5 Steps to Successful Insurance Billing in SimplePractice
We’ll go ahead and get started. So just to start things off, my name is Maggie. I am a SimplePractice employee. I’ve been working with SimplePractice for about three years, and I am formerly a medical biller. So primarily in the mental health space. We’ve also worked with a few other specialties. but I was able to use simple practice when I did my billing.
So I’m coming to this topic with a bit of expertise in the field. so just to give you a heads up about what the goals are for today and what we’re going to talk about. So this is an overview of how the insurance billing workflow is set up in Simple Practice.
This is an ideal session for someone who is just getting started with Simple Practice, and you’re in the process of setting up your account and working through- you’re setting up your workflows, what this class is not, it’s not going to be a live demo and it’s not going to be, as much of a product overview as some of our other classes that we offer. So a good. Classic follow-up with this session, would be our insurance billing class, which is, which is a product demo that actually will walk you through.
Step-by-step setting up your account. we also have a live insurance Q and a, if you happen to have, specific questions about the product and about your billing. so. We’re going to have a Q and a session at the end where we can talk through some questions about insurance billing and about our workflows.
I ask that you please hold off all questions until the end. so we may. You may have a question that pops up right away. we may be addressing it later on in the presentation. So I ask that you please just hold all questions until the Q and a and reserve using the, the question box and go to webinar for if you’re experiencing technical difficulties.
So it will be helpful for me to know if at any point. My video, there is no video. So if my screen cuts out or if my voice cuts out, let me know. Otherwise we’ll get to questions and at the very end and we’ll get started. Okay, perfect. So. What we’re gonna be talking about today are the five steps for successful insurance billing.
And like I mentioned, we’ll be talking about the workflow as it applies to simple practice. So the agenda will be, we’ll talk about enrollments, creating claims, submitting claims, tracking claims, and then ultimately reporting payments. Okay. So the first step is enrolling with insurance payers. Some of you this term may be foreign to, the term enrollment.
So, what an enrollment is, is it lots of payer know that you’re using simple practice to file and receive a file claims and receive payment reports. So that that’s two separate actions. So. some payers require an enrollment before you can even submit claims. I think of an enrollment as sort of a permission is just letting the payers know and not every payer requires that specific permission for submitting claims.
Now all payers require an enrollment before you can receive payment reports and a payment report is another word for an explanation of benefits. Or an electronic electronic remittance advice. So if you’re coming from having build with another system or, from having done the billing manually, those are terms that you might be familiar with.
in simple practice, we call those, we call it EOB as an era is, payment reports. So to initiate this process, you start from your simple practice account. And the steps are laid out within simple practice. So a lot of times it’s paperwork or it’s logging onto your provider portal with the insurance company and filling out some information, we’ll provide you with those steps.
And then it’s completed outside of simple practice. So to get started with enrollments, you’ll go to. Your settings. This is under my account. This is in your settings and you’ll click the insurance payers on the left-hand side. And this is the first screen. You’ll see, this is where you can access a list of all of the insurance companies that we are connected with.
this is searchable. it also lists the payer ID that may be listed on your client’s medical ID card. now you’ll see here, there’s two different columns here. That designate what types of enrollments there are, there’s the claim filing enrollment, and you’ll see that most of the payers that we have listed, you can start filing claims right away.
So when you see that listed under the column, you know, that you don’t have to proceed with the enrollment process in order to start actually submitting claims. now the payment report enrollment, it’s a separate enrollment that, In order to get started with your enrollments, you do need to be in a paid SimplePractice account.
So you can’t start this process when you’re still in a trial. However, if you enter your credit card information and you update your account, you’ll be able to start that process right away. And so if I was in a paid account, what I would see here instead is a prompt to enroll where you see not supported.
That means that that insurance company. But will not connect with simple practice to send us their payment reports or otherwise known as explanation of benefits or remittance advice. So that would mean that you would need to enter payment information from that insurance company manually. So again, just to clarify what a payment report is.
Is an explanation of benefits. It’s a breakdown of what was paid by the insurance company. It is not your actual payment. However, payment from insurance companies will still come to you directly from the insurance company, either through a wire transfer that you have set up ahead of time or through a paper check.
But simple practice is not involved in that actual receivement. And the actual receiving of payment or remittance from the insurance company, we’re just getting the information or the data to populate into your account. Okay. So once you’ve submitted your enrollment, so you have that process started or completed wherever you are, then your next step will be to actually create a claim.
