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Medical bill generator for Administration

so hello everybody welcome i'm kim tolson i'm a licensed clinical social worker and i have my own online private practice so let me go ahead and flip here i want to tell you a little bit about me so this is the traveling therapist and the insurance billing expert so in addition to having my private practice i also travel the world as a digital nomad covet slowed me down a little bit but i do have a practice of about 15 clients right now i do travel the world and i also teach insurance billing to therapists and now to vas so i just want to tell you a little bit more about all of that i used to have billers doing all of my billing and they took about nine percent of every claim that they filed for me and i really didn't mind paying it because it was a relief to not have to worry about that part of my business but eventually i realized that they were not collecting the money i was owed from my clients they weren't telling me the correct copays and deductible amounts that the clients were supposed to be paying me so i wasn't collecting the right amounts i didn't even know that they were billing lower codes for some of my services i was losing a lot of money that way with mental health billing sometimes you need authorization for certain codes so this billing company instead of going and getting the authorizations for the higher paying codes they just weren't doing it and they were billing the lower codes i had no idea until you know later when i started taking over my own billing i realized that they were doing that too so needless to say i was losing a lot of money after some investigation with the billers i was actually staring at a 10 year old 12 000 back balance report that was really the final straw for me when i saw that report i just could not believe it uh 12 000 was a lot of money i had to learn how to build insurance on my own after that i spent a lot of time trying to figure out insurance first it was for my brick and mortar office because i was still in my office back then and then it was for my all online therapy practice when i decided to become a digital nomad so through trial and error i learned pretty much everything you need to know about implementing insurance billing in your private practice i've developed courses and a membership to help therapists become empowered and educated to do their own billing i've coached over 450 therapists to do their own billing to this point since 2018. so now they've been grateful to learn and they've saved a ton of money but what i keep hearing over and over now is kim now that i know what i'm doing i need a trusted va or admin assistant to do it for me because i just don't have the time i now know what to look for but i need to scale up my business i need to hire someone who knows what they're doing someone i can trust and someone i know will get me paid quickly and efficiently so that's where you guys come in i've become really passionate about training vas and admins to do the billing the right way so i get asked maybe five times a day to recommend a va or an admin assistant that can take over the billing for my students or just even people that realize i'm you know teaching about insurance billing they'll reach out to me and ask me this question so let me go ahead and go to the next slide here let's see so the number one question i get asked by vas is do i need to be certified to be a biller so right now there are no regulatory standards requiring certification at this time for people to do billing with the insurance companies you will want to establish a business entity and have liability insurance to protect yourself but you do not need to be certified to be a biller as far as billing goes anyone can do it i do my own billing and you can do it too for therapists if that's what you want to do there's no restrictions on this once you learn the fundamentals about insurance billing particularly for mental health it's really just rinse and repeat after that so you just um you know once you learn it you you've got it and it's not really going to change much from there there's like some core principles that you need to learn in the beginning and then after that it's pretty easy to do it there are a few things that come up from time to time but it's all fixable stuff it's all stuff that you can go in and resubmit claims for or find a new system to make sure that it doesn't keep happening so i've created a free facebook group with over 7 000 therapists va's and billers in addition i created a membership community that offers the support of myself and an expert biller each month and a va to help with systems in within the membership so now for you guys if some of you do want to get certified in billing if you do think that you know what i'm hearing you kim i don't need to be certified but i think it would be better for my career to actually have the certification that i would direct you to go towards the aapc.com that stands for advancing the business of healthcare and they will certify you in behavioral health billing there's some other ones out there but that's the best that i found and that would probably be where i would recommend for you to go if you want to do that but hear me loud and clear you do not need to be certified in this to to do this let me go ahead to the next slide let's see here okay there we go okay so next what are the reasons therapists want va's admins to bill for them a lot of va's will say kim if you're doing it yourself what does the therapist need me for but let me let me tell you a lot of therapists need this the following reasons are really important for therapists and also will give you insight into your own marketing as a va biller so this will help in your marketing like knowing these core things that therapists are looking for one time so many therapists see 20 to 30 clients a week sometimes more they don't want to think about calling the insurance company and checking benefits or following up on claim denials the next thing is confusion so we are not trained in graduate school to build insurance at all in fact in graduate school they pretty much teach us to go work for an agency and not even worry about that stuff it's a confusing topic for a lot of therapists they just don't understand the fundamentals of billing so it can be really confusing for them and the next thing is they don't want to learn something new so therapists are required to earn ceus uh which are clinical education units for learning every year we have to do that to keep our licenses active for me as an lcsw i have to have what is it 30 