March 2012 - Newlsetter
Hi everyone. I can't believe the year is moving so quickly. I hope
your marketing and business plan is in place and you are marketing
away. It has been an informative week for me. I have been working
with various people on how to understand the financials of their
business; how much do you really make and what does it cost you
to make it? Also several conversations about insurance billing.
I am finding that some people are still not sure what they are legally
allowed to do, which insurance codes can be used and allowing clients
to run up large bills. I will go into more detail in the article
Workshop Dates & Online Support Group
Building A Successful Private Practice
Dates: March 31, 2012 or April 21, 2012
early registration discount.
Website for more information & to register for workshops
I take a three pronged approach to building a private practice.
You the therapist - how do you market, how do you keep your work
alive and who are you as a therapist.
Business - you are a small business owner are you aware of what
it takes to keep a business successful. Should you be on insurance
panels or not, how do you properly bill for insurance, what forms
should you be keeping, how do you manage bookkeeping and clients
whose accounts are in arrears.How do you set your fee and how do
you raise your fee. Do you have contracts with those you share space
with or how to lease office space. Just to name a few topics.
Marketing - how to market within your comfort zone and marketing
ethically. How to cut costs on advertising. How to create a website
that will generate referrals and cost very little to maintain. How
to create an online presence that is positive and generates referrals.
What I love about the workshops or consulting is I love talking
about business and marketing even more sharing it and watching others
become successful. The other thing I love about the groups is how
everyone jumps in to brainstorm and network with each other. I hope
you can attend.
Brief Thoughts On Insurance Billing & Understanding the Financials
Of Running a Small Business.
I know I have written about this before but what prompted me this
time was a post online asking if their client changes insurance
in the middle of treatment and they had been paying at the fee for
service rate and now their insurance is one where the therapist
is in-network , could they bill them for the remainder of their
fee for service charge? Then I was speaking with a group about how
are decisions made to purchase items or if they're marketing is
paying off. Lastly I was speaking with a therapist who because he
felt the insurance would not reimburse for a double session and
he did not know about the 90808 CPT code, split the session into
2 days, billing for a day he did not see the client.
To answer the question about billing the client for a fee for
service when you are a in-network provider: You should read the
contract you signed with the insurance or EAP company but a standard
contract says that you must charge all people who come into your
practice the agreed contracted rate, whether they use their insurance
or not. I have heard many stories of therapists having to repay
the insurance company if the client changes their mind and wants
to use their insurance. But regardless of that your contract says
you will charge the agreed fee.
Then came the question about seeing someone for a double session
or longer and the therapist felt the insurance company would not
pay for more so they added an extra day to the billing. This is
insurance fraud, you can only bill for days in which you meet with
the client. Knowing the insurance codes and how to bill can be quite
an art form.
Phone Sessions - I know there is a code for phone sessions but
have yet to have an insurance company acknowledge it. There is a
code for emergency phone sessions but if you are doing phone or
online therapy there is no code to bill insurance for. The clinical
hour codes are all for face to face contact.
90801 you can bill for the initial session and many times it will
reimburse at a higher rate.
90804 = 20 -30 minute face to face session
90806 = 45 -60 minute face to face session
90847 is for couples session.
Now here is a bit of trivia I did not know and learned in my accountants
office. And be sure I argued to the point that he pulled out the
IRS codes and showed me. I thought all therapy is a tax write off,
apparently marital/couples therapy is not.
A final comment about insurance billing, most insurance companies
first preference for claims submission is electronic claims. The
second choice is a HCFA or CMS-1500 forms and the last choice is
superbills or bills generated in non-standardized formats. The reason
is they prefer to scan all claims and self made forms require being
manually input. If you go electronic than you need to be HIPPA compliant.
The next best choice if you don't want to fall under the HIPPA codes
is to send in HCFA claim forms and the last is non-standardized
forms, though these slow down the return rate.
Regarding the financials: I know reading financial statements can
be confusing. Setting a budget is something I hate doing and I don't
always adhere to it. For my workshops I look at the cost of putting
the workshop on, flyers, ads, etc. and then look at what I brought
in as income. For my marketing I periodically look at what is worth
spending my money on and where am I losing money. I know for many
people the psychology today ads work, but for some reason for me
they never produced enough to make it cost effective. When I ask
people in my groups I hear the same thing, one person gets enough
referrals to make psychology today worth it others don't and this
is true for all the different ways of advertising, I don't mean
to single out psychology today. That's why it is important to use
as many marketing tools as you can and to try different ones from
time to time. But I digress, knowing how to evaluate the profit
and loss of your business is important. It helps you make the decisions
about how many hours you need or want to work, helps you make the
decision about setting your fee (which also includes your experience),
and helps you think about setting long term goals, things like retirement.
Many of us don't think about those things but as an independent
practitioner we are responsible for our own retirement funds. I
also like to think in terms of client hours, so if I want to purchase
something or go on vacation I will think oh, that massage is one
client hour, I can do that. I also have to think that if I go on
vacation I don't get paid, so that factors into what am I going
to come home to and what kind of money will be coming in to carry
me over for that vacation time. I usually like to leave on vacation
right after I have done my billing, because I know when I come back
there should be some checks to help me as well as my savings that
I put away so I can take vacations.
This is a small sample of what I cover in my workshops.
Thank you for all your support and if you know anyone who would
be interested please forward this on to them. If you go up to the
top you will see a link for events which takes you to my website
to check out the workshops I am offering.
Licia Ginne, LMFT
phone: 831 540-5567