So before you can create a claim, there’s some information that you need to enter into your simple practice account. As long as you have all of this information entered, you can create a claim with the click of a button. And so we’ll walk through the different places that you need to go and all the information that you’ll need to have.
So the first thing you need to focus on is your own information. So there’s a few places where you need to enter your information into your account, and that will apply to all claims that you create. So under your account settings, again, we’ll go under basic information. And this is where you’ll add your clinical information.
So your, your personal MPI number as well as your personal specialty and your taxonomy code.
The next step is to add your office location. So where wherever you’re seeing your clients and, where you’re providing services. So you can have multiple office locations. We see here, we have a physical office listed and we also have a tele-health office located, listed here. and so you can customize what you named these.
You can customize a color designation. And you also want to make sure that you have the correct place of service selected. So for a physical office where you’re seeing clients, one-on-one, the correct code for that is 11. So designate office for tele-health. The correct code to use is two now different insurance companies have different requirements around what they accept for tele-health place of service codes.
So it’s important to clarify that with a specific payer you’re working with, but generally two is the accepted telehealth code and, You do need to enter, it is required that you enter a street and city, for the address. So when you’re using tele-health, we will put in a fake address or we’ll just include your actual office address wherever you build to.
Okay. Now the next thing you’ll need to add is your billing information. So if you’re contracted with an insurance company, then they should recognize you under a specific address and MPI. And that MPI may, may be the same as your personal NPI, your individual. but if you’re part of a group practice, then.
You may have a separate MPI or a type two NPI as they call it. So here’s where you’ll add that information. And this is the, this goes at the very bottom of the claim form to show the insurance company where to send payments to that’s, how they recognize you. so you’ll need to fill that information out.
It’s under your billing and services settings under the insurance tab. And this is where you can say which type of provider you are if you’re submitting as an organization, or if you’re submitting as an, as an individual, as well as whether to include the service facility location, if it varies from your billing address, you’ll need to make sure that that’s there and whether or not you are opting to include multiple diagnosis, which varies based on requirements.
some insurance companies don’t need to see any secondary. Diagnosis. so that’s up to you in the pair that you’re working with. Okay. So at this point we have all of your information added and that will be easy. you only need to do that once. and then that will populate on every claim that you create.
The next thing that we want to focus on is your client’s information. So when we’re ready to create a claim, we have a client that we need to, select. Gather certain information for, so here’s our test client, Johnny. before we can even think about creating claim, we’ll need to have all of the client’s demographic information. So their date of birth, as well as sex, phone number, email address, depending on how they’re. They’re registered with their insurance company that all needs to match up a hundred percent and you’ll also need their insurance information. so what’s really nice about simple practice. And if any of you had the chance to attend our client portal lunch and learn, then, you know, a little bit more about how this works, but you can gather this information from your client ahead of the session and your client can fill this out, all paperless and, to the point where when you log on and when you start with a new client, you should already have this information. If the client correctly goes through and fills out all of their intake forms, you should come in to see their account, mostly filled out. that’s again, using the client portal and inviting them.
We won’t get too much in the weeds, but there’ll be able to also upload a picture of their insurance card. Now. My number one recommendation is to still verify benefits, even when you have all this information and it’s coming from your client. I still recommend going through the necessary steps with that insurance company to verify coverage so that maybe you can check online through an online portal, may, may require you to call the insurance company.
especially right now when we’re still, When everyone is trying to determine what is accepted and what is covered in terms of tele-health. not all plans, benefits include tele-health. So where you’ll see some payers make blanketed statement saying that they’re moving towards covering it. Clients who are covered by an employer may still have a restriction for that tele-health benefit.
And so it’s important to still verify. And a lot of times, the best way to do that is by calling the insurance company. but. Either way, always make sure to have a copy of the card on file. in case you need to refer back to it. And we’ll get into that a little bit more when we talk about tracking claims.
But let’s assume we have all of our client’s information. The next thing that we need to have is an actual session. So obviously to create a claim, you need to have something that you’re claiming. So before you can create that you need to have a session on the calendar, and this is what it will look like.
You’ll also need to have a diagnosis and treatment plan in the client’s record. So, When you create a diagnosis and treatment plan that will immediately apply. You don’t need to update that every single session, but if it’s a new client, you’ll need to make sure to update that. And if there are other treatment changes, to keep that updated so that the insurance company is receiving all of the most accurate information or most up-to-date information.
