WP 90 | Insurance Insights: Navigating Credentialing and Avoiding Mistakes with Kelley Sonnenberg

Written By James Marland

Navigating the world of insurance billing can be daunting for therapy practice owners. On the Wise Practice Podcast, Kelley Sonnenberg, Billing Director at Practice Solutions, shared valuable insights on credentialing and common pitfalls to avoid. Here are some key takeaways from her discussion with host Whitney Owens.

Understanding Credentialing

The First Step: Credentialing

Credentialing is the process of getting into a contract with an insurance payer, allowing you to accept in-network patients and set contracted rates. Kelley emphasizes the importance of choosing the right payers: "You want to make sure you're credentialing with a payer that makes sense for your area and population as well as your target patients."

Pitfalls to Avoid

  1. Choosing the Wrong Insurance Company: Kelley advises against selecting insurance companies that don't align with your target patient demographic. For instance, "if you really want to work with the veteran population, consider joining the TRICARE network."

  2. Credentialing with Too Many Payers: Kelley warns against overextending by credentialing with numerous payers at once. "Each payer operates individually and specifically...our most successful providers take just a few payers in their area with a higher reimbursement rate."

The Credentialing Process

Getting Started

The process begins with filling out paperwork on the payer's website, ensuring you have all necessary information such as your NPI and tax ID. Kelley highlights the importance of accuracy: "One wrong number or letter can really affect it."

Following Up

Following up is crucial. "Insurance is never quick on things, so it can take anywhere from three months to a year," Kelley explains. Persistent follow-up ensures your application is processed timely and accurately.

Group vs. Solo Practices

Credentialing for Group Practices

For group practices, Kelley recommends obtaining a type 2 NPI and credentialing under that number. "This way, if a provider leaves, your group remains credentialed, and you can easily add and remove providers."

Individual NPIs

Each provider should still have their individual NPI for claim submissions. "You'll need to put on the claim a rendering provider NPI," Kelley explains, ensuring clarity on which provider saw the patient.

Avoiding Common Pitfalls

Accurate Information

Ensure the information submitted for claims matches what was used for credentialing. Kelley cautions against simple mistakes: "Submitting claims with incorrect information, like your NPI or tax ID, can lead to denials."

Managing Contracts

Understanding your insurance contract is vital. Key aspects include timely filing limits and fee schedules. Kelley advises, "Know your contract's timely filing limit to avoid missing out on reimbursements."

Denial Management

Common Denial Reasons

Denials can stem from various issues, including credentialing errors and patient information inaccuracies. Kelley suggests, "Talk directly to a claim specialist for more information on denials and how to fix them."

Verification of Benefits

Running eligibility and benefit checks before seeing patients can prevent denials. Kelley recommends using payer portals or third-party portals like Availity for these checks.

Time Management

Balancing Tasks

Managing a practice involves numerous tasks, from credentialing to billing. Kelley advises setting aside dedicated time for each activity or delegating to specialists. "As your practice grows, consider hiring an admin to handle administrative tasks."

Conclusion

Navigating the complexities of insurance billing and credentialing requires careful planning and attention to detail. By avoiding common pitfalls and managing tasks effectively, therapy practice owners can streamline their operations and focus on providing quality care to their patients. For those seeking assistance, Kelley recommends consulting with a billing company like Practice Solutions to handle these tasks efficiently.

For more insights and tips on managing a therapy practice, listen to the full episode of the Wise Practice Podcast with Kelley Sonnenberg.

Show Sponsor: Practice Solutions

Practice Solutions, LLC provides mental and behavioral health billing solutions and services to your practice, freeing you up to focus on providing best-in-class care to your Patients and growing your practice. Free consult and 15% off your first 3 months of billing by clicking this link and asking for a consult.  

Guest Resources

Links and Resources

  • Insurance Insights: Navigating Credentialing and Avoiding Mistakes with Kelley Sonnenberg | WP90

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    [00:01:24] Whitney Owens: Hi, I'm Whitney Owens. I'm a group practice owner and faith based practice consultant. And I'm here to tell you that you can have it all. Want to grow your practice? Want to grow your faith? Want to enjoy your life outside of work?

    [00:01:38] Whitney Owens: You've come to the right place. Each week on the Wise Practice Podcast, I will give you the action steps to have a successful faith based practice while also having a good time. Now let's get started.

