Brand Your Practice Podcast

Hello, everyone, and welcome to the Brand Your Practice podcast, where you get

to learn about marketing, growing and scaling your private practice. I'm

Brent Stutzman, and today we're going to be talking about how therapists can navigate

insurance reimbursement and get paid. We will walk you

through the insurance networks, how they work, and patients and

providers with patients and providers so you know

how to collect money from insurance companies, because that's what it's about.

You got to be able to collect that money, because a lot of times they hold it hostage. And

to help me do that is Jeremy's a co-founder of Practice Solutions.

Jeremy has over a decade of experience in the healthcare industry. He's

also known for his expertise in insurance billing and frequently writes

and speaks on topics that support mental health professionals, and

achieving financial health and operational excellence. He

co-founded Practice Solutions with his wife, Catherine, in 2017. He's

a dad of two awesome kids and one

on the way. Practice Solutions is an expanded medical billing

company offering billing services, professional services, and educational resources

to thousands of mental health and behavioral health care providers

for optimal revenue cycle management. Woo!

Yeah. I barely made it through it. Well, we're going to

be talking about how therapists can navigate insurance reimbursements and get paid.

But first, let me just say like a personal thanks to you because I feel

like you embody a servant's heart. And I say this because when

we hang out in conferences together in the vendor booth area and just talking to people, I

constantly see you connecting with practice owners and

giving them resources, either that's resources you've created or other

vendors that are in the room. You're just you are a connector and

you create these little pockets of community. So I've seen

you really become just a really wonderful resource, not just for the work that you

do, but kind of the mental health community at large. And

I personally benefited from that kindness and thoughtfulness as well. So thank

Yeah. Well, let's kind of, let's jump in. So

I'll, I'll let you take over and we can talk about how practice

Yeah, no, I mean, this is such a needed a needed topic. So

Yeah, sounds great. So, yeah, the way that

therapists can navigate insurance reimbursement and get paid, the

first first place to start is credentialing. Right. I

mean, if you're not credentialed with insurance companies, you're

never going to get paid. And credentialing is as we talk about

it on the company, it's like a game between

the private practice and the insurance company and

the way to even Like in our house we have kids right

so we play a lot of whatever that game is we have to roll a certain number

to get on the board. Trouble or sorry or one of those right. If

you don't roll the right number, you're not getting on the board. So credentialing is kind of like that,

right? That if you don't get on the board, you can't play. So

you got to make sure you get in network, right? So

that means filing your applications appropriately, following

up on them on a good cadence. And to us, we define

that as a two-week follow-up period. So make

sure you get credentialed, make sure you read over your contract, you

review the terms of that contract or have an attorney review

the terms of that contract. And you agree to a fee schedule,

right? A fee schedule that makes a lot of sense. So that's-

Okay. I'll give you the answer we tell people, and then I'll give you

the answer that's most likely to happen. So

we tell providers 180 days. That's

six months, right? Really long, right? And that's to set the

expectation for private practice owners and

group practice owners that this is not a fast process. This

is slow, right? Because insurance companies are

not going to fork over money just because you went to grad school and

got licensed, right? They're going to make sure that you are who you

say you are. So it's a long process. There's

Uh, the real answer like your licensure, your EIN numbers

It's like a total expanded background check, but they're

not only going to do that, they're going to check the

source. They're going to verify the sources that you send information from, right?

So they're going to like call your grad school, make sure you graduated.

They're going to call the licensing board, make sure that you're actually licensed and

not fabricating this information, right?

There's an actual stage of the process for every insurance company called primary

source verification. So they're really going to check. So

that's a really important piece of this process. But

the real answer, going back to timeline, is it's

probably closer to 60 to 90 days, maybe 120, but

we like to tell folks 180 just to set the expectation on

the timescale that you should plan for six months just in

case something goes wrong or the application gets

denied or they say the panel is

closed, right? And then you got to go back and argue. So you

And you also talked about attorney review. That's interesting. So

should an attorney review the contract from the insurance company before

For sure. Yeah. You want to make sure that the contract you're

signing is as

two ways you can get it right. And there are parts of

these contracts that you can negotiate, like

timely filing is a very common, commonly negotiable clause

of these contracts, but you want to make sure you understand that like, is

there a common clause in a lot of these contracts is

called a silence acceptance clause, which means that

they don't need you to agree to a term like updated terms

of service, right? They could give you an update and say, this is a

change that's coming and they will take your silence as consent, right?