And when you are creating a session. You can select the service code there. as well as you’ll need to have the date, the time, whether it’s going to be a tele-health session. So here’s where you can add modifiers. So as we talk about tele-health billing and everyone is. Trying to figure out what the best practice is for that.
most payers require that you use some sort of modified indicate that it’s a tele-health service with the service code. You’ll still use the same service code that you would for an in-person service. So when we think about. Tele-health the service doesn’t change only the modality of how the service is being offered changes.
So that’s where a modifier comes into place. So no matter what we’re still offering, I know eight three, four nine, eight, three seven, whatever it may be that you have, you know, for the service to represent the service. And here’s where you can. Add modifiers. If you’re in the outpatient rehabilitative field, let’s say you’re an SLP or you’re a physical therapist.
Here’s where you can also add those therapy modifiers. you do it right on the calendar, fly out here. and you’ll see when we create a claim that that will be, populated automatically. here’s where you also designate what you’ll be billing, what the client owes, et cetera.
All right now we’re ready to actually create the claim. So in simple practice, there’s two different ways that you can create a claim. You can create a claim from the client’s record. So creating claims for one individual client at a time as well. As we’re showing here. So we know we’re working with Johnny.
We only need to create a claim for Johnny. Once you establish a flow that works for you, you’ll be able to create multiple claims from multiple clients at the same time. I recommend waiting until you understand. What the insurance payers come to accept on claims, make sure that you’re able to get paid at least with one or two claims before you move on to batch highly.
but once you have, once you understand what is reliable and what is working with your payers, then you’ll be able to use the batch cut the batch claim filing feature. And so this is available under your billing. Which you can see on the left-hand side, we go to billing and it’s more of the general billing settings rather than one client at a time.
And this list here under unbilled, your insurance and build appointments, shows every client in your simple practice account that you have designated as insurance, as their billing type that you haven’t created a claim for yet. And so. You’re able to select the clients that you want to, if you want to submit batch, but you only want to submit a batch of United health care claims.
You can go through and select the clients that have United health care designated. If your client has an orange exclamation point next to their name, that means that information is missing. And you’re not going to be able to create a claim until you add that information. So some piece of their demographics or their insurance information.
Diagnosis or service that something is not there. And you can click on that orange exclamation point to understand what is missing. So you could go back and add that. once you, once you add that, you’ll be able to create and submit claims all at the same time. So that’s how bad claim filing works.
Okay. So submitting the claim. So. We created a claim for Johnny, and this is what we’ll see before we can actually submit the claim. did touch on bad claim filing. You don’t get this type of review when you just click batch and submit. So that’s why I recommend it. Starting out small with one client. So you want to have a chance to look over the claim.
Double-check all of your information. this is all populated automatically based on that information that we talked through before. So you’ll see that client’s insurance company is listed here, their name, everything that they gave us, as well as everything that you added. This is at the top of the claim and the step, the status of the claim right now is prepared.
That’s listed at the top. So here’s where you can still make changes. If you see that something is missing, or if you see that something doesn’t look right before you submit the claim. Here’s the bottom of the claim. So we have our date of service looks correct. We have our place of service here listed as tele-health.
we have our code and we also have our modifier, you know, the amount being charged. We have our rendering information and MPI up at the top. You’ll have the diagnosis down at the bottom. You’ll see the service facility location as well as the billing information with the billing NPI. so. Everything looks correct.
Everything checks out and, here we’re ready to submit. So when you click submit, it goes through a process where the claim will go directly to our clearing house and then our clearing house will scrub the claim for errors and then the claim will make it to the insurance payer for review. So how do you track your claims?
How do you know where they are? how close you are to getting paid, where to see that. So under your billing settings, on the left-hand side, we go to billing and insurance and then we’ll go to claims, Here’s where you’ll see a list of all the claims that you’ve created and the different statuses.
So you will receive email updates when a claim status changes, and here’s where you can go to see all of the claims at once. So simple practice will automatically update you on a claim has been paid, rejected, or denied. And you’ll see that in your appointment or in your actual account reminders as well.
