January Reminders for 2021 - Navigating the Insurance Maze

Make 2021 Different: 10 New Year Billing Tips

By Barbara Griswold, LMFT

December 28, 2020

You can’t sugarcoat it: For most of us, 2020 was a hot mess. But it will be a year we will always remember. COVID-19 changed our lives. Our industry underwent an almost overnight shift to telehealth, a reality that many insurance plans still seem to be struggling to fully accept and support. We had to research telehealth platforms, develop new consent forms, figure out how to send documents to clients to get them signed, find new ways to collect fees, and decide whether to give up our offices. Meanwhile, many of us fell behind in writing notes and billing.

Below I’ve listed some ways to get back on track in the New Year, including some new considerations due to COVID, and thoughts about how to start the New Year off right when it comes to finances. Also, I invite you to consider which financial habits you might want to shed as we leave behind this difficult year. Think about which of your current habits lead to a loss of income — or a loss of feeling good about yourself as a professional.

1. Ask all clients about known changes in insurance coverage with the New Year, but don’t trust them. I know that sounds harsh, but often clients are not aware of changes in their plan, coverage, copayments or deductible, which can mean you may not get paid at all.

2. Call the plan for each client, and do it as early in January as possible, even if the client doesn’t think there have been changes. If you don’t have their insurance card on file, have them take a picture of both sides of the card and email it to you. When you call, be sure to have the client’s date of birth handy. Time consuming? Absolutely. But totally worth it to avoid costly denials and headaches down the line. You may find the client isn’t covered in the new year. Or you may need to request a new treatment authorization. Most importantly, they may have a deductible, which can mean no payments from the health plan (more later on this).

3. Come prepared to the phone call. See my worksheet “Checking Coverage: 14 Essential Questions” in my book and my Practice Forms Packet (available at www.theinsurancemaze.com/store). You’ll need to ask a lot of questions, which include asking about copayments, deductibles, in-network vs. out of network coverage, claim address for mental health, number of sessions allowed per year, whether preauthorization is needed, and whether the services you are providing (and your license) is covered. Don’t trust the card or website for any of this info.

4. Don’t make any assumptions about billing for video or phone sessions. As I write this, many plans are covering video and phone sessions, when pre-COVID they didn’t. Some are covering it with network therapists only. Some are waiving client “cost-shares” for telehealth (any amount the client would normally pay for the session, like copays and deductibles), but many aren’t, and it may vary by client account within the same plan, so you’ll need to ask ON EACH CLIENT when you call. Since this coverage information is always changing, you’ll need to call back frequently to get the latest information as the pandemic progresses. You may also want to confirm the telehealth billing codes you are using are correct. Read my many articles on billing for telehealth and giving up your office at www.theinsurancemaze.com/articles

5. Beware of the deductible. The deductible is the annual amount that many plans require the client to pay out of pocket before the plan begins to pay. Often thousands of dollars, the deductible restarts each January for most plans (though be sure to ask). Not all plans have a deductible, and it may be waived when a client sees a network provider. Since you will not be paid by the plan for these sessions during the deductible period, charge your client your contracted rate with the health plan (not your regular fee) for each session during the deductible period. You still need to bill the plan so the deductible will be whittled away.

6. Submit your claims early. I submit claims for January after the client’s first session so that I can find out earlier about the new year’s eligibility and coverage problems.

7. Take this moment to do a year-end review of each client file. Check to be sure you have billed for each session, and check for balances owed by clients or insurance plans.

8. Go over the list of insurance plans you work with. Carefully consider if it makes good financial sense for you to continue with each plan in 2021. Consider asking for a reimbursement rate increase from all plans before you leave (see my article on raises), and remember you may have to give 2-4 months written notice before you can leave a plan.

9. Set a new, stricter claim submission routine for the coming year, and add reminders to your calendar so it becomes a lovely new habit. I submit claims twice a month — on the 16th for sessions between the 1st to the 15th of the month, and at the end of the month for the 16th to month’s end. Daily or weekly is even better.

10. Make this year the year you change your note writing habits. Imagine getting a records request (which is happening more and more), but feeling completely confident in your notes. Join me in a live webinar in January (click here for more info) or check out my pre-recorded Progress Notes webinar at www.theinsurancemaze.com/store (click on the webinar icon for more information).

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Schedule your consultation with Barbara at www.calendly.com/barbgris to get answers to your insurance or practice business questions.