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One of the biggest decisions therapists face when building a private practice is whether to accept insurance.

There are good reasons to do it. Insurance can help bring new patients through the door, make therapy more affordable, and provide a relatively steady stream of referrals. But it also comes with tradeoffs. Reimbursement rates may be lower than your private-pay fee, billing takes time, and insurance companies have their own rules and documentation requirements.

So, is accepting insurance the right move for your practice?

There isn’t a single answer that works for every therapist. Your decision should take into account the kind of practice you want to build, the patients you hope to serve, your specialty, your local market, and what you’re willing to take on from an administrative standpoint.

Why Therapists Choose to Accept Insurance

It Can Make It Easier to Build a Caseload

If you’re opening a practice or trying to fill an existing schedule, insurance can be a useful way to attract new patients.

Many people start their search by looking for providers who accept their insurance. Being in-network with several commonly used plans can put your practice in front of people who may never have found you otherwise.

This can be particularly helpful early on, when building a steady caseload is often the biggest challenge.

It Makes Treatment More Accessible

For many patients, the cost of therapy is a major consideration.

Someone who can’t comfortably afford a $175 or $200 private-pay session may be able to manage a much smaller copay or coinsurance amount. Insurance participation can therefore make ongoing treatment possible for people who might otherwise have to go without care.

For therapists who place a high value on accessibility, this can be an important reason to participate with insurance.

It May Help Keep Your Schedule Consistent

A practice doesn’t necessarily have to rely entirely on referrals, networking, or marketing to generate new patients.

Insurance directories and payer referrals can provide another source of potential clients. In areas where there is strong demand for behavioral health services, this can help a therapist maintain a fairly consistent schedule.

That predictability can be especially valuable when you’re trying to grow a practice and establish reliable revenue.

The Tradeoffs of Accepting Insurance

Of course, insurance isn’t without its drawbacks.

Reimbursement May Be Lower Than Your Private-Pay Rate

This is usually the first concern therapists have, and for good reason.

An insurance company may reimburse considerably less than what you would charge a private-pay patient for the same service. The difference can become significant over the course of a year.

That’s why it’s important to look at actual reimbursement rates before joining a network. A full schedule isn’t necessarily a profitable schedule if the reimbursement doesn’t support the time and overhead involved in providing care.

Rates can also vary depending on the payer, plan, CPT code, specialty, and geographic market.

Billing Adds Administrative Work

Insurance billing isn’t simply a matter of sending in a claim and waiting for a check.

There may be eligibility checks, authorizations, claim corrections, denials, payment posting, credentialing, insurance correspondence, and follow-up on unpaid claims. Someone also has to keep track of patient balances and explain insurance-related issues when questions arise.

Some therapists handle these tasks themselves. Others hire a biller or outsource the work.

Either way, the administrative side of insurance needs to be factored into the economics of your practice.

Payers Have Their Own Rules

Insurance participation can also affect how you manage the clinical side of your practice.

Depending on the payer and the patient’s plan, you may have requirements involving documentation, treatment plans, medical necessity, authorizations, coding, and other aspects of care.

None of this necessarily makes insurance a bad choice. But you should understand what you’re agreeing to before signing a contract.

You Don’t Have to Choose One Extreme

It’s easy to think of the decision as either accepting insurance or becoming a completely private-pay practice.

In reality, there is another option: a hybrid model.

A therapist might participate with two or three insurance plans while remaining out-of-network with others. The plans you choose could be the ones that offer reasonable reimbursement, have a patient population that fits your practice, and aren’t excessively difficult to work with.

This approach can give you some of the benefits of insurance while allowing you to maintain more control over your schedule, fees, and overall practice model.

For some therapists, this middle ground makes the most sense.

Questions to Ask Before You Decide

Rather than asking whether insurance is “good” or “bad,” start by looking at what you actually want from your practice.

How quickly do you need to build your caseload?

If you’re starting from scratch and need patients quickly, accepting insurance may give you an advantage.

Who do you want to serve?

If your goal is to make treatment available to a broad range of patients, insurance participation may be an important part of that strategy.

What does your local market look like?

The answer can be very different depending on where you practice. In some markets, patients have dozens of therapists to choose from. In others, there may be enough demand for a particular specialty that a therapist can maintain a full caseload without accepting insurance.

What are the actual reimbursement rates?

Don’t assume that all insurance companies pay roughly the same amount. They don’t.

Look at the rates for the services you expect to provide and compare them with your expenses, desired income, and the amount of time involved in treating and billing each patient.

How much administrative work are you willing to take on?

