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