    [00:08:30] Whitney Owens: Today on the WISe Practice Podcast, I have Kelly Sonnenberg, who is the Billing Director over at Practice Solutions. She started there in 2018 as the first Billing Specialist, working hands on with providers to manage their billing before moving into her current role as the Billing Director. She manages teams of billers and supervises all billing work.

    [00:08:50] Whitney Owens: Her experience as a biller gave her the knowledge, skills, and passion to help expand the company, resulting in helping hundreds of mental health practice owners. She hopes to empower providers to gain the confidence and knowledge they need to take on insurance billing. Welcome to the show.

    [00:09:06] Kelley Sonnenberg: Hello. Thank you for having me.

    [00:09:08] Whitney Owens: Yes. I love it. I love this idea. You're empowering practice owners to take on the insurance companies. This is great. Um, so I'm so excited about this conversation today and I actually haven't had anyone come on the show to really walk us through this process of getting credentialed. How do we do that?

    [00:09:26] Whitney Owens: Where are the pitfalls and how can we be successful? So this is going to be great. Um, before we jump into the episode, I always like getting to know people on a personal level. So Kelly, tell us a little bit about where you're from, a little bit about you, whatever you want to share with the audience today.

    [00:09:40] Kelley Sonnenberg: Yeah. So my name's Kelly. I am from born and raised in Michigan. So I live with my boyfriend and my two dogs who are my world. Um, I went to college for healthcare administration, kind of came out of that. really interested in the billing world and how can I help providers kind of behind the scenes rather than working directly with the patients.

    [00:10:02] Kelley Sonnenberg: And that's what led me to practice solutions and just really being able to figure out where providers need the help and then being able to provide the resources and, and what they need to just kind of take on the, the really scary word of insurance. And, Yeah, how to make it more approachable.

    [00:10:21] Whitney Owens: Yeah, perfect.

    [00:10:22] Whitney Owens: Okay, let's hit the content hard. So if somebody's listening and they have, they're thinking, I want to start a practice. I want to take insurance. I have no idea what to do. How would they get started?

    [00:10:37] Kelley Sonnenberg: So the first thing here that you're going to do when you want to accept insurance patients, you're going to kind of start at the beginning and that's credentialing.

    [00:10:46] Kelley Sonnenberg: So this is going to be the first hurdle that you're going to encounter once you, you make that decision. Um, and I can go into some more about credentialing here, a couple of pitfalls that we see, um, being credentialed with the wrong insurance company. And so what I. What I mean by this is you want to make sure you're credentialing with a payer that makes sense for your area and population as well as your target patients.

    [00:11:10] Kelley Sonnenberg: So for example, if you've decided you really want to work with the veteran population, you may consider joining the TRICARE network, which works exclusively with veterans. Or perhaps you heard about a certain payer that you really want to work with. I would always double check that there's a population of patients in your area.

    [00:11:29] Kelley Sonnenberg: Um, so, so being from, I'm from lower Michigan, I wouldn't want a credential with an upper peninsula plan because I wouldn't have any patients. You know, down here to see. So just kind of being aware of popular payers in your area and also keeping in mind your target audience of patients as well. So that's kind of the first step.

    [00:11:47] Kelley Sonnenberg: It's deciding who to credential with.

    [00:11:51] Whitney Owens: Yeah. Okay. So this is, this is great because you're right. A lot of people don't think about that stuff. Um, if someone's listening, they probably know this, but let's just make sure. What does that actually mean to get credentialed? And like, what do you do? You call the insurance company and say, I want to be credentialed.

    [00:12:07] Whitney Owens: Like, how do you do that?

    [00:12:08] Kelley Sonnenberg: Yeah. So it definitely differs by each payer. Um, credentialing is just the process of getting into a contract with that insurance payer. And You know, creating rates and being able to accept in network is what we call it. So, um, you get kind of a contracted rate with that payer and you get exclusive access to their patients that they have.

    [00:12:31] Kelley Sonnenberg: So say it's Blue Cross Blue Shield, you'll have access to the Blue Cross Blue Shield patients. And so that's the first step is, is kind of filling out that paperwork. Typically you would Go to the payers website and it'll have more information on how the process looks since each payer is so different.

