When we have our own speech therapy private practice, we work for our patients. In order to stay in business, we must receive patient co-pays, deductibles and co-insurances as payment at the time of service. If claims are to be billed out to TPL, Medicaid or Medicare, these claims must be timely and clean in order to adjudicate appropriately. However, in this podcast you will discover that in spite of doing things correctly, insurance companies continue to be notorious for denying and delaying claims, and generally use tactics so that your business won’t get reimbursed for services that you provide. In this episode, I expose some of the reasons why insurance companies delay or deny claims and offer suggestions on how to mitigate these delays.
In this episode:
02:00 – Shout out to the California listeners!
02:25 – The Perfect Student
02:45 – All Access Membership community,
03:35 – Insurance Payment times differ from Payday time,
03:47 – Hurricane Katrina and insurance nightmares,
06:22 – Cash and the lean machine,
07:15 – Decreasing debt, expenses
08:02 – HCFA 1500 forms
In order to stay afloat and to stay profitable, you must run a lean business and stay out of debt and make your expenses on a monthly basis. What are those expenses? Electricity rent if you have insurance, Professional general liability those are expenses and whatever you have left over is a profit.[Commercial]
Hello everyone you’re listening to the Speech Therapy Private Practice StartUp Podcast. This is episode number 40. My name is Kyle Meades and I’m a speech pathologist since 1993. And these podcasts are designed to help you improve your business and your life one Podcast at a time.
Welcome back to the show everyone. Thanks again for all the emails, all the questions and as of today, Today is Saturday June 16 2018. We have well over 34,178 listeners to the show. And I’m super delighted you guys are out there getting good free valuable information and I’m going to say it every single podcast. Value is what you get in the absence of money and these podcasts are free for you so if you wouldn’t mind please go to the IOS or the Android platform of your choice and leave some good 5 Star feedback that way other people can get the same valuable information. Now when you go to the demographics and look at the world view most of our listeners a majority of our listeners are coming in from the United States. Then secondly we have Japan, Australia, India, the UK, Canada, Germany, the Republic of Korea. And then lastly is South Africa. And when you break the demographics of the United States as a whole you’ll see that California topping the charts. Then we’ve got Texas, Florida, New York, Arizona, Illinois, New Jersey, Georgia and then Pennsylvania.
If this is your first podcast welcome to the show, if there’s anything that you would like to talked about on the Speech Therapy Private Practice startup Podcast, shoot me an email firstname.lastname@example.org. Also want to tell you guys I have a space available for the Perfect student. That’s when you can fly in and work with me hand in hand and we will get you credentialed, ready to Bill and help you set up. You’ll have coaching calls with me, work with me here live in Tucson, Arizona. We will help you grow your own Speech Therapy Private Practice. But a lot of people reach out to me and they say they just simply don’t have the time. So I do have an all access membership community and that’s where you can log on and you have direct access to me. There’s a private coaching section in there, there’s tons of threads on billing, collections, How to Start grow scale your own Speech therapy private practice. We have monthly trainings, webinars, those are transcribed into PDF format. They have audio formats for you to listen to, video formats or you can watch those. So there’s a lot of information in there and that’s available at www.privateslp.com/coaching. Now when you go to forward slash coaching you might see an “Apply” button there or the membership may be open or close but you can go ahead and click that button and leave me your name & details and I’ll review your application.
So today I wanted to speak to you guys about Insurance time. Now what is insurance time? I can guarantee you that your Insurance time is different than your Paycheck time. Now what do I mean by that? Insurances have their own set of rules. They have their own time that they pay you on.
So here’s an example I remember after Hurricane Katrina. We had some leaks in our roof and we just didn’t have time to sit down and call the Insurance company. The insurance companies were inundated with phone calls. I remember the guy who came out to adjust our home and look at our home for our insurance company. He was called out of retirement. He was retired Airline pilot and he was also an Insurance adjuster on the side so I remember climbing the ladder and getting on top of one of these big duplexes in New Orleans. I don’t know for those of you who grew up in New Orleans or been around duplexes. The duplexes in New Orleans are kind of like a shotgun house but they have two stories and then this huge roof. And it’s way high up but I got on the roof with him and walked the roof and I was talking to him and he was just telling me they’re so backed up on these insurance companies. They just simply couldn’t handle the volume of calls. People who were calling in distress it’s Hurricane Katrina. People’s homes were flooded, their roofs were destroyed, their houses were gone and here I am just trying to get my roof taking care of.