every two years so it's a lot to keep up with the active learning that you have to do as a therapist to keep your license and it's hard for therapists with full caseloads and trying to get ceus to find the time to learn billing when we already have to focus on ceus and just kind of keep it up with our clients next it's too complicated for therapists usually many therapists believe billing is just too complicated for them it reminds them of math you know and most therapists are not good at math so when they when they even think about it it just feels close to like statistics and math and they run for the hills so that's another reason um lastly and most importantly they want a trusted person so literally almost every day someone messages me with this biller horror story and they're panicking and they say they need my help to sort it out and they just really need people who know what they're doing and will do a good job for them that's where you guys come in okay so let me go ahead to the next slide here let's see okay so next this is a really long topic i don't want to get into it too much but i did want to touch on it just so you know protecting yourself if you're getting into this field so i uh like i said i don't want to spend too much time on this but i felt it was worth mentioning just a brief overview hipaa stands for health insurance portability and accountability act hipaa includes many new rules that healthcare organizations must follow to ensure the privacy of patients is being protected it's sensitive data and it's kept secure at all times and you as a biller working with that information needs to know how to keep protected because if you violate hipaa it could open up a lawsuit for you or your therapist that you're billing for a lot of problems could happen because of that so you're going to be want to be really well versed in that before you get into this niche with mental health billing or any medical billing really you need to know about hipaa and how to keep patient information secure at all times if you're going to work with any providers that must protect client information you'll need to know about this so let's see next you'll want to have great policies in place to ensure healthy boundaries with your clients so you're going to want to decide your your billing standards like how far do you want to go do you want to be a biller that calls and checks insurance benefits for the therapist that's something you're going to have to decide up front because that is one thing that is a little bit time consuming it could involve being on hold and some billers don't do it some billers say hey that's the responsibility of my clinician and they'll give me the information and i'll go from there the claim gets denied against tonight other pillars and this is how i would recommend you do it do you take on that responsibility because that's really what starts the whole process so if you find out the client's benefits up front 98 of claim issues are going to be resolved right there you're going to find out if the policy is active you're going to find out what the policy covers you're going to find out what the copay is the deductible all of that so it gives you a little bit more control but i just want to use that as one example because there's so many examples around this that you're going to have to make decisions around and make sure you have it in your paperwork what you will and won't do as a biller my course covers probably about 50 different that you could do for mental health clinicians and it gives you an opportunity to look and see uh you know what i want to offer and not offer as far as the billing goes or just like trying to help a clinician run their online practice so lastly you'll want to obtain liability insurance for your business like just the basics of starting your own business you do want to get liability insurance because what if a clinician says oh my gosh this claim's denied i'm going to sue you because these claims are denied you know you're going to want to have insurance around that hopefully you're going to have great processes in place so you can explain why it was denied and that's an extreme example but i just wanted to point that out any business you have you need to have liability insurance in your business let's see let me go to the next slide here okay so i want to touch on understanding the basics of mental health billing so i want to briefly cover some common concepts in behavioral health billing i want to give you a brief overview of some of the lingo that is very common in this mental health billy field so the first is cpt codes cpt code stands for current procedural terminology cpt codes and are their numbers basically they are assigned to every task in service a medical health care provider may provide to a patient including medical surgical diagnostic services mental health psychiatric services all of that they're used by insurance companies to determine the amount of reimbursement that a health care provider will receive by an insurer for that service so cpt codes are the core of insurance filling you're going to need to know these codes and luckily with mental health there's about you know 15 cpt codes that are really important and once you get those that's pretty much it you pretty much got it at that point so that's the good news and that's what i was talking about the rinse and repeat almost all clinicians are going to be billing the same codes and you're going to get used to it really quickly which which each of those codes are the next that i want to tell you about are icd-10 codes so icd icd-10 codes are alphanumeric codes used by doctors therapists public health agencies all over the globe to represent different diagnoses so every disease every injury every symptom it all has their own icd-10 code connected to it so this is how a clinician would diagnose a client basically we would say excuse me we would say you know this client looks like they've got generalized anxiety disorder and we go and get the code and we're going to provide that code to our biller and the biller is going to put that on the claim form so the insurance company knows what the diagnosis code is what's being treated by this clinician so icd-10 codes are used for for everything from processing health insurance claims to tracking disease epidemics compiling statistics around the world all the health insurance portability and accountability act or hipaa as we were talking about before covered organizations must comply with the icd-10 codes and this is instructed by the u.s department of health and human services so that's a brief brief summary and there are some