This article is specifically for those that are on insurance panels or are considering getting on them and want to verify eligibility + benefits and do electronic claims. All options listed below are HIPAA Compliant.

You’ve just taken the bold step into private practice and after the stressful process of applying to Managed Care Panels you’ve been accepted onto your first Managed Care Panel. Congratulations! Now what? It’s time to bill. Billing is frequently cited as therapists least favorite activity and understandably so. Therapists want to do therapy, not paperwork and billing. Yuck! That being said, it’s part of the reality that therapists are also small business owners and self-employment taxes, accounting, and billing all come with this territory. It’s important to have a strategy. It will make your practice manageable, keep you profitable and allow you to keep your sanity!

Here we’ll cover Electronic Billing. There are many advantages to doing this 100% electronically. Electronic claims are accepted and processed by insurance companies quicker, generally have lower turnaround times, can be scrubbed for errors, give clearer records and waste less paper! In the end it saves time and ultimately money and reduces hassle significantly. This article will go over four different ways to bill your claims electronically.

Insurance Company Web Portals

This is the most obvious, immediate answer for many that want to file electronically. This means going to your Managed Care Panel website and submitting the claims. Billing electronically to the insurance company will be the fastest way to send your claim information to the insurance companies and depending on the individual insurance company can result in the quickest reimbursement. It is also nearly always free! If you are on only one or two panels and don’t mind submitting claims once or twice a week, this can be the way to go.

However, there are also some disadvantages to this. While many insurance companies have improved their web presence significantly, many still lag behind and can be difficult to navigate. Frustratingly sometimes the information available on their portals isn’t always accurate or up to date and can result in delayed payments.

Another major disadvantage is if you are on multiple panels. Now you have to manage multiple portals, all with different User Interfaces. This can be annoying and can get out of hand quickly! Managing all of these will often require some sort of practice management tool or spreadsheet to keep yourself on top of your claims and taxes.

Advantages: Fast, Free, Generally Accurate. Good for Single Panel Providers.
Disadvantages: Can be disorganized & finicky, those on multiple panels must be very organized.

Practice Mate

Practice Mate is free software developed by Office Ally, a full service clearinghouse. There are no installation fees or monthly fees. Practice Mate is also compatible with an impressive amount of insurance companies (5,000). One advantage to using a Clearinghouse is Claims Scrubbing. Essentially this means that the claim is scrubbed and if there are any errors you will be notified before it is even sent to the insurance company. This helps to efficiently find and fix errors, reducing the turnaround time for claims, especially when there may simply be a small typo.

Despite being functional the most common complaint about Practice Mate is the ease of use. It is not an elegant piece of software and is clunky and unintuitive requiring a significant learning curve. Many of these problems arise because Practice Mate is made for all-purpose medical billing, creating lots of unnecessary functionality for therapists. These problems can be mitigated with patience and are aksi more minor for quick technological learners.

Advantages: Free! One web portal to bill multiple insurance companies.
Disadvantages: Clunky, significant learning curve, requires manual entry of claim.

Software (Clearinghouse)

There are several other paid software options as alternates to Practice Mate. These offer much of the the same functionality as Practice Mate, except you’ll have to pay. These options will usually use a clearinghouse (like Office Ally) and will offer much of the same base functionality as Practice Mate. Pricing varies significantly from $29.99 to $199.99 a month.

Compared with Practice Mate, many are sleek and have more modern site design. Individual advantages and disadvantages can vary significantly option to option. We usually recommend people to select software specialized onmental health. This helps to eliminate alot of the clutter and fluff that makes Practice Mate so confusing!

Some Options: Therapy Notes, TheraBill, Therapy Partner, Clinic Source.

Advantages: More catered towards , flat monthly fee (not always the case).
Disadvantages: Bad for those with a few insurance clients, can be expensive (monthly fee), still requires hands on.

Note: Some of these are a combination between software and an actual biller, where the biller helps with eligibility, benefits and the more difficult claims.

Biller

Some therapists just want to do therapy. Hiring a biller is the most comprehensive option and the one that requires the least hands-on involvement with insurance. Billers are professionals that specialize in billing and handling managed care. Most will bill for all medical professions, but some specifically focus on mental health outpatient claims. It’s also important to note that communication and having good rapport with your biller are essential as they can only bill with the information they receive!

Billers usually take a % of the amount paid by the insurance (+co-pay). Typical services range from 6-10% of the total amount. Depending on how many clients with insurance you see regularly, this can be moderately more expensive than a software solution although sometimes it is cheaper. Hiring a biller also helps to eliminate claims follow-up. This is also appealing for mental health practitioners that take a limited amount of insured patients as some services don’t charge a minimum amount.

Advantages: Only costs money for paid claims, don’t have to follow up with claims.
Disadvantages: Can be expensive (% Fee).

Disclosure: We offer a billing service here that specializes in Mental Health Outpatient Claims. Our fee is 6% of all claims and $10/new clients with no hidden fees.