But I remember when Hurricane Katrina happened the very next day I was able to call a friend of mine. He was a contractor and I said “Hey, I need two roofs. What can you do for me?” He says how you pay and I said cash. And he said “I’ll be out there next week” and I said “I appreciate it”, and I’ll never forget we had a team of roofers on one house and then two days later they’re on the second house and it was ready it was a done deal. I think the total for each roof was about twenty seven hundred dollars each and I had cash in the bank and I was able to deal with the insurance company later. And so again think about what I just said, when you’re dealing with insurance companies you’re going to have to wait. Think about a natural disaster such as Hurricane Katrina you got all those people trying to call insurance companies, they’ve got a skeleton crew answering the phones and they got people who they’re hiring temporary employees to go adjust homes and it was really crazy.
But the takeaway that I learned as I was looking when I walked that roof I saw all those people waiting. They had blue tarps I don’t know if you google “Blue tarps New Orleans Hurricane Katrina”, You’ll see what I’m talking about. Tons of blue images just people who wanted to keep the rain out of their house they put tarps over their roof. And I didn’t have to do that because I was able to pay cash and get my service immediately. So what’s the takeaway from here. The takeaway here is have cash in the bank for a rainy day. Go figure “Hurricane Katrina Rainy day”, you get that. So have cash in the bank so you can stay operational.
Insurance time is completely different than your Payday. When you’re employed you’ve got a paycheck every two weeks or every other week or by monthly you might be a salary employee or an hourly employee or you might have a contract but you’re going to get paid. But with insurance companies it’s not set like that when you work for yourself you’re employed by your patients and ultimately their payments to you whether that’s a cash rate or it might be a copay towards their insurance or a deductible towards their insurance or it might be that actual payment from Insurance companies. But in order to stay afloat and to stay profitable, you must run a lean business and stay out of debt and make your expenses on a monthly basis. What are those expenses? Electricity rent if you have insurance, Professional general liability those are expenses and whatever you have left over is a profit. Now in order to maximize your cash flow you have to realize that insurance time is different from your time or your pay time. So you’ve got to have money in the bank so you can get paid and so you can sustain your business.
You’ll get your payment hopefully if you do it right with insurance companies and we do talk a lot about that in the All Access Community, how to bill and collect from insurance companies. But when you deal with Insurance companies you have to put all the information for each claim on a form and that form is called a HCFA 1500 form. CMS – The Center for Medicaid services, they have an official standard form that’s used by physicians or speech occupational physical therapists. When you submit a bill or a claim for reimbursement to Medicare, Medicaid or even private insurance companies, that form is called a HCFA 1500, and HCFA just stands for Health Care Financing Administration. It’s a standardized form and when you fill that form out it’s got to have other appropriate patient demographics, that diagnostic codes, CPT codes or pick codes all those codes go on that form and then it’s sent to the Insurance company for payment.
Now you have to submit a clean claim in order to get paid or let’s say someone has Medicaid for instance, if they have Medicaid and then they have a third party payer like a private insurance company like Cigna, UnitedHealth or Blue Cross you still have to submit a clean claim to the Medicaid company in order to get payment or you have to submit a clean claim to the third party liability company. Normally when it comes to Medicaid though the state always wants to be the payer of last resort. So you will bill the private insurance company, first submit that clean claim, get the denial then send that denial. If you still need to get paid to the Medicaid companies. So it’s a tricky process but you’ve got to have cash in the bank in order to avoid delay. Now when I talk about delay I mean delay. We’ve seen it all with Speech therapy private practice and our company therapy group of Tucson in Tucson, Arizona. We see a lot of kids and adults for treatment with communication disorders and we bill all day long. But that doesn’t mean we get paid all day long either.
We call and follow up on the claim a couple days to a week later and they’ll say, “Oh, we didn’t receive it”. Even though we filed electronically or sometimes we send certified mail to the insurance company because some of these companies they want documentation they want certain things. Different payers require different items to get a clean claim and so sometimes we’ll send a big stack of notes with a certified mail so we can track it and they’ll say, “Oh, we never received it”. So some of those insurance companies they make it up. They have their delay tactics to avoid making that payment. So again go back to the Hurricane Katrina and the Blue roof theory. You’ve got to have cash in the bank and if you’re borrowing that cash from the bank you’re working for the bank you’re not even working for yourself.
So don’t forget Insurance time and Payday time are two totally different things. Talking about clean claims, denials, insurance, billing and HCFA 1500 forms that’s something that we do all the time in the Speech therapy All Access community at www.privateslp.com.
So I hope this has been a good informational podcast for you guys and if you have any questions, below this podcast you’ll see a place for questions. So please don’t hesitate to ask if there’s something that you’re looking for that you’re not seeing on our podcast simply shoot me an email email@example.com and as always thank you for listening.