very common ict 10 codes that mental health clinicians use on a regular basis and you'll get really used to those as well the next thing i want to tell you about is the hicfa 1500 form so this is the claim form it stands for health care finance administration form that's the hikva hcfa so this form is used to document medical procedures in essence it's a claims form that the medical professional or the medical office completes and submits to the health insurance company it's important that this form is completed with as much detail as possible to maximize the likelihood of the health insurance company approving it and paying for the claim so of course i can't get into this but they're every every block on the hickory forum i think there's 33 boxes that each box means something different you're going to need to know exactly what each box stands for because let's say let's say you need to resubmit a claim because the clinician made an error and said oh my gosh i put the wrong diagnosis and you need to go resubmit the claims there's a box for that you would go you would edit the claim you would use the resubmission box you'd click that you'd enter the old claim number and you'd resubmit it to the insurance company so each box on that form means something and of course i can't go over it all today but it there's a lot to it but once you get that and you know what each box means you're good to go with that as well the next thing i want to tell you about is co-pays so a co-pay is a fixed out-of-pocket amount paid by an insurer for covered services it's a standard part of many health insurance plans insurance providers they often charge co-pays for services because that's what the insurance plan requires so it'll be the service is a hundred dollars but your co-pay is 25 so you have to pay 25 for this service so that's how co-pays work you guys probably know about those with your own insurance plans they are specified to a dollar amount usually rather than a percentage but sometimes their percentages usually it's like something like that so i hope that explains co-pays a little bit the next thing you're going to want to know about are deductibles and deductibles are the amount you pay for covered health care services before your insurance plan starts to pay so for example my insurance pilot my personal insurance policy i pay like 450 a month which is really high it's terrible i have like a 6 000 deductible so i'm paying my premium am i and and i've got this deductible so my health insurance benefits even though i'm paying a premium each month does not kick in and cover um my services until i meet that deductible so this is another really important thing that you're going to want to know about when you're calling and checking insurance benefits for the clinicians and for their clients the last one i just want to touch on is co-insurance this is another benefit issue that you're going to learn about when you call to check benefits coinsurance sometimes is also part of the plan and that's the percentage of cost of a covered health care service and you would pay like for example that's like a 20 coinsurance after the person's met their deductible so usually when there's a deductible there could be a coinsurance that then comes in and sometimes there's a deductible coinsurance and a copay so it could get a little complicated but again i've got formulas for all that written out for you in the course but i just wanted you guys to know those little beginner like lingo that goes along with mental health billing to get you started if this is the direction you want to take your career so let's see let me go over here and let's see let me go to the next slide here oh let me okay so this next slide so for for vas what you really need to know is what do therapists want to know from you if you're doing their billing basically they want you to do all of it behind the scenes but they are going to need to know benefits and coverage information because as i was saying in the beginning we almost always are collecting that from our client at the end of the session some therapists build at the beginning so if it's a 25 copay we're going to need to know that upfront so you're going to have to develop a system to get the client's information and then call and check benefits and then relay that information back to the therapist you're going to need to know that process you're going to have to get the benefit somehow you're going to have to call and check you're going to have to relay that information to either the client or the therapist the therapist is going to need to know what to bill before or after the session next if they are a telehealth therapist they are going to need you to call and check and make sure telehealth is covered telehealth is you know it's it's pretty prominent right now because of cova and the pandemic but before that pre-pandemic some of the insurance companies did not cover telehealth and a lot of us that have just online telehealth practices are concerned about that that it's going to go away after the the pandemic is over whenever that is but you're going to need to check that every single time you call that a policy is telehealth covered and there's a lot of nuances to that i don't have time to go into it today but you're definitely going to want to know that up front if your therapist is working via telehealth like through video and not in person in the office so it's going to be real important to know that the other thing the therapist is going to want to know is how much do you need to collect from the client like i was saying before basically we need to know that stuff but we don't collect it up front or at the time of the session we might not ever get paid so you know the client might not come back their credit card on file might expire you know there's all kinds of things that could happen so we really want to know that up front be able to collect that from the client at the time of service if we can especially if it's a deductible if it's a deductible you know us as the clinicians we're going to need to collect the entire contracted rate up front from the client so if the insurance company pays us 150 dollars for a session the client has a 160 or 1600 deductible that hasn't been met yet we're going to need to collect 150 from the client before the insurance is going to start paying us so the clinician is really going to want to know that upfront so i just want to emphasize that those are the really the important things you're going to have to know and have a system to give back to the clinician so they know what's going on with each and every client okay so let me go on to