So right now the Johnny claim, we just submitted it. It’s going to be in the submitted stage. We’ll see it move through a different, a few different stages. It will go, it could go from accepted to pending and eventually to paid now. and that’s what we, that’s what we long to see. however, if your claim does end up getting rejected or denied, there’s a few things that you will want to consider before, before problem solving before looking into calling the insurance company.
So I find that majority of claims that deny are because the information is incorrect either by the insurance. Like the ID is incorrect or the patient’s demographic information is incorrect. so make sure that you review the client’s ID card. That’s the first step when you get a denied claim. There should be.
If it’s denied, you should have a laid out reason from the insurance company. However, if it’s rejected, you might not. So rejections can come in different forms. They can either be rejected at the clearing house level, meaning the insurance wouldn’t even accept it. or they can be rejected once they actually make it to the insurance company.
Those reductions usually come back with. With clear guidelines. However, if it’s rejected from the insurance company, before it even makes it past the clearing house, it usually means that something is, is not correct with the information that the patient or the client has given you. So, if everything checks out, according to what you have, then, then you want to call it provider services.
You also may want to call your client just to double check that their insurance is accurate. It’s up to date. From verify your client’s coverage is current. You would be amazed how many people are still using old insurance ID cards that may be in their wallet. And they just don’t know. so that’s a lot of where rejections and denials happen, when everything is recorded correctly and you have all you’re armed and equipped with the right information, you you’ll, you should not seal a ton of rejections or denials.
Okay, so the next step is reporting your payment. So we followed all the steps correctly, everything went perfectly, and now we are getting paid by the insurance company and. So, this is what a payment report. This is what that automatic document, the automatic update from the insurance company that comes into simple practice looks like.
and this is again, to talk back about enrollments. If you have enrolled to receive payment reports and you’ve been approved and everything, is good to go there, this is what it will look like at the end when your claim is. When your claim has been paid and you’ve received a payment either through wire transfer or through a paper check.
this is what appears. So just to decode this a little bit, we know that we had our session date, and we had our service code. When we build a hundred dollars, the insurance paid $60 and you had to write off $15 and the client’s co-pay would be 25. So. If we had verified benefits ahead of time, then we likely, already knew that the client owed $25.
And if you know that from working with, let’s say, United healthcare, that your contracted rate for nine Oh eight three seven is $85, then you could anticipate that that, that $60 is what you expect to be paid. And then you have to write off the rest, meaning that your client. you will, you won’t be charging that to the client.
This is again an in network scenario. So you would write that off and not build it to the cloud.
Okay. So when we receive automatic payment reports, it will also update and breakdown into the payment page here within the product. So it’ll make it a little bit easier to see and a little more straightforward. And this will populate automatically. So. And like we explained them the scenario before it, you received $60, your client owes you $25 and you’ll write off the rest of that 100.
Now, if you are not set up to receive payment reports yet either because they’re not supported by the payer, or because you’re still waiting on your enrollment to be accepted, then you’ll need to enter your explanation of benefits or your payment information manually. And this is the same screen that you’ll go to, to do that.
So, It’s pretty straight forward. You’ll you’ll take a look at what you’ve been paid and you’ll list here. How much the insurance paid you, how much your client will pay you. And then you’ll write off the rest and you should have a total at the top that equals the amount of the check that you received from the insurance company.
So when you go to add a payment for United health care, You’ll select the date range and it will show all United health care clients that received services during that date range. And you can add any payments that you received from the insurance company there.
All right. So that just about covers the full, a generalization of the full workflow for simple practice. Billing for insurance. like I said, if you’re interested in a more thorough product demo of actually walking through a live demo, then I definitely recommend signing up for some of our live daily classes.
These are completely free. So getting started with simple practice, that’s an overview of the full system insurance billing. There’s also an insurance billing Q and a that’s live with our insurance specialist team. As well as classes on our other features, client portal, online booking and client billing.
And now we have some times, so I will answer any questions that you have. And I just want to put this up. just to remind you of what we talked about today. So the, the five different steps and it looks like I have so questions already. and I do have to give you a warning. There are a lot of people on the phone, but I, so if I don’t get to your questions, I’m going to do my best to get through as many as I can but I would definitely recommend reaching out to support. If your question is product specific, if it’s specific to your accounts, then that will be your best course of action. And that is through support that simple practice.com. and you can use our chat feature or email into support. All right.
So let’s see. So Anne asked, how do we get to the claim page?
