Insurance Reimbursement Tips for Your Private Practice

An important step in maximizing insurance reimbursements is to, every year, download your fee schedules from every insurance company you work with. At ABC Pediatric Therapy, I was a provider with every insurance company in our area and I made sure to download the fee schedule for every one. 

You can access your fee schedules from your provider portals. Therefore, you need to know how to use your insurance company’s websites and the provider portals. You also need to know where your newsletters are on those websites and then read those newsletters because there’s data in them that you’re responsible for knowing. 

Once you get your fee schedules, make sure you are familiar with their fees. Compare your prices to their fees to ensure you’re getting paid at the correct rate. 

Organize Your Insurance Contracts

You always want to have ready access to all your insurance contracts. If you just came in network with a provider, you have an insurance contract. If you’re still working with paper contracts, you want to put together a binder of all your insurance contracts. 

If you’re working electronically, assemble a folder of all your insurance contracts so you know your pay arrangement with each insurance company. Usually, they guarantee you payment within 30 days. Some might extend that to 45 days.

Keys to Making Sure You Get Insurance Reimbursements

There are a few important points to making sure you get prompt reimbursements. 

1. I learned through the Effective Reimbursement Program from Survival Strategies that claims need to go out within 24 hours. Therefore, our claims for Tuesday went out by noon on Wednesday. For an appointment late on Tuesday, a claim would go out in less than 24 hours. 
2. All documentation needs to be done by noon the next day as well. Some EMRs allow you to send out a bill without the documentation being completed and some don’t. When we had an EMR that allowed billing without documentation, we gave our staff a little more time to get their documentation done. But for those EMRs that did not allow us to send a bill out without that note closed, staff had to complete the documentation by noon the next day. 
3. You have to make sure you know you’re getting your invoices out correctly the first time. That’s a key part of making sure you can collect on that claim.

Working with Insurance Companies to Get Your Payments

You need to be aware of how long your insurance companies take to pay. For example, Anthem Blue Cross Blue Shield in our area took about 28 to 30 days to pay. With Humana, our contract said 30 days, but they tended to pay in two weeks. If I wasn’t getting a claim with Humana paid within two weeks, that was a red flag to me that there was a problem somewhere. 

You have to know both your contracts and the usual patterns of payment from your insurance companies to be certain you’re going to get insurance payments in a timely manner.

Handling insurance is challenging, I know! To build your skills, visit our Lemonade Library to review past webinars to learn about billing, collections and much, much more!

About Diane Crecelius

Diane Crecelius is a physical therapist and founder of a multi-million-dollar, multi-location practice with well over 3,000 visits per week and 200 staff! In the past several years, Diane has worked tirelessly to support the Peds-A-Palooza group and the success of Private Practice Owners. Diane has presented at nearly every Peds-A-Palooza live and virtual conference since the first sold-out conference in 2018. Her extensive knowledge derives from her decades in practice and from being trained and consulted by Survival Strategies, Inc. She uses this training to help Private Practice Owners learn how to thrive and expand while keeping their stress low.