If you’d prefer to spend your time almost entirely on clinical work, insurance may be less appealing unless you have someone else managing the billing and administrative responsibilities.

Would you rather see more patients at a lower reimbursement rate or fewer patients at a higher private-pay rate?

There isn’t a universally correct answer. It depends on the kind of practice you want and what makes sense financially for you.

Don’t Look at Reimbursement Rates in Isolation

It’s tempting to compare insurance plans based solely on the fee schedule.

That can be a mistake.

A plan with slightly lower reimbursement might still be worthwhile if it has a large patient base, sends consistent referrals, and pays claims reliably. On the other hand, a plan with a higher reimbursement rate may become much less attractive if claims are frequently denied or the administrative requirements consume a significant amount of your time.

Think about the whole relationship.

Consider reimbursement, potential patient volume, payment reliability, administrative requirements, and whether the people covered by the plan are actually the patients you want to serve.

The numbers matter, but so does everything that happens around those numbers.

So, Should You Take Insurance?

For some therapists, the answer will be yes. Insurance can be an effective way to build a busy practice while making therapy more accessible to patients.

For others, a private-pay model may be a better fit. It can offer more control over fees and scheduling, reduce insurance-related administrative work, and potentially produce more revenue per appointment.

And there are plenty of therapists for whom a combination of the two makes the most sense.

The important thing is not to accept insurance simply because it seems like the thing you’re supposed to do.

Take a close look at the numbers and the practical realities before signing a participation agreement. Understand the reimbursement rates, contract requirements, administrative workload, and patient population associated with each plan.

Most importantly, think about the practice you actually want to build.

The right insurance strategy isn’t necessarily the one that fills your schedule the fastest. It’s the one that supports your financial goals, your preferred way of practicing, and the patients you want to serve.

A Note from Psychiatric Billing Associates

Psychiatric Billing Associates works with behavioral health practices that participate with insurance and helps manage the administrative side of the revenue cycle. Services can include eligibility verification, claims processing, payment posting, and insurance follow-up.

If you’re considering joining an insurance network, understanding the financial and administrative implications beforehand can help you make a more informed decision—and avoid committing to an arrangement that doesn’t make sense for your practice.

The answer is sometimes—but it is important to understand what “under supervision” actually means.

One of the questions we hear most often from group practices is whether they can bill an insurance company for services provided by a therapist who is either provisionally licensed or not credentialed with the insurance plan. Those are two very different situations, and the answer can depend on the therapist’s license, state law, the insurance company, and the practice’s contract with that payer.

Clinical Supervision and Insurance Billing Are Not the Same Thing

Many therapists are required to work under clinical supervision while they are completing the requirements for independent licensure. Depending on the state, these clinicians may hold titles such as associate, intern, limited licensee, or another type of provisional credential.

State law may allow that therapist to provide psychotherapy under the supervision of a fully licensed clinician. That does not, however, automatically mean an insurance company will pay for the service.

Each payer has its own rules about whether it recognizes provisionally licensed clinicians, how they must be reported on a claim, whether the supervising clinician must be credentialed, and how the service will be reimbursed.

In other words, being legally allowed to provide therapy is only one part of the equation.

Billing for Provisionally Licensed Therapists

Some insurance companies do allow practices to bill for services provided by certain provisionally licensed therapists. When they do, the payer may have very specific requirements.

For example, the payer may specify:

The type of provisional license the therapist must hold
Who may provide supervision
Whether the supervisor must be credentialed with the plan
How the therapist and supervisor should be reported on the claim
Whether a modifier is required
Whether the service is reimbursed at the in-network or out-of-network rate

Some plans will reimburse these services. Others will not.

The fact that a therapist is receiving supervision does not, by itself, establish that the service is covered. Before billing, the practice should confirm that the particular payer recognizes that type of provisional license and allows the service to be billed under its supervision rules.

What About a Fully Licensed Therapist Who Isn’t Credentialed?

This is where practices can run into trouble.

A fully licensed therapist who can practice independently but is not credentialed with a particular insurance company is not in the same position as a provisionally licensed therapist who is legally required to receive supervision.

The issue isn’t clinical supervision. The issue is network participation.

You generally cannot take a fully licensed, non-credentialed therapist and bill the services under another provider’s credentials simply because that provider is credentialed with the insurance company. If the therapist actually performed the service, the claim must be submitted in accordance with the payer’s rules regarding the provider who rendered that service.

Having a clinical supervisor does not automatically give an independently licensed therapist access to that supervisor’s insurance contracts or in-network status.

Why This Matters

Using one provider’s credentials to obtain reimbursement for services performed by someone else can create problems with the insurance company.

