Should I Do My Own Insurance Billing?
You’ve decided to start a private practice and want to accept insurance. After getting credentialed with the insurance companies you wish to accept, you have the option to pay a biller or billing service to handle your insurance billing, or you can do it yourself. Either option is valid. It really depends on your situation, which may change over time. Hiring a biller depends on how much money you want to spend and your overall knowledge of insurance billing. Here is a breakdown of some of the pros and cons of hiring a biller versus being your own biller.
Hiring a Biller
When starting out in private practice, it can be a lot to manage. Jumping into billing, especially when it’s not something you are knowledgeable about, can add yet another stressor. Hiring a biller can be a great solution, allowing someone else to set things up and handle billing while you get your footing in private practice. In general, if you don’t have the time and don’t know much about insurance billing, and you don’t want to learn about it, then it is best to hire someone to do these tasks for you.
It can be helpful to find a biller who will work within the Electronic Health Record (EHR) system you use. This way, if you ever want to take over billing yourself, everything is already set up in your EHR, and you are familiar with how it works.
If you are considering doing your own billing eventually, be upfront with the biller you work with. Let them know that this might be a short-term arrangement and that your priority is to establish your practice first.
Make sure to do some research into different billers before hiring someone. Start with getting referrals from colleagues who like their biller. Also ask about how they charge for their services; do they charge per claim, a percentage, or do they charge a flat fee. You can also look on local therapist Facebook groups or your EHR’s Facebook group. For example, I know Simple Practice has their own Facebook group where people often post that they are looking for billers.
Be Your Own Biller
Doing insurance billing yourself is, generally speaking, pretty easy, especially when your Electronic Health Record (EHR) has the capacity to submit claims. Working with insurance companies is the most challenging part of all of this, not the billing itself. If a claim is denied, then you have to look into why. If something doesn’t look right, then you have to investigate further. You have to call the insurance company and check the status and benefits of the client.
Having to call insurance companies is often what I see people say is the biggest deterrent for not wanting to do their own billing. While situations do come up when you need to reach out to the insurance, and you might sometimes have to wait on the phone for an hour (or more) to talk to a real person, it is not something that happens often. Between my own billing and the billing I do for others, there are very few calls to insurance that I have had to make.
Sometimes you can put that responsibility on the client, and other times it can be an email to the provider representative. Having the contact information for your local provider rep is very helpful. It offers a more direct connection to someone so that you don’t have to call the generic provider relations number for that insurance.
If you want to be your own biller it is helpful to have:
basic billing knowledge
willingness to learn
can be patient (with insurance companies)
have the time for the admin work
problem solving skills
Can you answer these 6 questions?
What are CPT codes and which ones will you use?
What does each insurance (you’re credentialed with) reimburse for each CPT code you will use?
What are place of service codes and which ones will you be using?
What are modifiers and do you need to use them?
What client information do insurances want when you submit a claim?
Do you know what an EOB is, how to read it, and how to access one?
If you can answer these questions then you are in a good place to be your own biller. If you don’t know the answers that is okay, you can still be your own biller. You can easily learn the answers to all these questions.
If you want to learn how to be your own biller, I offer a 3 session program to teach you! Click HERE to learn more.
If you’re looking for more one-on-one support with billing, schedule a free consultation below.
I’m Kristi Cornforth, a licensed social worker supporting other clinicians to become their own billers and grow their businesses with practical tools and unwavering support to achieve the practice of their dreams.