    [00:12:49] Kelley Sonnenberg: Um, it's, it's typically just filling out a form, making sure you have your NPI, your tax ID, all your practice information on there. Correct. Um, you would submit that and then there's a whole processing time, which, you know, Insurance is never quick on things, so it can take anywhere from, you know, we've seen it in three months, and then we've seen it happen in a year.

    [00:13:10] Kelley Sonnenberg: Another thing to note here, too, is not all insurance companies are accepting new providers. So you'll also want to make sure that their panel is open and accepting new providers in order to to credential with them.

    [00:13:25] Whitney Owens: This is this is helpful, but that sounds like a lot of work. I got to go to each one.

    [00:13:30] Kelley Sonnenberg: Yes.

    [00:13:31] Kelley Sonnenberg: Yeah, it can get a little tedious, but I always recommend kind of starting at the beginning, just collecting all the information and the information is going to be pretty similar on each contract that you're filling out on each application process. And once you have all of your information, it's really just a matter of.

    [00:13:49] Kelley Sonnenberg: Of filling out that form and making sure though that everything is correct on that form because one wrong number one wrong letter, you know, can really affect it there. So once you've got kind of. What you need on the forms down, it's really just filling it out and then following up is probably the most tedious part of that process because you're going to want to keep checking in.

    [00:14:10] Kelley Sonnenberg: Do you guys have the application? Is it processing? Where are we at? And just being on top of it.

    [00:14:18] Whitney Owens: Yeah, I've heard some horror stories of people filling out their credentialing stuff wrong and trying to go fix it. It's really challenging. Yeah, um, and if there was only a company that would do it all for me, but we can get to that at the end.

    [00:14:33] Whitney Owens: Okay, all right. So someone has done their credentialing, they put their stuff in, they're diligently calling. Okay. So what is going on after that? And what are some more of the pitfalls that happen?

    [00:14:45] Kelley Sonnenberg: Yeah, so another one that I really want to mention, because I really see this pitfall quite frequently, are providers who credential with too many insurance companies at once.

    [00:14:56] Kelley Sonnenberg: Um, you know, providers who decide to take on insurance, they may be under the impression that the more payers they work with, the more opportunities and revenue they can have. However, it's not necessarily the case. Because each payer operates individually and specifically, they differ widely. So, taking on numerous insurance plans means you'll have to know all the specifics of each and every one of those contracts.

    [00:15:22] Kelley Sonnenberg: The more contracts, the more details and nuances you'll have to learn. Um, and you might be losing focus too on your ideal patient. So our most successful providers we see are those that take just a few payers in their area with a higher reimbursement, right? And, you know, just really limiting and getting to know that pair 1 or 2, um, it gives you a more clear and focused strategy.

    [00:15:47] Whitney Owens: I think that point is so important and yeah, I'm blown away when I start doing consulting with people and I'm like, what panels are you on? And they'll list, like, 6 or 7. like, what are you doing? Like, that is so much to manage. And then, like, you just said the reimbursement rate and what you're getting. It is a negotiation.

    [00:16:04] Whitney Owens: It's picking the ones that are going to pay you better. Because you deserve to be paid well for the work you do. Exactly. Spot on. I'd be curious what you think. I feel like the people that I see that are really getting it well are seeing like three to five. And that's it. Yeah,

    [00:16:19] Kelley Sonnenberg: I think three to five. I think to start out, I always recommend starting out with one or two, really getting to know them.

    [00:16:26] Kelley Sonnenberg: And kind of as you grow, you can start taking on, you know, one more at a time. Get to know them, then take on another. Um, but yeah, when you first start just taking on like six all at once, you're learning so many different things, how to bill for each of them, which plans you're actually credentialed with.

    [00:16:43] Kelley Sonnenberg: So definitely limiting that at least to start.

    [00:16:46] Whitney Owens: Yeah. Okay. And maybe you're going to get into this. So I'm sorry if I'm jumping the gun here. Um, for a group practices and solo practices, Could you explain the difference, a little bit about the credentialing, the NPIs, I believe, are different, right, and like, within your practice, you credential the whole practice, you credential each person, and what's the advice on that?

    [00:17:08] Kelley Sonnenberg: Yeah, so there's definitely a couple different ways to do it. How I always recommend is if, you know, you're going from a solo provider to a group practice, the first thing you're going to want to do is, To get a type to NPI. So, you know, y'all have your type 1 NPI and the type 2 is going to be specific to that group.