Depending on the circumstances, the payer may deny or reprocess the claim, request records, audit the practice, or seek repayment of claims that were paid incorrectly.

For that reason, practices should be careful about using the phrase “billing under supervision.” It is not a universal billing method that can be used whenever a therapist is not credentialed with an insurance company.

Don’t Assume a Payer Allows Supervised Billing

Before submitting claims for a provisionally licensed therapist, we recommend contacting the payer and asking some very specific questions:

Does the plan reimburse services provided by this type of provisionally licensed therapist?
Does the plan allow those services to be billed under a supervising provider?
How should the rendering provider and supervising provider be reported on the claim?
Does the supervising provider need to be credentialed with the plan?
Is there a modifier or other billing requirement?
Will the claim be paid at the in-network or out-of-network rate?

Whenever possible, get the answer in writing and keep it with your payer documentation.

UnitedHealthcare/Optum is one example of why practices should not make assumptions. Its rules regarding billing for services performed under supervision are limited and may vary by state and by the terms of the provider’s contract. Simply having a credentialed supervisor does not necessarily mean that services provided by another therapist can be billed under that provider’s name or network participation.

The Bottom Line

There are really three separate questions:

Is the therapist legally allowed to provide the service?

Does the insurance company reimburse services provided by that type of clinician?

Does the claim accurately reflect the provider who performed the service and meet the payer’s billing requirements?

A “yes” to the first question does not automatically mean the answer to the other two is also yes.

For practices employing provisionally licensed therapists, understanding the rules before claims are submitted can help prevent denials, recoupments, and more significant billing problems later.

How Psychiatric Billing Associates Can Help

Psychiatric Billing Associates works with behavioral health group practices to help identify payer requirements affecting the billing of services provided by provisionally licensed therapists and other clinicians.

Because the rules can vary by state, license type, insurance plan, and provider contract, it is important to verify the requirements that apply to your specific practice before assuming that a service can be billed “under supervision.”

Do Insurance Companies Cover Teletherapy?

The internet has had a huge impact on how patients seek health and medical care. These days, a growing number of people are accessing mental health professionals via teletherapy. This allows patients to meet with their doctors using a live communication service.

Teletherapy is convenient and flexible, and it provides access to mental health care for those patients who live in areas where there is a shortage of practices.

The problem is that most insurance companies have yet to catch up with this new form of providing care. This means that for psychologists, psychiatrists, and therapists, it’s a toss-up as to whether or not insurance companies will reimburse the cost of teletherapy sessions. Despite the growing popularity of teletherapy, there are still many insurance providers that will potentially deny claims that are submitted for these services.

In some instances, a patient can choose to submit their own claim, which means that they have to pay for services out of pocket. To make matters worse, there have been recent changes in CPT billing codes, which makes it harder for patients to correctly submit claims to be reimbursed for teletherapy services.

For more than a decade, telehealth services have been reimbursed by Medicaid and Medicare. The good news is that the Affordable Care Act has accelerated telehealth parity, which means that a growing number of health plans are following suit. This is in part of the ACA making healthcare more affordable and accessible for patients.

Coverage Is On a State-by-State Basis

At the same time, even though coverage is becoming more widespread, blanket coverage isn’t available. It’s important to note that most plans will only reimburse teletherapy in certain situations. For example, a patient may need to be located in a rural area where there is no mental health care provider within a certain number of miles. This means that an insurance company may offer teletherapy coverage in one state but not in another.

What Mental Health Professionals Need to Know

In the event that the patient’s insurance company does not cover the cost of teletherapy, they may be willing to pay out of pocket. Many patients are willing to pay for the flexibility and convenience that telehealth services offer, especially when it comes to mental health. People often feel safer speaking about their mental health from the comfort of their own home.

But before you decide to offer HIPAA-compliant teletherapy, there are many things you’ll need to do in order to protect yourself and your patients. Some of the steps to take include:

Checking with insurance companies that you work with to see if they offer reimbursements
Confirming with your billing service to determine billing codes
Confirming the rates in which you would be paid

The most important thing to do is to ensure that your teletherapy sessions are HIPAA compliant. There are more than fifty teleconferencing and video services that have been determined to be HIPAA compliant. Choose a platform that is easy to use so that you can get started offering mental health care for patients.

Need assistance filing claims, resolving rejections, or claims processing? If so, contact Psychiatric Billing Associates at 800-650-6334, extension 947.

Benefits of Using Psychiatric Billing Services

Whether you are starting your own practice or have been in practice for years, there are several benefits of outsourcing your psychiatric billing to a qualified billing service like Psychiatric Billing Associates. In recent years, there have been changes to cpt diagnostic codes, billing processes, billing forms, and the complexity required when submitting claims. In addition, further reforms and changes are expected in the future.

