Taking Insurance for SLPs and OTs: What Are My Options?

Taking insurance is a great option to grow an independent practice! It opens your practice to new families and helps you fill your caseload with a more reliable client base. It all sounds great, but you might be wondering, where do I start? When it comes to taking insurance, you have a number of options: 

1. Do it yourself
2. Hire an assistant
3. Work with a Revenue Cycle Management (RCM) company
4. Work with a company like Beaming Health

Here’s what each one of these options entails and what option might make sense, based on the scale and size of your practice. 

Option 1:

Do it Yourself 

If you’re feeling courageous (and have an abundance of patience), you might be able to handle all of the insurance-related tasks yourself. Full disclosure, this will entail quite a bit of work: 

• First, you’ll need to go through the credentialing process with the insurance company by submitting a number of forms to a general “point of contact” email. Instructions vary by insurance company and what is listed online might be an out-of-date process. You’ll want to follow up with multiple people in order to ensure that you’re in the right place and your application has all necessary information. This process can last anywhere from 3-6 months, depending on the insurance company.  
• Next, you’ll need to learn how to fill out a CMS-1500 form. This is how you’ll submit claims to the insurance company for reimbursement. The CMS-1500 form requires specific information about each client and your treatment including ICD-10 diagnosis codes, CPT codes, and location-based modifiers.
• Before seeing a client, you’ll want to do a benefit eligibility check for each new client to ensure that treatment is actually covered under their plan. You’ll also need to submit the appropriate paperwork to get an authorization on file before starting services. Note: Make sure to keep a record when the authorization expires or if there are any visit limits to keep track of, if you go beyond an authorization date or visit limit, a claim will automatically be denied. 
• After you complete a session, you’ll be in charge of submitting claims to the insurance company. If you take multiple carriers, this often means using multiple systems. We’d recommend using a clearing house like OfficeAlly to verify your claims before they are sent to a claims department. 
• Once you submit a claim, you’ll likely wait anywhere from 3 weeks to 4 months to get paid. You’ll want to keep track of these payments. Sometimes, the insurance company will say they paid you, but you never receive a check. Other times, they might randomly pay you less than the agreed upon amount. Or, they might deny the claim straight away! If issues arise, it’s up to you to speak up. 
• For any issues that arise throughout the process, you will need to reach out directly to the customer support team at the respective insurance company. Buckle up! This can be a patience-testing experience with significant time spent on hold or being transferred between departments.  

When taking insurance, doing the administrative work yourself is a good option if you’re just starting out. It allows you to understand the process first-hand and you can drop at any time. But, be careful, you can quickly get sucked into an insurance black hole and take away precious time from doing what you actually want to be doing, seeing patients. 

Option 2:

Hire a Billing Specialist

If that last section was exhausting, you might consider paying someone to do all of it for you! Hiring a billing specialist can help take some of the work off your plate. There are many people who have experience in this field. They might have: 

• Worked in a billing department at a major pediatric hospital 
• Worked as an administrative assistant at a large clinic that accepts insurance
• Worked on the other side of things, processing claims for an insurance company 

Hiring one of these people can bring much-needed expertise to your team and allow you to focus on more care. Of course, there are a few drawbacks: 

• Hiring a staff member who isn’t providing care can be expensive as a small practice. You’re making barely enough to support yourself, it can be difficult to imagine supporting a second person's salary! 
• For a salaried employee, it can be difficult to weather the changes in your practice. If your caseload dips in the winter months from 20 families to 12 families, you’ll still pay the billing specialist the same amount. 
• Having more expertise on your team won’t erase all the insurance issues. Claim denials from insurance unfortunately still happen regardless of how good your specialist might be. It’s estimated that 17% of all claims get denied, which means there will always be a subset of sessions you’ll never get paid for. 

For these reasons, hiring a specialist on your team usually only makes sense for large, established clinics. With multiple therapists under one roof, you can be more confident that the specialist will be worth the investment and you have a little bit more money in order to pay them.    

Option 3:

Work with a Revenue Cycle Management (RCM) Company

Have you been bombarded with calls from companies promising to get you in-network with insurance for a small fee? These are likely coming from RCM companies, looking to help you submit claims in return for a processing fee. They often have an upfront offer to credential you with insurance (e.g. $100-$150 per insurance carrier) and will submit claims on your behalf for a 4-5% fee per claim. These offers can sound appealing at first, but a few things to know: 

• These companies are often very responsive up until the point that you sign up and pay the $150 fee to start with them. After that, when you actually need them, their responsiveness tends to go out the window. 
• While they can help filling out the CMS-1500 form, they make no guarantee that your claims will get paid. If a claim gets denied, they often just move on. 
• These companies are limited in scope. They’ll handle filling out claim forms, but you’ll still need to do benefit eligibility checks and keep track of visit limits. 

In some cases, these RCM companies can be helpful if you have no idea where to start and you are unclear about your options. But be wary of their aggressive tactics that will get you in the door, only to find that no one is home. 

Option 4:

Work with a company like Beaming Health 

You might be thinking, is this it? Are these my only options? That’s how we felt when we created Beaming Health. We wanted a better option for independent providers who want to take insurance, but don’t want to deal with the headache. Here’s a bit about us: 

• Beaming handles everything insurance-related from negotiating rates to credentialing to authorizations to billing. 
• We guarantee payment for every completed session and pay out on a bi-weekly basis always within 6-8 weeks. 
• No credentialing fees, no billing fees and the reimbursement rate that we share with you upfront is what you get paid regardless of what happens with the insurance company approving or denying the claim (we take on the risk). 

You can get the benefits of increased client flow through insurance without the back and forth with insurance. To learn more we’d love to talk with you.