    [00:17:26] Kelley Sonnenberg: So once you get your type 2 NPI, what we recommend is credentialing under that NPI, and then you would put providers. It's kind of like an umbrella, right? So your type 2 NPI is at the top and then you would credential and kind of add providers underneath of that group. And that way, if a provider leaves, You know, they'll have to recredential on their own, but your group is still good and you can easily add and take away providers.

    [00:17:52] Kelley Sonnenberg: Some people do it where they have a type 2 NPI and credential each provider individually, and so, but that provider is still going to be attached to that group. So we always recommend just doing it under your type 2, credentialing the whole group, and just being able to add and take away providers as you grow.

    [00:18:12] Whitney Owens: You might have just given me the best explanation I've ever gotten for this. Oh, It's confusing. It's hard. Yeah. Well, you just said it and it's not confusing. Yeah, that's how I learned it. And to me, it made sense. So, all right. So, so within that part right there, if they have an. Would somebody need an NPI 1 still if they're in a group practice or no?

    [00:18:38] Kelley Sonnenberg: Um, yeah, each provider is going to want their own individual NPI as well, because you'll need to put on the claim a rendering provider NPI. So it'll be, it'll still have your type 2 on the claim, but they'll also need to know which provider did see this. This patient and so you'll still want your type 1 as well.

    [00:18:56] Whitney Owens: And it's my understanding that it's the same kind of concept. You're credentialing that person. You're still going to have to wait a few months before they can take clients and using their insurance. Yeah, it's definitely

    [00:19:07] Kelley Sonnenberg: though it's easier to add a provider under your group. Then it is to just fully credential that provider.

    [00:19:14] Kelley Sonnenberg: Yeah,

    [00:19:15] Whitney Owens: that's great to know. And so, within that, can you select which people take which insurances within your practice? Or if you're doing the MPI 2, does everyone have to take every insurance?

    [00:19:25] Kelley Sonnenberg: Oh, you can definitely pick and choose. Um, we have practices where I see a blue cross blue shield, and they've got maybe 3 providers that are credentialed under that.

    [00:19:34] Kelley Sonnenberg: But some that are credentialed under other payers, you know, or what have you. So, yep, you can definitely pick and choose there. Great.

    [00:19:41] Whitney Owens: Great. All right. I know I took us on a little sidetrack there, but that was really helpful for me. What do we have next?

    [00:19:48] Kelley Sonnenberg: Yeah, so kind of the last pitfall, um, that we see with credentialing is not submitting claims with the information that you were credentialed with.

    [00:19:57] Kelley Sonnenberg: So most commonly your NPI, your tax ID address, or provider name. And credentialing the correct way, you know, filling out those forms the correct way will ensure the claim payment. So sometimes when providers first start out, they will start billing under their social security number instead of their tax ID.

    [00:20:17] Kelley Sonnenberg: Maybe they haven't gotten it yet. And so, you know, at some point they get a tax ID. They're like, Oh, I'm just going to update this in my EHR and start submitting claims under that. However, you have to make sure that you're updating everything directly with the insurance company first, that they have that information.

    [00:20:34] Kelley Sonnenberg: It's been updated and approved. And then you can go ahead and submit claims under, you know, your new tax ID, or if you move to another address, you know, we see that a lot. Oh, I moved to, you know, just down the street. Do I have to do anything? Yes, you'll definitely need to update that individually with each insurance company.

    [00:20:54] Kelley Sonnenberg: If anything changes.

    [00:20:58] Whitney Owens: Yeah, so important. Yeah. Well, great. Any other pitfalls you have there before I have lots of questions for you.

    [00:21:07] Kelley Sonnenberg: No problem. Yeah. Credentialing is definitely it's a whole thing in and of itself. You know, you've got credentialing and then the billing portion of. And so this is definitely that that first hurdle you're going to encounter and it can be a super smooth process or it can be, you know, difficult.

    [00:21:25] Kelley Sonnenberg: So it's just really making sure you're starting off on a good foot, making sure you have all the information correct and that you're choosing the right payers to credential with as well. Mm

    [00:21:36] Whitney Owens: hmm. Yeah.