the next slide let's see okay so this slide let's see how much can i make doing mental health billing so this really depends on the model that you want to follow so you can bill by a percentage of each claim that is submitted and paid to the clinician you can bill on a monthly fee where you could say hey for you know 250 a month i'll do all your claims and i'll take care of it or you can do it by hours spent billing so the decision's up to you what you want to do most therapists really want a biller to charge a percentage of each claim that they've collected and gotten paid for usually um that percentage is between 4 to 12 i've seen that range of what billers bill mine were billing nine percent of each claim that they actually got paid on and let's see how much i paid them i saw about 30 to 40 clients a week and i paid them about 1200 a month and now that i'm doing my own billing i see that that was like a great deal for them and i'm telling you that so you know that that's probably a great deal for you because it takes me about 30 minutes a week to do my insurance billing and that's it i rarely have problems with it but there's the occasional thing that comes up but it's just like really rare that anything happens and that's probably going to be your experience too so once i figured that out i was like oh my gosh that was a lot of money i was spending um but it was good to have them for some things too because they could follow up when there were problems and now i have to deal with that myself so um you know that's just an estimate for you if you're charging around nine percent the clinician sees 30 clients a week you're probably going to make about 1200 a month off of that clinician and if you have you know 10 clinicians you could make you could actually make a ton of money doing it on a percentage basis so that's what i would recommend and probably what most clinicians are going to expect if they hire you let's see what else i don't want to tell you guys about this so also i just wanted to mention like on top of like the claims that are paid you can choose to charge for other services so in my course i detail a lot of different services that you can add on like packages so you could charge you know percentage of the claims but then you could say well you know i also charge 200 a month to do insurance verifications which is what i was talking about before we actually called the insurance information and get all of the clients insurance information up front so you could say you know i take a percentage of the claims but i also charge a flat 200 a month to to call and check these benefits you'll have to figure out how much you want to charge for stuff like that but i've listed like i said about like 50 different services you can offer the clinicians really need and you can up charge for all that stuff you can make additional packages i've seen a lot of billers do it that way so you know it this is a lucrative business if you can get past that initial learning curve and then like i said it's really rinse and repeat and just figuring out you know what you want your systems to look like so okay let me go to the next slide here let's see okay um so i touched on this a little bit but i just want to talk about like smart systems to streamline the billing process for you so for any va that's going to be getting into this field i would recommend learning specific ehrs ehrs are electronic health records it's where clinicians keep all of their client information and do their insurance billing some of the most popular ehrs are simple practice the therapy notes they're a nest and that's just a couple that's the ones that most clinicians are using that i see there are some other ones and a lot of times once you learn that the big ones the other ones are pretty intuitive you'll probably be able to figure it out if you need to some mental health billers vas and admin assistants will specialize in a certain platform so simple practice i think simple practice is probably the most used ehr and maybe therapy notes those two are a tight run there for for which ones not more users i'm not really sure but those are the two that you went across the most um so in your practice you're probably going to want to specialize or or learn a couple of these you can start to develop a streamlined process you know once you figure out these hr's to check client benefits and then you enter them into the electronic health records that the clinician is using again this is all in my course and if you want i can give you a copy of my insurance verification form just put down in the comments below if you'd like one just give me your email address and i'll send you a copy of that insurance verification form because that that is key to all of this like you're going to need to know every single question to ask when you call the insurance company so i'm happy to share that with you guys just let me know if you need it if you want it another thing you're going to want to need to know about like systems is providing the clinician with the correct amount to collect from the client so i said this before but i just want to touch on it again you'll need to gather this information when you obtain the benefits for the clinician and that again is on that insurance benefits verification form that i said i would give you guys a view like a copy i would recommend choosing like one time a week or a you know at one time during the day to complete all the billing in bulk so a lot of billers will you know say oh i i file claims every day at five o'clock or the next morning i go through and file all the claims from the day before so you're going to want to just like set aside a block to do it you don't want to be like like every 20 minutes so here comes uh another clinician just finished a session let me go let me go bill for it right now it's it's smarter to put these systems in place where you're doing doing things in blocks it's a more effective way to get tasks done just in general but for billing i would recommend that so like i said set it cite a time each week for the billing set aside a time each week to follow up any denials that you might have any claim rejections that might come up and as i said before if you do a really thorough job up front you're not going to really run into those problems very often but i would still encourage you to set some time aside for that okay so let me go into the next one here so where can you learn mental health billing for mental health clinicians one is my free facebook group i do have a free facebook group it's got over 7000 members it's got billers vas therapists i'm in there you know we're all