So in order to create a claim, you’ll need to enter the information first. And then, once that’s all created, you’ll be able to do that from your client record to create claim.
Does the professional level account allow us to access all of these features or are there additional fees for some of them?
That’s a great question. So the professional level account does allow you to access all features with the exception of telehealth. Telehealth is $10 extra per month. Now insurance billing. There is an additional cost of 25 cents per claim submitted. you don’t need to upgrade your account or do anything. It’s that’s the clearing house fee, and that will be charged at the end of each month with the rest of your subscription.
Katie asks, should there be different MPIs in box 32 versus box 33?
So box 32 in box 33 33. Is your billing. Information and 32 is where your service facility is. So if you are a group, then they’re likely the same exact MPIs.
and unless you are using, unless you’re, billing, unless you’re working out of someone else’s office, those MPI is, should be the same. and most insurance companies would expect that, unless you are set up. Under a different address. Let’s say you use a PO box for your billing. there is a chance that you may have a separate MPI there.
Stacy asked, do I have to be paneled with insurance companies before I re enroll for ERs?
So it varies by the insurance company. So some insurance companies will not agree to send ERs to you when you’re not in network. and they also may not allow you to use a, a, they may not allow you to submit claims electronically.
It depends. They’re not contractually obligated to send you any kind of explanation of benefits when you’re not in network. So, you would have to work with them to understand as well. When you’re applying for enrollments for submitting claims as an out of network providers, you may need to still submit a w nine to the insurance company because they don’t have any, when you’re out of network, they usually do not have any information for you on file.
they. So they need something to be able to recognize you so that they know who to submit like an address and, that you are a valid provider.
Okay. So Shannon says we have had claims denied due to their state not shown on their claims, but when I open up their client profile, their state is shown there. How do I get this left off from the claim?
so if the claim was denied, I would reach out to provider services and ask them to provide an image of the claim that shows where that, that is missing to see if they can fax that to you.
Otherwise, if it was rejected, I recommend reaching out to our insurance specialist team and they should be able to take a look at the claim to see if something isn’t being recorded on it correctly. and so Jolene asks if there’s a different process for out of network providers. So again, like I said, it’s much of the same, however, you may need to reach out to that specific insurance company, let them know what system that you’re using, send them a w nine and, make sure that you’re in their system as an out of network providers.
That is able to submit claims electronically. Otherwise they may just reject them automatically. So when a claim goes through the clearing house, this the insurance company will run. w we’ll look at the claim to see if the MPI is identifiable in their system. And if there is no MPI for that provider in their system, they’ll just reject it without even looking at it.
so Laura asks, did those explanation, explanations become part of the client’s record or do they get a raised?
So they do not get a raise. They do become part of more or less of the client record. So you’ll. There, you can view them from the claim. So when you open a claim that you know is paid denied, and you have a payment report attached to it, then you can revisit that any time by looking at the claim and clicking view claim details.
There are also, you’ll be able to. View all this information in your reports. So you can see any payment reports that came in. And that’s a really great way to keep track of all of the payment reports that you’re getting from, from different companies. So again, that’s under your reporting feature, which is an option on the left side of your, of your page.
Laura asked if you could, if I could please briefly review the claim resubmission process. So to resubmit a claim, let’s say you have a claim rejected or denied that you need to submit a corrected claim for depending on how far the claim has gotten with the insurance company will depend on how you handle resubmitting it.
So if a claim was rejected, And there’s no claim ID attached to it. It likely, never made it into the insurance company. and don’t understand what that means. you have to look at the, the actual claim status itself and where you see rejected. There will be a claim ID that. That goes along with the insurance company, for the most part, rejections, you don’t need to create a correct claim rejections.
You can usually correct what was wrong with the claim and submit it right then. And there, if you have a claim denied and the insurance company is instructing that you need to submit a corrected claim. What you’ll need to do is take the claim reference number from that insurance company. So they’ll designate a specific numeric code to identify that claim.
And you’ll need to delete the, the existing denied claim and create a new claim and it’ll be marked as a corrected claim. And that is inbox. I mean, double check exactly what, which box that is on the claim, but you it’s inbox 22 and usually the resubmission code is seven and you’ll need to do that manually.
So you’ll go through, you’ll create a new claim. You’ll. Select resubmission the box 22, which is number seven, you’ll need to put the original claim number as the original reference, within the claim form. Now different insurance companies have different rules about how resubmissions work. So you’ll want to clarify that, but that’s the standard practice for resubmission.