    [00:21:38] Kelley Sonnenberg: So in

    [00:21:39] Whitney Owens: your line of work. How many, or I shouldn't say it like this, okay, how much money would you say the average practice loses by not getting payments from insurance companies?

    [00:21:53] Kelley Sonnenberg: That's a hard question because it definitely varies. Um, so claims can, you know, deny for a multitude of reasons. Credentialing is going to be one of those denial reasons that's going to be more intensive to fix because you're going to have to go back and kind of update everything at the beginning, reprocess claims.

    [00:22:13] Kelley Sonnenberg: Um, you know, if it's a solo practice versus a group practice, you could be losing much more as a solo provider. Maybe you're only seeing a few patients with that pair. So if things aren't working out, claims are getting denied, you know, you can, you lose a few hundred dollars if you're a group practice and now you've got 150 patients that you're seeing with that pair, you know, that number is going to be a lot higher there.

    [00:22:37] Whitney Owens: Yeah, I see this pretty often. And that, I think that really goes back to making sure you've got that system down, either in house or out, or, you know, an external company that you're working with, because. Even though you are paying them to do this, you're saving money, you're making money off them doing it.

    [00:22:54] Whitney Owens: And I think people have a really hard time, like, putting those together. And that's why I wanted to be like, hey, here's what we're losing here. But you're going to get it all back if you have someone doing this for you, and as your practice grows, there's just not capacity. To be on the phone call with insurance and figuring that kind of stuff out.

    [00:23:09] Kelley Sonnenberg: Yes, absolutely. It's definitely, you know, if you have the time and the resources to do it on your own, go for it, but if, you know, you really just don't want to kind of get involved, you really want to outsource it. It is. It's worth it. I don't know exactly how much credentialing companies are charging, but I know it's maybe, you know, 2, 300 to fill out an application.

    [00:23:32] Kelley Sonnenberg: The end of the day, that's really comes down to, like, 2 appointments that you've had. So, just kind of. Paying that up front, but then knowing everything's going to be smooth on the back end and not running into those, those hurdles and billing it's it's worth it.

    [00:23:48] Whitney Owens: Yeah. So I'm curious what you would say if somebody was they come to me and they say.

    [00:23:53] Whitney Owens: I just don't really know, um, if I should hire out for this. Should I do it myself? What's the best thing? Like, how does somebody figure out if they should hire out for insurance billing?

    [00:24:04] Kelley Sonnenberg: I always recommend, um, if you're a smaller practice and you have time on your hands and the resources to be able to do it, you can definitely do it on your own.

    [00:24:13] Kelley Sonnenberg: You know, if you're seeing just a few patients a week or maybe 10 patients a week and you're with only credentialed with one insurance payer, um, it can be pretty smooth sailing. But definitely as your practice grows, as you're getting more patients, more insurance companies that you're credentialed with, it definitely makes sense to outsource and hire out for your billing because it's going to end up taking up a lot of your time, especially once you start running into denials or credentialing issues, you know, having someone there to just handle that for you.

    [00:24:45] Kelley Sonnenberg: And really just so that you can focus on the patient care, you know, you're able to see See more patients and to help more people while we're kind of worrying about the back end of things. , I was

    [00:24:57] Whitney Owens: thinking the same thing. And it's, it's sad to think therapists are, we have this gift and ability that we got trained in to see clients, and then we're spending our time doing something else.

    [00:25:07] Whitney Owens: Yes. That's not really the best use of our time. Not only financially, but just to help clients. Like that's why we're doing what we're doing. Yeah. You know? Um, and I'm guessing, I'm, I'm curious, could a company such as Practice Solutions negotiate better rates with insurance companies than trying to do it on our own?

    [00:25:23] Kelley Sonnenberg: And so for that, we recommend a credentialing specific company. So we only do the insurance billing portion, you know, the claim follow up denial management. We don't actually do the credentialing portion itself. But, um, yeah, so that would be the credentialing companies will be able to negotiate rates for you.

    [00:25:44] Whitney Owens: That's great. Yeah, that does seem like a really specific skill set. Both of them do, you know, and then doing the billing on top of that. Yeah. So tell us, um, you work with all kinds of practice centers. Like, do y'all work with solo group? How does that work?

    [00:25:57] Kelley Sonnenberg: Oh, yeah, yeah, we have practices with just 1 clinician who are part time seeing a couple of patients to group practices with 60 providers.