in there helping each other so that's a great place to start and i'll drop that link at the end of this presentation for you it's insurance billing for telehealth practitioners on facebook so you're welcome to go join that group and then a lot of the ehrs like simple practice for example they have tutorials on different topics so you know if you're like oh i don't know this this i did this insurance verification and now they want to know what is what is an op i need an authorization for this service or whatever i have no idea how to do that so a lot of times you can go like to simple practice or whichever ehr and look that up and they'll give you like a little tutorial on how to do that stuff so that's those are really important things to know and then let me go to this next slide and let's see here okay the other places to learn is one by mental health billing 101 for virtual assistants and admin assistants it's being released in a couple weeks i'm so excited about it i really put a lot of work into this i think you guys are going to love it and the other thing is my support community it's called bill like a boss so i touched on this in the beginning but i did develop a support community that is a supplement to my therapist billing course that i created and now we've got vas and billers in there as well so it's a nice mix in there the support community is myself uh expert biller that's been doing it for 20 30 years and we're in there 24 7 answering questions we have live meetings three times a month where you can jump in my zoom room live with us and we will help you through anything you've got going on also you can post you can post in the group anytime you've got anything going on so the billers are just like on standby i'm on standby if something comes up you don't know how to deal with it you just post it in there and we will help you or if it's complicated and you want to wait till the next live meeting with us we'll you know be having in the next week or so because it's we do it like on a rotating monthly basis so there's three meetings every month that are live so that's another way that you can get support and learn more about this tube you don't feel like you need the course you just need the membership for support we've got that we've also got the course and the membership together like in a lifetime package so there's lots of options for this and then as i was saying before the free facebook group is also a great resource so let me go over to this next slide here let's see okay so this is something else that a lot of va's asked me is how am i going to market myself so therapist facebook groups you can join those every one of those groups has like a promo day where you can you know enter your information and say hey i'm a biller you know if you need my help here's what i can offer um instagram accounts that allow marketing that sort of thing you can sign up for those you can ask to be on therapist podcast to share helpful tips about your services so if you go over to the app store or and look at all the podcasts there's like a million therapist podcast so you can look for ones that have got a lot of followers and you can you know scroll to the contact me and you can just put together a presentation like this and ask the person that's doing the podcast hey can i come on and tell your you know your listeners how to strategically check benefits or something like that so you can do that you can offer discovery calls and free audits of the clinicians current systems to help offer more effective ways to help in exchange for maybe a testimonial so hey hey i'll give you this audit for free if you think i do a good job and you want to work with me great or hey could you give me a testimonial and just say that you know it's a really thorough audit for you and you could post that on your website so that's another way and what is this other one i've got helpful and educational content via an email list or on a business page or account so this is you know writing blog posts on your website that when people google search certain terms they're going to find your information your blog it could be really helpful you can have an email sign up list where you're sending out helpful tips and tricks for organization and structure and billing tips and all of that you can send that out weekly or monthly or however often you want to do that and then the last thing i would recommend is something i'm also launching in the next couple weeks it's my virtual assistant flash biller directory there's no like comprehensive va slash biller directory out there that i've been able to find so i decided to make one and we are now currently accepting applications to be on that directory and you don't have to even be a mental health va you can be any kind of va because i get these questions all the time hey kim do you know anybody that does good copywriting or do you know anybody that can help me build my website or do you know anybody that can organize my files on my computer i mean i get all kinds of questions so we're going to have a lot of va categories on here and one of the categories is going to be mental health va billers because as i said before i get asked this all the time so if you want to be on the waitlist for that i will drop the link also in the comments and you can come join the va directory when it launches i think it's probably going to launch in about three or four weeks so i hope you guys will check that out as well and that's all i have i know that was a ton of information but i'm here if you have questions about anything if you need me to follow up on something i look forward to connecting with you if you want to get on the wait list for the course or the billers directory let me know i'm going to drop all the links so you have them i just want to say thank you for joining me today i think that this service is really needed for therapists and all the other services that i mentioned as i said i get questions all the time about who can i recommend so if you think this is a career path for you and you want to learn this i had this course i've poured my heart and soul into it um really because i do not want other therapists to get bad billers like i did so it's kind of my goal now to make sure i'm training vas to be good billers so therapists can do good work with their clients and so on and so on so that's really one of the big reasons that i even decided to make this course to begin with so anyway grab a spot on the early bird wait list we're gonna have bonuses and discounts if you sign up early on the wait list okay so thank you very much take care and i hope you guys have a great day