I have been in private practice over ten years and have learned the hard way how to get psychotherapy billing done. I found a better way to get my mental health billing done, and I'm willing to share.

Less Desirable Ways to Get Psychotherapy Billing Done:

• Be a part of a group, have their staff do your psychotherapy billing. Pay a large chunk of your income for the administrative costs of the group.

When I started out, I had my psychotherapy billing done by the group I was part of-- but I paid through the nose for the services.  I also had little knowledge of which clients and insurance companies paid well and which didn't. 

• Try a local medical billing service.

When the group demanded an even larger chunk of my income, I went solo. I tried a local medical billing service. It didn't cost as much as being part of the group, but I was doing much more work.  Although the medical billing service filed claims electronically, I had to send them all my information and get back monthly paper reports of what had been filed.  I started checking the reports and found some claims for psychotherapy sessions never got filed. Had I never checked- I would have not got paid! I found I had to record, monitor, and follow-up myself.  That was in addition to the time I spent sending them information about what visits I had done and what payments I received.

• Do your billing yourself. 

So I decided to explore doing my psychotherapy billing myself.  I found the highly recommended Office Therapy software and tried doing some the claims myself. I was delighted to find that it was easier and less time consuming than using the medical billing service. However, I still was spending hours on the drudgery of calling insurance companies and following up on denied claims.  I didn't enjoy it-- that is not how I wanted to spend my time. 

As my practice got full, I realized that since I averaged around $100 per psychotherapy session it made little sense for me to reduce the number of clients I coud see because of the time it took for me to do my psychotherapy billing myself.  I also realized that even during the times when my practice was not full, it would be better to spend my time doing marketing than doing psychotherapy billing.

• Hire someone without medical billing experience and train them to help you.

So I managed to work out a deal contracting with the landlord of my executive suite to use the receptionist part-time to help with my psychotherapy billing.  This was another improvement and saved me alot of time, money, and hassle.  

But as is typical of low paid receptionists, the turnover was high. Training staff in psychotherapy billing is very time consuming. I still ended up doing many things myself, because it was easier to do it myself than keep training receptionists in the more intricate tasks. I didn't have control over what my landlord paid the staff or how she treated them, so I became convinced no receptionist was going to stick around long. I finally swore I would not keep retraining secretaries for a landlord that was not willing to pay them adequately. I decided to cut out the middle man and pay my own person.  

My practice was growing and another therapist had joined me, but the practice was not big enough for me to justify the expense and time required for hiring my own employee, doing payroll, and having payroll taxes withheld for them.  I considered seeking out psychologists or other psychotherapists to joing the practice to make it more cost effective to hire my own full-time staff.  But that would have also meant big hassle, big risk, and finding finding a new office. And even if I paid my staff very well, there still would likely be the risk of having to repeatedly retrain staff, due to tendency for todays families to have both spouses working and to move around a lot. 

A Better Way to Get Psychotherapy Billing Done:

What I did then was start to explore ways I could use technology to run a more efficient practice. I saw a report on telecommuters and the success of Alpine Access, a call center with an extraordinarily high quality and satisfaction ratings.  I learned that their success is attributed to using workers who work at home and telecommute.  They are able to hire workers who stay much longer than others, who have higher levels of education, who are more mature than average,  who provide documented better quality services, and who are willing to work for less because they want to work at home.  The report indicated that telecommuting worker save an average of $4 per hour and an employer is able to hire staff of much higher quality by allowing the workers to telecommute.  I called Alpine Access, but learned that I would have to have 50 staff people before they would work with me.  

At around the same time, my colleague and I started using GoToMyPC.com to securely, remotely access my computer from anywhere.  I realized that if I could find a biller I could trust to share secure information, the biller could also remotely log onto a computer on my network from her own home and bill for me using my program.  The biller could do much of the data entry, while I could also enter the information I wanted to. (Some information, like who kept their appointments that day, is quicker and easier to enter myself than to take the minute to give it anyone else to enter-- and that way I am absolutely sure that the visit will get filed.)  The biller could easily access information to file claims and followup on insurance problems without me having to spend hardly any time sending information.  Using an clearinghouse for electronic claims submission, the biller could even get the electronic remittance advice and I would never even need to send her EOBs like I had to do with my old local billing service.  And with my program up-to-date on my own computer, I could easily look for myself at current information anytime I want to see what has been filed, what my clients owe, or what their copays are.  I could have the ease of access to my information with the drudgery of the more time consuming data entry and insurance claims follow-up. 

I definitely wanted to keep my current database and practice management software that I love (Office Therapy), which has an easy database and easy claims filing system that is wonderful for practice management with many reports to easily monitor my business.  It even allows me to see how much money is coming in from different referral sources.  It allows me to more effectively target my marketing and build my practice inexpensively. It also integrates with QuicDocs, the electronic records program I use that is especially for mental health professionals that saves my tons of time on my clinical documentation.  My biller can enter the basic data on patient information into Office Therapy and I can then easily import the information into the clinical records program. With QuicDocs, I do not need a secretary to type or file records for me.

Using Angela for my Psychotherapy Billing:

I feel God brought Angela and I together, as an answer to a prayer.  I found a site and put out a bid request on a free lance site that Angela had also just stumbled upon. We are both Christians who were praying for help.  I was praying to find a better way to run my business.  Angela was praying to find a way she could work at home and be available to let her daughter participate in activities she had not been able to, to help her father who is a pastor, and to have more flexibility to do her church work.

When I read about Angela and talked to her she sounded perfect. Angela is a mature Christian wife and mother who wanted a long term business relationship working at home.  She has computer skills, a wonderful warm personality, and a great work history with tons of experience in medical billing. (She also has brothers who are professors with computer skills who could help us find the best technology to use to make our new system work effeciently and securely.)  Angela had been doing medical billing for over 10 years, and had helped several doctors change over from paper billing to electronic filing.  She had already learned several different practice management systems, and found they tend to be so much alike that she can learn new systems quickly and easily.  She was working daily with Gateway EDI, the preferred clearinghouse for my practice management system.  She was willing to take phone calls, schedule appointments, and do other secretarial work if I wanted her to.

I felt so lucky to have found such a gem. Because of my interest in website design, I initially made this site to share her services with other mental health professionals through a billing service. However, her own circumstances became such that she was not able to leave her daytime employment and be available enough during during daytime hours for me to continue our relationship without using other billers, and I simply don't have adequate time to administer a medical billing service. My practice has grown to include several other therapists, part-time on-site staff, and other virtual assistant billers. I converted this site to a referral service to help other mental health professionals in an automated way that requires no interruptions in my schedule of seeing clients.

However, recently I have not had the time to keep the referral list adequately up-to-date and have removed billers who are no longer responding well to inquiries I have referred.

Currenly, there is one biller, Cindy Dicara, that I can confidently refer to, who I use to help my staff with overflow calls and I also received positive reports about in surveys of therapists who have used this service in the past.  You can reach Cindy at Patient Medical Claims Assistance LLC, 1-888-653-3933 ext 506. Or email her at cindydicara@verizon.net

Susan Huebert, L.S.C.S.W.  www.wichita-counseling.com