    [00:26:07] Kelley Sonnenberg: So we're kind of, you know, everywhere on that scale. Yep. Yeah. Yeah. Okay. So how does

    [00:26:13] Whitney Owens: that work financially for a practice owner if they were to hire out practice solutions to do their billing? Like, um, is it like a percentage or how does that work?

    [00:26:21] Kelley Sonnenberg: Yep. So we charge a percentage on all collected insurance revenue.

    [00:26:27] Kelley Sonnenberg: So if you hire us out, we do your insurance billing. You know, we won't touch on the private pay clients. Because we didn't bill for them. So we would only charge on the insurance patients and just a percentage of the revenue there.

    [00:26:39] Whitney Owens: Great. So basically you only get paid when I'm making money. Exactly. We get paid after you guys get paid.

    [00:26:46] Whitney Owens: Yep. That's how I like it. Great. Was there anything else that we missed out as far as the nuts and bolts of insurance billing and

    [00:26:54] Kelley Sonnenberg: denials? Yeah, so that's kind of covered the credentialing portion, and then so now I'm going to kind of talk a little bit about that insurance contract. So after you're credentialed, you're going to get your contract, and this is very important because your contract is going to house a lot of information that you're going to need to know moving forward into your billing.

    [00:27:15] Kelley Sonnenberg: So the first thing in your contract here that I always look for is the timely filing limit. As this will play a big role in claim submission. Timely filing is the amount of time you have from the day of the appointment to when you submit the claim. And if you submit the claim after the timely filing date, you'll no longer be eligible for reimbursement.

    [00:27:35] Kelley Sonnenberg: So, and this can really range anywhere from 90 days to a year, all dependent on the insurance company. Contract there. So just really being aware of those limits and completing notes, which is a big thing and being able to complete those notes on a regular basis and kind of having a good system in place for that.

    [00:27:55] Kelley Sonnenberg: A lot of times I see providers get so behind on their notes. And they accumulate very quickly. And so you kind of hit and then you hit the deadline there and you're kind of losing out on on that revenue. So, you know, you worked hard for those sessions. So make sure, you know, you have a good system for your notes there.

    [00:28:13] Kelley Sonnenberg: That's so important. Yeah. Yeah. And the next thing in the contract that I would look for is your fee schedule. And your fee schedule is going to tell you which CBT billing codes that you can use and what you're going to get reimbursed for, for each of those. A lot of time providers ask, like, can I do group therapy or psych testing?

    [00:28:34] Kelley Sonnenberg: And You can if it's in your contract and on your fee schedule, you know, if they have that CPT code on there, then you'll be able to do it and be reimbursed for it. So it's definitely important just to know what's in your contract, know what to look for in your contract and make sure that you house it in a safe space that you know how to access it.

    [00:28:58] Whitney Owens: Definitely.

    [00:29:01] Kelley Sonnenberg: Yeah. Um, so yeah, that's kind of it for the credentialing and insurance contract portion. And I can definitely get into denials, which is I get asked very frequently, you know, what are what are the most denial reasons that you get? And it's it's so hard to answer that sometimes because it's so variable by by each provider and payer.

    [00:29:24] Kelley Sonnenberg: And, you know, denials can happen for provider. In a variety of reasons, ranging from easy fixes to more complex solutions. And just know, though, it is not a reason to panic. It'll be okay and get it figured out. Um, so to start with the denials here, you'll kind of want to 1st understand why They denied, you know, what was the reason?

    [00:29:46] Kelley Sonnenberg: And I would always reference your explanation of benefits, which is going, you know, the insurance company will provide you that. Sometimes it's an easy fix and it's very clear on that EOB, you know, the date of birth for the patient was incorrect. Like, okay, I can easily fix that. Go back to the patient.

    [00:30:03] Kelley Sonnenberg: Sometimes it's a little more unclear or ambiguous, something like invalid places, service modifier, procedure code, and kind of like, Oh, what does that mean? What do I have to fix here? So, um, I always recommend just talking directly to a claim specialist at the insurance company for more information on what the denial entails and then also how to fix it too.