That's a clause you want to make sure you understand that

if they change your fee schedule and they say, if

you have an silence acceptance clause, if

you don't argue with the fee schedule, they're just going to update it. You want

to make sure that's not necessarily in there. You want to make sure you're actually reviewing

the terms of these contracts. Otherwise, they could just change your fee schedule, like what

we're seeing in Indiana, for example. Carillon takes

over the management of the Anthem contracts. and

slices the reimbursement by 50%, 47 to

52%, right? That's happening right now in Indiana. And

a lot of those providers had a silence acceptance clause, and so they

can do that, right? And providers in Indiana

are having a little bit of a moment right now, Because

they're realizing that their pay just got cut in half. And so

you want to make sure that you're tracking this stuff. You're aware of

what's coming down the line. And if you're going to take a 50% cut

Is that like how long you're allowed to file a

Yeah, good clarification. So timely filing is like how

much time needs to elapse before the first submission

of a claim before the claim is no longer processable, right?

So oftentimes 90 days, but payers are

starting to walk this back 30 days, 45 days. Really

you should submit claims like weekly or bi-weekly just

on a regular cycle, like a machine. um

but payers will allow you to have more time and oftentimes you

can extend that time frame which i would recommend you do uh so

timely filing rate rate negotiation often happens right

away right it's Payers are far more

likely to negotiate rates on the front

end of a contract than they are after you sign it. Because after you sign

it, some payers are like, you have to be with us for two years before we negotiate rates.

So you should try to do that right away. The

Can I just ask Jeremy, is this like you're just having a conversation? with

somebody you were like having to go into the contract and like cross out

the $150 reimbursement and say, next, I want 175 or

Yeah. So you're talking with a person. There's a provider network consultant

that you're speaking with. And they have a

generally a lot of authority to change this stuff for sure.

Now there are some payers that just will say, we're not negotiating rates.

This is the best rate you got because we're the best rate around. Other

payers are different. So it's really one of those one

of those contingencies or clauses that

I think you should negotiate for. And can we just say this for a second? Cause

you're married to a therapist. Therapists often

undervalue their work. They don't ask for more. And

so I always advocate with therapists and

providers to say, ask for more, like for sure

So what can you do? Like what's reasonable then? Like, I

Yeah, here's what we're seeing a lot of, if we can talk about

current trends. Certain provider specialties right

now are commanding the room in terms of provider

reimbursement. So one trend we're seeing a lot of

is if you work with children or teens, youth, Generally,

that's an underserved population. And generally speaking, again,

these are broad strokes. Generally speaking, those folks

are able to command a higher reimbursement rate because networks are lacking providers

in those specialties across the country. Here's another one. maternal

mental health has become a hot topic. Again,

an underserved population like postpartum depression is

not a specialty that a lot of therapists are

in at the moment. And so there's a

provider we work with, a practice that, this was like the smoothest rate

negotiation I've ever seen. She approached a certain payer about

a rate and they gave her essentially everything she asked for.

And they just said, like, what is kind of what's

the range for something like that? Because I know a lot of therapists were like, well, look

at what's possible, like in that case. So

In that case, it was like low 200s for

reimbursement rates. And that's very high. I

mean, that's like very high. But

I've seen providers negotiate from like low 100s

or even like $80 a session to like mid 100s.

I mean, so I think you can. You can negotiate anything.

It is business. And so especially if you are serving an underserved

population, insurance companies have to

maintain network accessibility requirements according

to national quality organization standards. If

they don't meet that, they can lose their certification as

an insurance company. And so knowing those demographic

Okay. So we talked about negotiating rates claim.

I don't know, man, I'm learning so many words here that my

brains are going to, my brains are going to forget this. I'm

glad you clearly know what you're talking about. Timely

filing. Yeah. So definitely like have, yeah.

Any other things to, you would say, Hey lawyer, please negotiate on

Yeah. Those would be the, the, the things I would negotiate right off

the top. Also like termination, like make sure you understand the termination clauses.

Yeah. So you want to make sure that those are clear. Um,

but that's just like the, that's just the tip of the iceberg, right? So you're going to

get credentialed, get in network. And then once

you're in network, The way that navigating

insurance reimbursement and getting paid works is you have to

set up something called the revenue cycle or revenue cycle management within

your private practice. And that starts at credentialing, but

then moves to patient registration. So you

gotta make sure that when, and this is, I think, where TheraSAS comes

into play, right? That collecting patient

information is critical to

Yeah. Yeah. Like we have it on our, their SAS forms to be able to verify benefits.

They, they can submit insurance card images or

whatever, you know, to be able to, to verify that and get them in

Well, when I show people the demo on the form for their SAS, you

know, they're like, oh, you can do that. And so a lot of times people just

have you upload the card because they type it in wrong all the time.

