Billing and Reimbursement: Part I

Today, we're kicking off a 2-part series about reimbursement and billing. Check back on Wednesday for Part II. 

The amount of work that goes into managing your practice's billing can be daunting. The process of contracting, filing claims, and receiving reimbursement is very involved, and extra care must be taken to ensure accuracy at every step. To add to the chaos, the insurance jargon at every step certainly doesn't make it any easier on you! Luckily, Healthy Bytes has a dedicated team of experts ready to assist you with any billing questions or issues you may have. 

Outsourcing Billing

First things first: who is going to do your billing? This decision will depend on a number of factors, including your patient volume, your level of comfort with insurance companies, and the amount of time and resources you're able to dedicate to billing. If you decide to outsource, our team will get you set up with everything you need to maximize the chances that your claims are accepted on the first try. 

What to Charge

You may also have questions about your rate. Insurance companies often speak about covering a percentage (sometimes 100%) "of the allowable amount" and "medical necessity." But how do you know what the allowable amount is? Well, after a long process to become an in-network provider, that value will likely be communicated to you. You must then decide what to charge your patients based on your geographic location, specific expertise, and experience. Another consideration is how to manage discrepancies between your rate and the allowed amount. Please note that Healthy Bytes does not recommend balance billing, or charging your patients the difference out of pocket. 

Visit Units and Limits

Alleviate potential confusion by knowing how to bill using units. According to most insurance companies, a "unit" corresponds to 15 minutes of patient contact. But we all know that appointment length can vary. For this reason, it's important to always have an idea of your patient's eligibility before meeting with them. Some plans set visit limits based on unit, visit, or hour within a certain timeframe (usually per year, but sometimes per lifetime) or give the caveat that this limit is based on medical necessity, which may mean that they will request additional documentation at some point. 

How to Charge

Once you've seen your patient, it's time to submit a claim. This will include filling out a report with billing codes to detail the purpose of the appointment, as well as its duration and outcomes. This can be done through the Healthy Bytes website, and our team will make sure to send it in promptly. We also take care of demystifying the codes for you and adding any modifiers for telehealth appointments.

Did we help clear up the process of reimbursement? Check back on Wednesday for Part II, and please comment below about your experience with reimbursement and billing!