    [00:30:26] Kelley Sonnenberg: So it might be something, you know, you denied for credentialing reasons and or a process out of network, but you're are in network. So really just going to be on the phone with the insurance company for that one, trying to figure out what's incorrect, what's not on my claim. And this is also to the benefit of, of outsourcing or hiring out your billing company, leave us to talk to the insurance companies.

    [00:30:49] Kelley Sonnenberg: I like to think of it. You know, we're kind of in this battle between provider and the insurance company and the billers, the one in the middle fighting for the provider and to get them paid. And so we're your roar. You're out there.

    [00:31:01] Whitney Owens: I like that.

    [00:31:03] Kelley Sonnenberg: Yeah. And sometimes it's the patient information. Like I mentioned, the date of birth is incorrect or the address is incorrect.

    [00:31:11] Kelley Sonnenberg: And so that's a pretty easy fix. I always recommend to collecting the Back and front of the patient's insurance card so that you know the exact number for the patient's plan, what kind of plan they have, um, and really able to connect with the insurance company streamlined rather than calling, you know, 10 different numbers for Blue Cross Blue Shield.

    [00:31:34] Kelley Sonnenberg: Blue Cross can be that way. Yeah, they all can. So, there's also additional denial reasons outside of credentialing or patient information, such as prior authorization was required, or a maximum visit limit reached. So, just really checking your patient's verification of benefits. We always recommend doing that, running that check before you see the patients and the verification of benefits will tell you, you know, how much your patient owes.

    [00:32:02] Kelley Sonnenberg: Are they eligible to be seen by you? Is this a plan that you accept? Do they require prior authorization? I'm just getting all that information prior to seeing the client or prior to submitting the claim will really help you limit any denials that may arise in that category.

    [00:32:22] Whitney Owens: So how do I do all that?

    [00:32:24] Kelley Sonnenberg: Well, that's a great question. Um, you can do it on your own. So, like I said, collecting the patient's insurance card, it can, you can, you know, take the back of the card and call. Usually there's a mental health and substance abuse number on the back of their card and calling that directly, speaking with the representative, asking them those questions.

    [00:32:44] Kelley Sonnenberg: Also, you could use, um, payer portals. So, For example, and, you know, at our signal, they all have a portal online where you are able to run eligibility and benefit checks. Um, there's also 3rd party portals, such as a validity. And that's the big 1 that we use a lot of insurance companies are connected to a validity now and in any state, actually.

    [00:33:06] Kelley Sonnenberg: And so you're able to pull up the benefits there as well. Perfect.

    [00:33:14] Kelley Sonnenberg: So, like I said, you know, denials, they can be easy fixes, or there can be more complex denial management really just depends on what the reason is and and really discovering the issue there. So, ultimately, they're an inevitable part of the billing process. But with the right knowledge and time, you can resolve them.

    [00:33:34] Whitney Owens: Yeah, great. And what are some of the other pitfalls that we have? Yeah.

    [00:33:41] Kelley Sonnenberg: So the last one here, the last pitfall is realistic time management. You know, there's only so many hours in a day and a lot goes into managing a practice. No, everything is going to take time. So either setting aside time to dedicate to each activity or delegating to a specialist in that area.

    [00:34:03] Kelley Sonnenberg: Yeah. You know, as we discussed earlier, credentialing itself, that's going to take time just from gathering the right information, filling out the paperwork, and then waiting for it to process. Like I said, it takes 3, 9 months, a year. It really just depends, you know, once the credentialing is done, you're, you know, you're done.

    [00:34:22] Kelley Sonnenberg: able to see the patient, you'll have the intake process. So answering patient requests, scheduling the appointments, having the intake paperwork. Um, you can definitely do it on your own, you know, if you have the time, but as your practice grows, it may be a worthy investment to bring an admin in just to take these tasks off of your plate.

    [00:34:43] Kelley Sonnenberg: And next, so after you, you know, schedule and see your patients, you'll have those clinical notes and then in relation to the timely filing, you know, you only have a certain amount of time to complete those. So making sure you have a good schedule and system in place for that. Um, and then the last part to the billing itself, that's going to take time from claim processing.

    [00:35:05] Kelley Sonnenberg: Which can take anywhere from, you know, week to 4 weeks. If they have a secondary, it's going to take longer because you have to submit to the primary 1st. It's just important to keep in mind too, for cash flow purposes and then the denial of reconciliation, you know, figuring out why tonight. How do I resolve it?

