Whether you’re a private practice clinic or a university clinic training students, insurance billing can often be a complicated headache that no provider wants to navigate. After all, you’re trying to help patients—and insurance can often just feel like another thing to add to your busy day.
But accepting insurance can have a major impact on your practice—and once you master the basics, it can be a great way for your clinic to increase its accessibility and impact on patients.
Why should I accept insurance at my practice?
Extended Client Base
Accepting insurance broadens your potential client pool. Many individuals seek services covered by their insurance plans, increasing your practice’s visibility and accessibility.
Financial Accessibility
Insurance coverage reduces financial barriers for clients. Patients may be more inclined to come to your practice if they can use their insurance benefits, making it more affordable and accessible.
Diversified & Predictable Revenue Streams
While it requires diligence in managing billing and claims, accepting insurance can offer diversified and more predictable revenue streams compared to cash pay only.
What questions should you ask when considering taking insurance?
Which payers should I contract with?
Consider the prevalence of each insurance provider in your area and their alignment with your target client base. Consider:
- The largest employers in your area and the insurance providers they work with.
- If your practice specializes in populations more likely to have a Medicare or Medicaid plan.
- Reimbursement rates offered by these insurance companies and whether they’re reasonable and sustainable for your practice.
How will insurance policies impact treatment decisions?
Consider how insurance policies may influence treatment planning and the therapeutic relationship with clients (e.g., session limits and treatment authorization requirements).
Is the payer accepting new providers into their network?
Sometimes payers may close their networks if they feel like they have enough coverage in your area.
How long does it take to get contracted with the payer?
Different payers have different lengths of time and different requirements to join their network. Typically this process can take 3–6 months, but could be longer for some payers.
How does credentialing and contracting work?
Once you’ve decided to accept insurance, it’s time to get credentialed and contracted—two distinct but connected steps in the process.
Credentialing: The process of verifying your qualifications, experience, and eligibility to participate in an insurance company's provider network.
Contracting: The negotiation and signing of agreements between you and an insurance company, outlining reimbursement rates, terms, and conditions for services.
The Process
- Application Submission: Complete and submit the provider application form provided by the insurance company. These are often found in the Provider section of their website.
- Credentialing Review: The insurance company evaluates the provider’s credentials, which may include education, licensure, malpractice history, and work experience.
- Contract Negotiation: Once credentialing is approved, negotiate contract terms with the insurance company, including reimbursement rates, billing procedures, and service provisions.
- Contract Signing: Sign the provider contract and any associated agreements.
- Enrollment and Onboarding: Gain access to the payer web portal and set up for claims processing and payment.
What best practices should I use when accepting insurance?
After contracting with an insurer, it’s time to integrate a few best practices into your daily clinic operations to keep things running smoothly.
Intake
- Gather all necessary billing information at the time of intake, including the policy, primary insured, and secondary policies. It is also good to get a front and back copy of the insurance card(s).
- Check for eligibility and benefits before the first appointment to confirm coverage details, including deductibles, copayments, and authorization requirements.
Copay Collection/Patient Invoicing
- Clearly communicate copayment requirements to clients during the intake process and appointment scheduling.
- Collect copayments at the time of service. This increases cash flow and reduces accounts receivable and back-end collection costs.
- Invoice for any remaining balances (deductibles, co-insurance, etc.) in a timely and consistent manner.
Insurance Billing
- Submit claims consistently and as close to the date of service as possible.
- Utilize electronic claims submission to reduce the claims processing cycle.
- Sign up for electronic payments via EFT.
- Using an EMR and Clearinghouse can streamline your documentation and claims processing workflow, helping reduce billing errors and improve audit compliance.
Interested in how EMR can help you streamline clinic operations as you incorporate insurance?
Visit our website and learn how an EMR from ClinicNote can help you better serve your patients at your university or private practice clinic.