Insurance Considerations

Video Transcription

[MUSIC PLAYING] Hey, me again. So this lesson will discuss additional issues that may arise between you and the insurance companies. The issues we'll address here are file auditing, rate negotiation, revisiting a biller.

EAPs, or Employee Assistance Programs, and insurance companies can request an audit of a single client record or of a set of records over a designated period of time. Audits are typically done to confirm that the case file and diagnosis of the client are accurate and complete. As a result, it's important to know if an insurance company or an EAP has special requirements for what is to be included in the medical record. It's best to avoid errors in the first place by being sure that medical records include all necessary components required by the insurance and the EAP.

So it's hard to say if or when an audit will occur as they tend to be randomly assigned. I've never personally had an audit request, but that doesn't mean that it won't happen or that I'm not prepared. If an audit does happen, typically a letter will be sent to inform you that an audit will occur on a specific date, giving you time to prepare, or, at least, that's what they tell me.

Different insurance companies pay different amounts per session. You'll want to get comfortable negotiating payment from the insurance companies. If you ask for higher rates, you'll need to give a rationale for why the payment should be increased. Reasons include advanced degree; specialization in a niche problem or treatment; acceptance of unique populations, for example children under 5 or adults over 65.

So I've asked for a rate increase many times from a certain EAP company that will remain nameless and only received one. And that was years and years ago. They still only pay me $50 dollars per session.

So I decided to stay with the company as a provider because they occasionally use me for CISM, or Critical Incident Stress Management, work, which is on-site counseling after some sort of traumatic event, such as bank robberies, employee death, natural disasters, or things like that. The company pays $90 an hour plus travel, making these gigs very interesting work and very lucrative, as well.

Billing can be complex, detail oriented, and tedious. Insurance companies have subsidiaries, subcontractors, changing policies, and changing systems for billing. They are typically chaotic organizations with an endless number of departments and employees often who don't know where to send you when you need help. Also, billing processes are occasionally in flux, and policies and procedures can change.

Because of these issues billing can be a hefty job, so you need to strongly consider how you will spend the hours of your day. As business grows, a biller may be essential due to time constraints. These folks generally charge 7% to 9% of the money collected. And office administration generally costs between $10 and $20 per hour. A biller or office administrator is generally worth the money paid and allows a counselor to do counseling instead of paperwork.

So here's what we covered in this lesson. First, file auditing. Next, rate negotiation. Revisiting a biller.

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