Access to expertise and specialized mental health billing skills. Billing services that specialize in only mental health billing ensure claims are completed accurately and correctly the first time. They understand correct coding, and are familiar with the third party and managed care companies that handle mental health reimbursement. Billing expertise is especially important when filing claims for neuropsych, academic testing, ECT, EAP and Hospital based services.
A reduction to your practice’s operating costs. You do not have to waste precious time recruiting, hiring, and training staff to perform billing operations, nor investing in the latest billing software applications. An experienced billing service takes care of recruiting the best employees and software, resulting in paying less in the long run for collecting your payments for services rendered.
Fewer headaches and more control over your practice. By outsourcing your billing, you do not have to deal with the red tape, rejections, complications, and other stressful aspects of billing procedures. Rather, you are freed up to concentrate on the needs of your patients, providing them higher quality of care.
Eliminates having to learn the complexities of medical billing. Even if you do not perform your own billing directly, you do not have to worry about whether your staff is spending sufficient time staying on top of the latest updates and changes.
Always know what medical billing codes are relevant for your services and treatments. Medical billing codes are constantly being updated, changed, and even deleted. Your billing service will keep you informed of these changes and help you determine which codes are the most appropriate to use for your practice to reduce the number of rejected claims.
Quicker reimbursement times. Mental health billing services submit claims on a timely basis, deal with resolving rejected claims quickly, and other such issues, so you can get paid faster and improve cash flow. They will also submit as many claims electronically to providers, who accept electronic claim submissions, thereby decreasing claims processing times.
Affordable rates. Qualified billing services will only charge a percentage of the amount of money they actually collect, not the total amount billed. As a result, they work harder to help increase your collections rate. Not only does this mean they will earn more, but also helps increase your revenues and cash flowing into your practice. With the increase in revenues and decrease in overall operational costs, most practices can easily justify the billing service fees.

To discover how Psychiatric Billing Associates can help your mental health practice, contact us today by calling 800-650-6334, extension 24. We offer customizable solutions and provide the assistance you need with claims, processing, collections, and more.

How to Negotiate Fee Increases with Insurance Companies

Physicians are often unaware they can consider negotiating reimbursement rates with insurance companies. After all, health care providers and their networks play an important role in the insurance business. There may be times reviewing your existing contract helps, such as when there are changes or updates to CPT, diagnostic, and behavioral health billing codes.

In doing so, you could find opportunities to renegotiate a contract with an insurance provider. Depending on the practice, the reimbursement rates may differ, even for similar types of treatments and services. This can result in being reimbursed less than other practices, which negotiated their original contract differently. A thorough review can also reveal outdated codes that are no longer accepted and which should be updated.

If you’re not satisfied with your insurance provider’s reimbursement fees, these tips for negotiating rates with insurance companies can help:

Understand Your Role in the Network

The more you understand how your practice fits in, the more negotiating power you may have. You’ll also need to prove you’re an asset to the network. Cost savings is one way you can stand out. Be prepared to bring numbers and figures to the negotiating table. Desirable factors include providing specialties scarce in your area, having favorable clinical outcomes, and employing a nurse practitioner who provides less acute care at lower rates.

Gather Your Data

To negotiate a better reimbursement rate, first you need data to back up your reasoning. First, list your most common CPT codes and their frequency; this reveals how often you provide a particular service over a specified period of time. Billing software can generate reports automatically to avoid time-consuming manual processes.

Next, identify your top payers, reimbursement for each code, and fees for each one. Then organize all the data into a chart or spreadsheet for analysis. Codes with higher volumes and dollar values will yield the most return, so focus your efforts here first. Another negotiating point can target health plans with lower rates or codes that are paid at a much lower percentage of Medicare than others.

Negotiate Individual Fees

Your data analyses can reveal individual services you can try to negotiate fees for. Payers generally don’t grant fee increases across the board, but you can deliver your argument targeting specific services to the health plan’s provider relations representative, who can forward it to a network manager or contracting manager. For a new procedure or one that’s not well-defined, a medical director can support a payment increase request for its respective code (although they’re typically not responsible for negotiating rates).

Whenever any contract changes or proposals are made, read the plan and its addendums or attachments carefully before signing it. The changes shouldn’t, for example, conflict with malpractice coverage. If anything is unclear, have a legal consultant review the contract.

Psychiatric Billing Associates can help if you need assistance with claims processing, collections, patient billing, or financial reporting for your mental health practice. To learn more about how we can help, call us at 800-650-6334 extension 947 today.