Therapists are known for our incredible “people skills”. Our number skills? Maybe not so much. Even if you are fortunate enough to be great with numbers, you still might prefer to free yourself from the day-to-day responsibility of staying on top of patient billing so that you can focus on the actual therapy aspect of your private pay therapy practice. When I first started my practice, I did everything including the billing-- but I quickly found that by having a biller, I was able to find the time and energy to invest more in things like getting private pay clients and taking great care of the clients I already had. Like many therapists, I like working with clients on their therapy issues MUCH better than I like dealing with billing. Investing my time directly in the therapy visit rather than focusing my energy on the billing for each visit actually made me happier, and resulted in a better bottom line for my practice since the revenue I generated in just one private pay client visit was easily more than enough to pay for a week of billing services. It was a very simple choice for me: spend more time on billing paperwork and make less money; or spend less time on billing paperwork and actually make more money to further build my private pay therapy practice.
Clients loved my addition of a professional biller too, since we no longer had to discuss “admin stuff” like billing. It was easier for them to see me as the psychology expert I am rather than seeing me as their therapist and the “billing department”. Billers also help private pay clients to use their out of network benefits, which is actually difficult for many busy clients who are able to afford private pay. Although I’m out-of-network with insurance companies, many of my private pay clients have “Cadillac insurance policies” with great out of network benefits. The only snag is that the clients with executive positions and the great benefits that go with those positions are often too busy with their own professional obligations to get bogged down with a mountain of insurance paperwork to get reimbursements for therapy visits; so they don’t even factor in the insurance reimbursement when they evaluate your private pay fees. Making it a simple, seamless process for private pay therapy clients to get their out of network insurance benefits often cuts their out-of-pocket expense for sessions by 50-80%, which makes clients feel much more comfortable with a higher private pay therapy session fee than they would feel if they had to shoulder the entire burden themselves.
Although I'm now extremely happy with my biller, I must admit that I encountered several expensive, time consuming, and frankly heart-breaking lessons along the way to “biller heaven”. I’d like to share them with you so that you can avoid making the same mistakes I made. Here are some questions to ask as you interview billers for your private pay therapy practice:
1. Who owns my billing data; and would you be willing to work within my billing software account rather than yours?
Many billers will offer to “spare you the trouble” of setting up your own billing software and just manage your accounts from within their own master account at a billing software provider. While this may sound tempting in the short term, I advise you to make have YOUR OWN account so you can easily LOCK YOUR BILLER OUT and switch billers quickly and easily if there is ever a need for you to do so. This way, YOU OWN AND CONTROL THE DATA rather than being beholden to your biller. OfficeAlly is an excellent and FREE HIPAA-compliant billing software that lets you run credit cards, submit claims to insurance companies for patients to facilitate their out of network benefits, issue patient statements, and meets all other standard billing needs. You can set up OfficeAlly in about an hour.
2. Will you check benefits for my prospective private pay therapy patients? If yes, how often and how quickly?
Checking benefits is a great perk to offer your private pay client inquiries. When they ask how much your services cost, it helps to be able to tell them their estimated out of pocket cost which is going to be less than your full fee, if the client has out of network benefits (don't worry, you will still get your full private pay fee since the client's insurance company will pay the balance!). To be able to provide potential private pay theapy clients with this information, someone needs to look up benefits. This is sometimes as quick as punching some numbers into a website such as Availity.com, and sometimes requires a phone call to the insurance company. Either way, it helps to ask the biller about this while the biller is in “sales mode” trying to win your business. Many billers do not check benefits; or they say they check benefits but they actually take 1-2 days to complete a lookup, by which point your prospective private pay therapy client may have moved on. Best to set expectations early and while you have the leverage of “shopping” for a biller. Also find out if they’re willing to speak to your private pay therapy clients directly about benefits or if they’d rather relay it through you. I have found that demurring “talk to my biller” whenever questions about my fees arise is very liberating.
3. What are my exit options?
In an ideal world, you and your biller would stay “together forever and ever”. In the real world, this is unlikely. I’ve known many private pay therapists who unwittingly signed agreements where they had to pay a $2,000 early cancellation fee if they ended the billing relationship prior to a yearlong period of service. Many billers may try to argue for this by saying that they invest time and effort to “onboard you” and they need to make it worth their while. I advise you to push back. Tell them that you are also investing in them, and that you have every intention of remaining for many years if the relationship works well; but the idea that you must commit to a year of billing with someone before you even know how smooth the process will be is just not feasible for your business. I’ve been with my biller now for years, and we have a fantastic working relationship; but there was no way I could have felt certain of this before actually working with her (especially after some of the billing nightmares I encountered before finally finding her!). You may like the person who does the sales call with you, but the person actually handling your account is different, or the service is great at first but then worsens as they get other clients they are prioritizing over you, or any other myriad reasons why things might not work out quite as planned. Give yourself the power to walk away if you’re not satisfied.
4. How often can we have a regularly scheduled “check in call”?
Have a REGULARLY scheduled phone meeting with your biller, and be “on the same page” regarding past due accounts. I have a weekly phone meeting with my biller where we review any billing issues, including any therapy clients who are past due. You may not need to talk quite that frequently, but determine in advance of signing a contract how often you’ll have your regularly scheduled calls. Do NOT depend on your biller to just phone you up and tell you who is past due. A good biller will and should do this, but then again we all get busy and your biller may have an assistant who “forgot” to tell you. “Trust but verify” is your mantra here. It is EASY to run a 1-minute report in OfficeAlly or similar software that tells you a LIST of anyone whose bill is past due, and the total of your past due accounts; and to set the report to spotlight anyone who is more than 60 days past due. Having your standard past due numbers is incredibly helpful because you have an “early warning system” if the number starts creeping higher. It was also super helpful to me one particular time when starting with a new biller who tried to say it was “normal” to have “a certain amount” of past due accounts and she was “diligently working on them”. I was able to easily show her that the levels of past due accounts weren’t “normal” for MY practice because I had records of my normal past due figures. I know numbers are daunting, but this is ten minutes well spent: each week, run your past due report in OfficeAlly or wherever your billing records are; and have that report in front of you for your quick weekly call with your biller (or monthly or whatever you do-- monthly is a minimum). Figure 60 seconds to run the report, and 5-10 minutes for the call. Bonus points if you email the report to the biller before the call as a way to structure things.
5. Can we add into your contract that you will NOT work with any of my current or former employees for a certain period of time? If not, WHY NOT?
This might be shocking, but I actually once had a biller who contacted MY OWN EMPLOYEES behind my back to ask if she could do billing for them to help them jumpstart their own private pay therapy practices. The conflict of interest was obvious to everyone but her.
If you want more information on how to vet a biller, or referrals to billers, or if you have any other questions about how to succeed in private practice, please do join my on-demand video program here you can enjoy an information-rich community with smart private pay therapists like you and me! You will learn everything you need to know in order to attract, book, and retain more private pay therapy clients and build your private pay therapy practice. By the way: Even if you’re not planning to join my program, I may be able to provide you with a referral to a decent biller- feel free to ask me.