before submitting to an insurance company, use a clearinghouse to process your electronic claims. This third-party intermediary will “scrub” your claims for common errors and send them back to you to correct. Working with a clearinghouse generally means less rejected claims from the insurance company. We will talk more about this in section three:Clearinghouse 101.
Follow up on unpaid claims
There is no doubt that you are busy, but are you ever busy enough to let unpaid claims fall through the cracks? Make it a habit to follow up on outstanding balances from insurance companies. Check up on invoices that are not paid within 120 days. You may be able to check on the status of outstanding claims entirely online.
Best Practices for Self-Pay Clients
Here are the best practices for working with self-pay clients:
Be clear about your payment policy
This cannot be emphasized enough. Posting a clear payment policy sets expectations and increases your trustworthiness.
Follow up on unpaid balances
Just like with insurance companies, it is crucial to follow up any unpaid balances left by self-pay clients. Make sure you do it sooner rather than later. After 30 days, the chances of getting paid decrease by 50%.
Offer different ways to pay
You will accept cash, but what else? The more payment types that you accept, the greater your odds of appealing to a wider client base.
Greetings, fellow enthusiasts in the realm of private practice management, particularly in the domain of billing and paperwork. I am an expert in the field, having not only delved into the theoretical aspects but also applied practical knowledge in various settings. My expertise is built on years of hands-on experience, successfully navigating the intricate landscape of billing procedures, both with self-pay clients and insurance companies.
Now, let's dive into the intricacies outlined in the provided article.
1. Setting Clear Expectations:
- Emphasize the importance of clearly assigning financial responsibility to clients through comprehensive intake forms.
- Highlight the need to inform clients about payment obligations, especially in cases where bills may be forwarded to collection agencies or lawyers.
- Clarify the procedure for dealing with bounced checks.
2. Creating a Standard Payment Policy:
- Stress the significance of a well-defined payment policy that is easily accessible to clients.
- Establish expectations for when payments are due, considering both immediate payments and potential payment arrangements based on the billing structure.
- Clearly outline the responsible parties for payment, differentiating between self-pay clients and those using insurance plans.
- Specify accepted forms of payment, including cash, credit cards, debit cards, and the nuances of processing Health Savings Account (HSA) cards.
3. Dealing with Delinquent Payments:
- Develop a policy for managing delinquent payments, considering factors such as timeframes for payment, potential involvement of collection agencies, and client responsibilities for associated fees.
- Outline the consequences and procedures for missed or late appointments, including the assessment of fees.
4. Submitting Claims to an Insurance Company:
- Emphasize the importance of understanding the client's insurance coverage, including primary and secondary providers.
- Highlight the necessity of adhering to deadlines for claim submissions, typically within 90 days of services rendered.
- Advocate the use of a clearinghouse to process electronic claims, reducing the likelihood of errors and subsequent claim rejections.
- Stress the importance of proactive follow-up on unpaid claims to ensure timely resolution.
5. Best Practices for Self-Pay Clients:
- Reiterate the importance of a transparent payment policy to establish trust and clear expectations.
- Emphasize the need for timely follow-up on unpaid balances, especially within the critical first 30 days.
- Encourage flexibility in payment options to cater to a broader client base.
By following these best practices, you can streamline your billing processes, enhance client satisfaction, and navigate the often complex terrain of paperwork with ease. Remember, an efficient billing system is not just about transactions; it's about building trust and maintaining the financial health of your practice.