    [00:35:22] Kelley Sonnenberg: And really, the ultimate solution here is you can do it on your own if you have the time or build out the time. Otherwise, we always recommend. You know, hiring out, let, let a specialist do it in that area so that you can focus on your patients and what you do best.

    [00:35:40] Whitney Owens: Yeah, this has been super informative.

    [00:35:44] Whitney Owens: Thank you so much. Yeah. Okay. So if somebody is listening and they're thinking, man, I want to find someone to do this for me. What is their next steps?

    [00:35:57] Kelley Sonnenberg: Yeah, so the next steps I obviously I would reach out to practice solutions. We can help you, you know, you can have a free consult with our sales rep and kind of talk through is this the best fit for you?

    [00:36:07] Kelley Sonnenberg: Are we the best fit for you? Um, you know, what, what do you need help taking care of in your practice? Is it the claim processing, the denials? What can we do to help take that off of your plate? And so just, you know, finding A company such as practice solutions that would be able to handle those tasks that you're not equipped to and and give you time back.

    [00:36:31] Whitney Owens: Great. This is fabulous because I think a lot of people need this service. Um, so as far as, um, scheduling that billing consult, y'all gave us a link here. It's practice soul. So that's P R A C T I C E S O L dot com, practice soul dot com backslash was. And if you go there, you can fill out their form and get that free consult call to look at your practice and get that feedback that's going on.

    [00:36:58] Whitney Owens: And then you're offering us. Special deal here for a wise practice listeners. Correct? Absolutely. Yeah. So they're offering 15 percent off your first 3 months of billing on practice solutions. So thank you for that deal. Yeah, you can't beat them.

    [00:37:15] Kelley Sonnenberg: No, no, that's a good 1. I don't think we've done that before.

    [00:37:17] Kelley Sonnenberg: So,

    [00:37:18] Whitney Owens: well, thank you. Well, and, and we didn't really talk about this at the beginning, but just to also say, even though I'm meeting Kelly for the 1st time here, which now I love to pick in your brain. I also know Jeremy who owns practice solutions is a friend of mine, and we've known each other for. And I'm at 5 plus years, so really excited to be partnering with practice solutions to practice solutions will also be at the wise practice summit.

    [00:37:42] Whitney Owens: Are you are you you're going to be there? Right? I will be. Yeah. Okay. Yes. So there are 1 of our top sponsors at the summit this year. So that's going to be in October. The. through the 5th of 2024 in Charlotte, North Carolina. So if you are going to already going to be there, then you definitely come talk to Kelly and get some help.

    [00:38:02] Whitney Owens: And then if you haven't bought your tickets yet, you should, you can go to wisepractisconsulting. com. Slash I think it's summit dash 2024. Just go to the website. You'll find it and grab a ticket. But we're gonna have a lot of really good vendors just like practice solutions to be able to sit with you.

    [00:38:17] Whitney Owens: There's just something you can do those consult calls. And those are great, but there's something about being with people looking at things together and talking through it to really, like, get your hands dirty in a good kind of way.

    [00:38:30] Kelley Sonnenberg: Oh, yeah. We are so excited to go and to help as many people as we can. So we will be there.

    [00:38:38] Whitney Owens: Well, we appreciate all this, the deals and the special information. Is there anything else that we missed out on today? I want to make sure to mention.

    [00:38:45] Kelley Sonnenberg: No, I think that was everything. I'm sure there's, there'll be more questions. So feel free to give us a call and we can talk through it.

    [00:38:52] Whitney Owens: Great. Great. And so if you have questions for practice solutions, again, that's practice soul.

    [00:38:57] Whitney Owens: com backslash wise and Kelly. Thank you. Thank you.

    Take care.

    [00:39:21] Whitney Owens: Special thanks to Marty Altman for the music in this podcast. The Wise Practice Podcast is part of the Sitecraft Podcast Network, a collaboration of independent podcasters focused on helping people live more meaningful and productive lives. To learn more about the other amazing podcasts in the network, head on over to sitecraftnetwork.

    [00:39:41] Whitney Owens: com. The Wise Practice Podcast represents the opinions of Whitney Owens and her guests. This podcast is for educational purposes only, and the content should not be taken as legal advice. If you have legal questions, please consult an attorney.



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