They also may need to void the original claim. Some insurance companies require that that. You need to void the denied claims. So they have a fresh slate that they have to delete that service. So it doesn’t look like you’re trying to double bill for something. And once it’s voided, you’ll receive a confirmation and then you can submit a new claim.
So again, those processes vary, but that’s generally how you do it and you need to edit the claim manually.
Okay. He asks, if you can make notes on the day of service line, Within a claim you cannot. So, Th that that claim would be scrubbed or rejected out. If you tried to make a note on that with the data services. However, if you need to make a note to remind yourself of something, you can do that within symbol practice, within the client’s record, separate from their actual progress notes, you can create chart notes.
to remind yourself, but, you know, if we say, April 30th, session completed via tele-health or session cut short, something along those lines that you’d need to do to remind yourself to revisit.
so Eric asked in field 14 date of illness. I have to manually put in a qualifier. Is there an automated way to do this at this time? There is not. An automated way to work with box 14. If that’s required by your insurance company, then you will need to add that manually. Now I recommend reaching out to our support team to put in a feature request so that our product team can prioritize that if that’s something specific to your field that, we would want to build out.
Okay. So. Another question is, does the platform verify that client insurance is current on data service or do we need to verify as we normally would? So I recommend verifying with the insurance company directly. So. There’s different ways you can do this. I don’t think you need to verify at every single session for every single date of service.
I think that if you verify at the top of the session and you keep track of, I mean, I’m sorry at the top of working with that specific client and you keep track of what the start effective start date and end date is for their plan. then you might just need to verify once a year for that client. we do have.
Coverage reports available in simple practice. So there is a feature where you can, run the client’s benefits. It’s 5 cents per coverage report. The issue is that that we run into with a lot of our customers is because behavioral health benefits aren’t usually administered by the, by the. The sorry, I’m losing my words by the medical insurance companies.
Then those benefits aren’t usually very clear or made, made known to all of us. So the best thing to do is to call, because what may happen is those benefits may be carved out to a different administrator. So even though the client’s coverage is through, let’s say blue cross blue shield of Pennsylvania independence, blue cross, Magellan may be the one who actually created those benefits and created those medical policies.
And that case you won’t be able to, to determine coverage for specific services just based on whether or not the client has active coverage. so a long-winded way to say the best way is to just call verify, know your codes that you want to bill for. And, come equip that information before the client comes in.
Okay. So Sandra asks, does it matter if the payer ideas, multiple names addresses, and which do we pick? So that’s a great question. Payer IDs are what is used in the electronic billing word, billing world to identify where the claim should go and which insurance company it should go to. it does not matter what name is listed for the payer when we’re submitting claims electronically.
The only thing that matters is that specific ID. So what we did with our system is we’ll have claims under, We’ll have insurance companies under lots of different names. So, because plans are because the cards that you may come across for your clients may have hundreds of different plan names listed, but the claims usually will go to the same place.
So for example, United healthcare has hundreds of different plan types that you’ll come across. but all of their codes are eight, seven, seven, two six. So, The most important thing is having that, that payer ID, right. Rather than the name. And if you’re not sure which payer ID to choose, if it’s not listed on the client’s ID card, then the provider services will be your best resource for that and clarifying what the pair ideas.
And if they’re not able to tell you, then submit a request to our help center with, Securely attach the URL to your client’s account. And as long as there is an ID card on file, we’ll work with our clearing house to determine what is the correct filing, payer ID. but the name is not as significant as the actual ID.
So, I hope that answers your question. okay. So Matthew asks, can you explain writing off payments? Definitely. So if you are paneled in network with an insurance company, then you have what’s called a con contracted rate or a what can also be there’s other terms for it that are accepted, right. Or, I’m blanking on, but there are lots of different ways that they say this, and there’s a lot of different ways that this is represented on your explanation of benefits.
What it means is. Because you are re you’re reaping some benefits as being, being part of their network. And you agree to get paid a certain rate that is lower than what you would normally bill clients. So, let’s say your, your session rate is a hundred dollars, but when you’re seeing United healthcare clients, you agree to receive $80 for every session, every night and eight, three seven.