And so if you at least have the card, you can at least have

Oh, it happens more often than you think. Like we see dates of

birth wrong. Yeah. There are certain cultures that

like like for like immigrant populations, first generation

immigrants that come here, sometimes they write their names different on

forms. I know that seems kind of odd, but that

And so creating a unified process that gets

Name, date of birth, everything right at the front end is extremely important.

And then, yeah, eligibility benefit verification is extremely necessary

after that. And then for for us on our novel

way of doing this stuff is we don't go straight to claim submission. We

actually start at payment posting. So if you start at payment posting, you

Yeah. So payment posting is like the, we start with the, at

the end of the process for a lot of folks. So claim submission

is like, I got this claim now I got this patient and I've

done my, I've done my note. I have a claim. Also do your notes

please. I mean, it seems like you wouldn't need to say that, but

I mean, you got to get your notes done to generate a claim. But,

and then I send my claim off to the clearing house. The

clearing house turns it into a machine readable file that the

insurance company then processes. That's claim submission. Payment

posting is we've gotten payment for a service and now I'm going

to apply that payment to a record in my EHR

system. Because they don't pay you, insurance companies don't pay you

in like individual checks, they pay you in batches. And so you

take this batch of let's say $5,000, but that $5,000 represents 40 sessions.

You got to know where to apply that. But

what you do is you catch denials at payment posting so that you don't

submit a claim that's going to result in another denial. If

you just go from eligibility and benefits to claim submission,

you might be filing a dirty claim and

just wasting a bunch of time. So if you go to payment posting,

you can catch all that stuff. Then from payment posting, you

go to like aging follow up. And most practices have a

balance, right? Aging claims age.

And then you clean all that up. And then you can go to claim submission,

where you file a claim. And you know the claims you're going to file are

clean because you've done the hard, gritty

work of working through an aging report. And

so you've got to set that whole system up in order to get

paid by insurance companies. Otherwise, you're

It's complicated. I

Susan's all cash, right? Yeah. Remind me again. You guys are just cat,

Like session payment, charge

money in the bank. Right. No, but you know, we have mutual clients

that like the payment process, all that stuff, it got really dirty.

Like it got, it got crazy and they get paid for weeks. And

you know, even my, the marketing clients and the practices that I helped launched

a couple of them are, have one or two payers,

right? They contract with them. But

like 80% of the conversation is around insurance

money and reimbursement. How do we get the money? Like, what's wrong? Why

is this not, why is it, you know, like a lot of the conversations just

revolve around that all the time. So, yeah.

Revenue cycle management and navigating insurance reimbursement and

getting paid. is only easy if

you have the right orientation, right? The

processes themselves are not particularly difficult.

They become difficult when you don't have the right direction. Does

that make sense? It's probably similar to marketing. It's

like, what's marketing? Every time you ask a marketer what marketing is, they kind

of go like this. They go, well, It really just kind of depends, right?

It depends on what your goals are. What do you want to accomplish? There's

no unified theory of marketing as

Yeah, yeah. It can be a lot of different things for people. Like I

said in my talk, marketing is

Yeah, that's right. That's right. Billing is

like you have to have the right orientation in order

for it to become easy and get paid. Right. And

it depends on what role you want insurance to play in the life

of your practice. Right. Like if you love

working with active duty military people, you should be

in network with Tricare just as like a broad strokes

piece of advice. But the reimbursement from Tricare might put

you out of business. Right. Like going

back to the Indiana example, if they cut your rates by 50%, you

So you either are going to make a mission driven decision

around which payer to accept. And at

the same time, you have to know what is going to

run your economic engine so that you can keep the doors open.

So for like Susan's practice, for example, if

she was like, Jeremy, we'd love to be in network with insurance. I

would ask her why. Not in like a, well, that's a dumb idea.

But what is the purpose that insurance company status

in network insurance company status is doing in the life of your practice? Is

that mission driven? Is it economic? Is

it a passion? What is it? And how are you going to know? if

being in network with an insurance company is a

good idea, right? So you gotta start there first,

and then you gotta build the systems next, and then you can see

Yeah, yeah. So we talked, yeah, so we're

Billing. Yeah. And then we were also talking

a little bit like the system by like the different steps with that. It

sounds like there's 100,000 of those. And then, then

you have like common roadblocks to reimbursement. I

know that was something that we were planning to talk about some like problems and

solutions. What are you seeing there? We talked a little bit about the

That's right. So common denial reasons. So

well, first, let's back up. So when you submit a claim and it goes

to the clearinghouse, one of two things happens. One,

the claim can get rejected, which means The

claim never got to the payer, to the insurance company. The

claim went out of your electronic health record system. And

the company that's in charge of taking a claim file

and converting it into a readable format for the insurance company saw

something wrong and said, usually these are demographic issues.

