Billing insurance companies and keeping track of payments is a rather formidable challenge faced by all of us. Â How to do this in the most effective way with the least expenditure of time and frustration is often a matter of preference.Â The era of handwritten insurance bills is over and typed CMS 1500 forms are entering into the twilight as well. In fact, some insurers will not accept anything less than electronic submissions while others will only accept mailed CMS 1500 forms.
I would like to lay out the three basic choices we have for dealing with insurance billing.
The 1st choice which reflects the lowest tech involves you typing CMS 1500 forms and mailing them via US mail to the insurance company. I donâ€™t need to go into the obvious challenge faced if we either increase the number of patients, or number of insurance companies.Â The cost of postage, paper, and time should also be factored in.Â We also lack the ability to track, gather data or keep a cohesive picture of the insurance
billing over months for any patient.
The 2nd choice involves paying somebody else to do everything related to insurance claims. There is an abundance of commercial billing services that will handle virtually every aspect of record keeping, filing claims and working with your insurance company to solicit payment of the bill. These services work on a percentage or a flat fee per claim and can be found locally and on a national basis. Generally you simply have to notify them of the dates of service and CPT billing code and they will handle the rest. The fees for set up, problem solving, resolution of unpaid claims and obtaining authorizations, are but a few issues that you would want to thoroughly investigate prior to engaging the services of a billing company.Â Of course it goes without saying that you will need to have some sort of oversight to insure that your claims are being properly paid.
The 3rd choice is for those of you who would like to keep your billing in-house. This choice has two options as well. The first option involves utilizing software that exists in the cloud on the servers of an intermediary/clearinghouse. Historically, clearinghouses charged both the provider and the insurance companies per transaction. However in the past several years several electronic clearing houses Â have taken a rather proactive approach where we as providers benefit. Specifically several of these services, including Office Ally (OfficeAlly.com) and Availity (http://www.availity.com) charge only the insurer for the filing of an insurance claim. Â Further, Office Ally offers a free billing software that allows the individual practitioner to enter office visits on cloud software provided by the clearinghouse. This is probably the least expensive means to use an electronic intermediary and they can do everything for the clinician in terms of billing, payment and even notes.Â However at this time the Office Ally â€œPractice softwareâ€ is Windows based. Â Use of Office Ally as an electronic intermediary though is available to you whether
you be a Windows PC or MAC OS person.
Another available option to electronic billing option is provided by many of the insurance companies who have their own electronic billing service that allows you to upload or use their website for insurance billing. The only difficulty here is that each insurance company has their own protocols, their own website and you would need to contact each insurance company separately to bill.
The second electronic option available to purchase dedicated billing software. Software varies from about $ 500.00 upwards and can be selected for individual or group practices with single or multiple office locations. There are various companies that provide software for both Windows and Mac operating systems. The cost vary and are dependent on whether the software is truly a robust product in terms of what it does and the level of customer service provided.
Iâ€™ve been using billing software in my practice for over 18 years. If you are looking for a bare-bones product, you can build one of your own in either FileMakerâ€™s (www.Filemaker.com) or in Proviewâ€™s Panorama (www.Provue.com) flat file database software. Both of these products can be used cross-platform (Windows or Mac operating
system). It does take a fair amount of programming knowledge and expertise to
develop anything close to a sophisticated piece of software.
You also can buy software that has been developed for psychotherapists. The cautionary tale however is that you get what you pay for. I can tell you from experience, though I will not mention the name of one company in particular, that just because software is expensive does not mean that you get quality, decent customer service or software that is free of bugs or inherent design flaws. Having had that experience, I have spent a fair amount of time exploring the various software that is available. Regardless of what you spend, it is vital to have software that is robust (no bugs, user and computer friendly) provides timely upgrades, improvements and is built on trusted database platform (such as Filemaker).
I have listed several providers of billing software for psychotherapists.
Beaver Creek Software:Â Â http://www.beaverlog.com
Practice Magic:Â http://www.practicemagic.com
Therapist Helper:Â http://www.helper.com
I would strongly recommend that you take the time to visit the software sites of the vendors that Iâ€™ve listed above and read about their software. Several companies allow demos that will give you the opportunity to practice and evaluate the software. Other companies will only sell you the software. Some have maintenance fees, upgrade fees, charges for technical support and other â€œhidden costs.â€
Features you would want to have in software regardless of cost.
– An easy to learn interface.Â You shouldnâ€™t have to be a computer programmer to understand how to use the software.
– The Software of choice has been thoroughly tested and is free of bugs and flaws.
– Technical support is readily available and the personnel are knowledgeable, friendly and able to immediately address your concern/problem.
– Software must be easily upgraded with little effort on your part. (The corollary is that software is regularly updated as quality improvement is an ongoing process).
– Software must be stable and robust.Â For example, even if your software corrupts due to a malfunction of your computer, power failure or software crash, your data is never compromised.
– Flexibility- Your software has all the services you need built in, e.g. email, note taking, HIPPA compliance, forms, patient billing,data input, CPT codes, DSM diagnostic codes, credit card processing, report functions, batch preparation, and batch download information from the clearinghouses, custom forms (to name a few features).
There is fairly unsophisticated software available for billing that simply fills in the CMS 1500 form. Â This type of software is limited to little more than form completion.Â On the other side of the spectrum, the most sophisticated of the software out there not only produces billing for your clients, but also bills all of your insurance companies in a single batch. In addition the better software has the ability to take credit card payments, checks, send letters, and keep your billing and insurance payments organized.Â Calendars that allow you to enter the office visit and payment if made by the client are also included that automatically set up the insurance billing, etc.Â Basically, the best software makes for an easier task in billing, note taking and insurance reimbursement processing.
I can tell you from my experience that I could not efficiently run my practice without the benefit of quality software that is supported by exemplary technical support.Â I can effectively run my entire month of patient and insurance billing (multiple companies) in about 1 hour.
While it would be inappropriate for me to recommend a single software product or service over another in this article, if you contact me directly, I can talk to you about the software I use and believe to be the best choice of the lot.
Depending on the complexity of your practice and your level of expertise and interest in using the computer, the solution to billing insurance companies and patients comes down to individual preference.Â At the end of the day we all want to spend as little time as possible in pursuit of reimbursement.
By A. Scott Greer, Ph.D.
Chair of Academic Programs