And so you have to write off the. Difference. So you can bill a hundred dollars. So United healthcare you’ll only ever be paid out a total amount of $80. You’ll always have to write out, write off $20. And so when they break that down, they’ll give a part of that to your client sometimes depending on your client’s benefits.
So if you have a client that has a deductible that hasn’t been met, then you’ll be expected to collect that full $80 from the client. And if you have a client that has a copay, then it may be you collect $20 from your client. And then another 60 from the insurance company. That’s 80. You’ll always have to write off that amount.
And that’s part of your contract. You can’t, You can’t bill that to your client when you’re part of an in network. If you’re out of network, those those same rules do not apply. You’re not contractually obligated to write off any amount and you can charge the client the full $100 or the full asking service for your, the full asking fee for your service.
Okay. So Beth asks, do you put the copay amounts, the client paid on the insurance claim you filed? No. So you do not need to put the amount that you collected from the client or the amount of copay that the client will be paying you at any point, that’s not required on a claim. So the only thing that the insurance company wants to see on a claim is the full service fee.
So like we said before, If you charge a hundred dollars for your service, that’s what, that’s the amount that needs to be on the claim. And then the insurance will do the rest. as far as breaking it down and determining what you’ll actually get paid or what your contract says, you’re allowed to get paid for.
Lisa asks the simple practice, provide a business associates agreement. Yes we do. And for more information on the business associates agreement, you can go to simple practice.com/privacy. I have a couple of minutes, so I’ll try to get into a few more questions. Okay. so Rachel asks, can you charge different rates for private pay versus insurance or offer a sizing scale rate?
Yes, you can. As I explained before, with private pay you’re you don’t have that contractual obligation. To charge, clients, according to how you agreed to be paid by the insurance company. So that’s the difference between out of network and in network with in network, you agreed, only receive a certain amount.
so you can. You have to, you’re limited to what you can be to what you can receive. but you can bill whatever you want to the insurance. And they’ll, they’ll determine what you get paid just based off that contract. without a network you don’t, those same rules do not apply. So there may be, if you are, if you’re a practice that is half and half, you have some private pay clients and some insurance pay, then you’ll see those clients being charged different things.
Okay. So Dylan asks, do we need to set ourselves up as approved providers with an insurer before we’re doing work on simple practice? Or do we need to do this through simple practice? So if this question is regarding enrollments, we don’t need to do that, through simple practice. So, It’s best to handle enrollments within the system, rather than trying to do it outside of it.
and that’s because we are fully integrated with our clearing house and they’re completely linked to talk to the insurance companies once we have that enrollment information completed for you. and that’s what, that’s how the system will know when you’ve been approved. And we’ll let you start filing claims.
when you do it outside, You do it outside of simple practice, it’s missing that piece of communication that lets the system know that you’ve been approved. and that this is, this is your account name and, that you can see are receiving payment reports or filing claims. and now if this question is yes, regarding being in network or out of network, it depends on what your plan is.
So if you plan to stay in network, then I recommend completing. You’re paneling before completing your enrollments. So making sure that you are accepted as a provider before you start, before you submit your enrollment to, because it may just get, it’s a very delicate process with paneling. For those of you who have gone through that, you may understand how timely it can be and how easily it can get.
Dragged out. So once you’ve been approved, then the next step is to set up your, your EHR or your, yourself for claim filing with that provider. But, my advice for that is to be patient and don’t try to jump the gun with the insurance companies. wait until you’ve received confirmation that you are officially contracted and then move forward with setting everything up in terms of billing.
Okay. So Laurel asks, just to clarify, a simple practice does not manage the payment of electronic funds transfers for insurance. That is something we set. We directly set up with the insurance. Additionally, we do not only enter our bank accounts. so we’re running out of time. So this is the last question I’ll answer.
And, the answer is, yes, that is correct. Simple practice does not manage the electronic funds transfers. So that’s the money that you receive from insurance companies? we are not part of that process. That will still come directly from your insurance company. And that is something you will set up outside of simple practice.
If you plan to receive, electronic payments, or if you plan to receive paper checks, you’ll need to work directly with the insurance company to handle that. Okay. So I see that there are a ton more questions that I didn’t get to. and so we’ll, we’ll be sending out a follow-up. With some pointing you to the different resources that we have for insurance billing, including our classes that you can register for as well as resources, our help center to walk you through the process of getting started.
Thank you everyone so much for tuning in. I hope this was helpful and everyone has a safe, great rest of your day and week.