This book is designed to provide helpful insights into general billing practices for a successful third party billing system for the behavioral health practitioner and/or Group Practice. Strategies will be introduced on how to establish and maintain an effective billing system. Although some steps may not be advisable to the situation in some practices, this book will provide you the reference material needed to assist you in establishing your own third party billing system. It will provide information about setting up, maintaining and effectively operating a billing system both for the private for profit practitioner and the not for profit practices.
The use of third party reimbursement in a provider practice will differ from practice to practice and it will also differ from client to client. A provider practice may elect to accept assignment and treat clients on specific insurance panels or the provider may elect to only accept private pay clients. If a provider elects to only accept private pay it may be necessary for them to create an itemized receipt to provide the client with appropriate information that they can submit to their insurance. In some instances if a provider is not in network the client will not be reimbursed at all or the deductible will be so high it is not possible for the client to ever reach it. Either way it is important that the provider be well informed of the choices when establishing the Practice.
There is a need for the practice to be flexible where insurance/third party reimbursement is concerned. The very survival of the practice may rely on this flexibility. There will be some clients who prefer to pay full fee and will not use their insurance while others will not be able to afford therapy without using their insurance. It is good business to have a variety of pay sources that a practice receives reimbursement.
Three major factors come to mind when considering third party reimbursement, client eligibility, service eligibility and provider eligibility. All three factors have to come into play in order to receive third party reimbursement.
Who benefits from third party reimbursement? The client, the provider and generally it is beneficial to the community, and the insurance company also benefits. Now you say how can the insurance company benefit from reimbursement? It is a proven fact that many times a client seeks the care from their general practitioner for depression and anxiety that may manifest as physical aches and pains. In turn they run up bills for services that were not, entirely necessary in the diagnosis of the condition.
This is part of the Intro to my book to be published some time in the fall hopefully. I welcome your feedback.