So a rejection is like, you spelled Brent wrong.

or you got the date of birth wrong, or the address is wrong, or we don't

have the NPI on file. Those are generally very easeable,

The whole goal of a clearinghouse is really just maybe clearing, to clean it

up, right? To just kind of clean up that data, check to make sure

it's right before they go bugging the insurance company to

That's right. They're like a middleman. between the

Does the insurance company pay for that clearinghouse or how does that, how

Clearinghouse gets paid usually by the provider. Like,

so a lot of electronic health record systems have like a 14 cents

per claim submission. So that cost is passed through to the

provider, which is why we generally recommend

a biweekly claim submission process because you can batch claims.

So you can fit multiple dates of service onto a claim and

then you're charged less than if you submit every day. Right.

Because there's this perception that if I submit every day, I get paid more. You're

going to get paid when the insurance company says you get paid. So you might as well pay less

in clearinghouse fees. So a claim can

go to the clearinghouse and get rejected and get kicked

back. And then you got to fix that because that hasn't made it to the payer yet. Side

Can you, are any of these clearing houses publicly traded? Because

Yeah. There's a really popular one known as change healthcare that

All roads and they're not always good roads lead back to United

They lead back to United. They're very, yeah, they're

very polemic in that sense. But so, yeah,

UnitedHealthcare owns Change Healthcare. And

if, okay, so let's talk about that a little bit. I feel like we can talk about it. UnitedHealthcare

owns ChangeHealthcare. ChangeHealthcare got hacked. ChangeHealthcare is

a clearinghouse. Most people have heard about this situation, but if you haven't,

ChangeHealthcare is a clearinghouse that handled one

out of every three claim in the United States at

the time. One out of every three, insane. They

get hacked by a bad actor. and

shut down reimbursement for every provider that was using Change

Healthcare, right? That's kind of a big deal. UnitedHealthcare

executives all went to good schools and they got really good grades.

And I mean, they got- Jeremy, providers often

don't get to choose the clearinghouse because if the EHR that

they're using, the EHR determines the clearinghouse, right?

That's exactly right. That's exactly right. So

if your EHR had a relationship with Change Healthcare, you were

impacted there, right? So Change Healthcare,

again, those guys got those guys and gals got really good grades

from really good schools. So they said, OK, we've

got a problem. Change Healthcare is bleeding. It cost them

three and a half billion dollars. That whole breach, 100 million

patient records got exposed. they

were not going to lose three and a half billion. So what they did was they said, what if

we loaned nine and a half billion dollars to

providers that were impacted by this situation, which

is what they did. So they made $6 billion. You

So they created a little bank, which by the

So like banking people that could, they, they figured it

out, I imagine pretty quickly. So they created a loan pool to,

to be able to give to the, to the providers money

to cover. Tell me, tell me they charged interest

Oh yeah, they did. Yeah, for sure. Yeah. I mean, they're very smart.

So they took lemons and they squeezed those lemons into

$6 billion worth of lemonade. Right. Again, you can read these in

This is a catastrophic crisis for a lot of people. Make

Anyway, so yeah, that's a little side note, a little bit of information there.

Again, go read UnitedHealthcare's annual reports. It's all in there. They're

like, all right, Change Healthcare cost us three and a half billion. We loaned nine

and a half billion with interest. They're going to make a lot of

money off of the Change Healthcare breach. Right? So

anyway, a claim goes to the clearinghouse. Assuming the claim is clean,

the claim is then sent off to the payer, the insurance company. The

insurance company can then look at that claim and they have two choices. They

approve that claim for payment. And a claim

form, all the architecture of a claim form does is

get to payment. It doesn't communicate any information. that

is not helpful for determining payment or nonpayment. So

then the insurance company looks at the claim, they say approved for payment, or

they say denied. And there are several reasons why you could

deny, right? One of the most common denial

reasons is duplicate claim submission. which

means the provider is just submitting claims, just

like, oh, claim denied, resubmit, resubmit. There's

not been any action taken to rectify the

original denial, which for a biller, that's like

our worst nightmare, because it means we have to go back to the original denial.

And you could have resubmitted

that claim like 20 times, right? And you just get the same denial.

So you have to go back, you have to find the original denial, and then you have to fix the

original denial reason. So that's one of the most common is duplicate

denial. That's like the most ambiguous denial reason you could

have. Another denial reason is timely filing, right?

Going back to the beginning of our conversation, you

didn't submit the claim in 60, 90 days. You

just sat on it. Either you didn't get the note done, or the note was incomplete, or

it kept getting rejected by the clearinghouse, right? And

so now you have to figure out, denied for timely filing is

a bummer, because it usually means you cannot get paid

for that claim, which means you did the service for free. So

that one is usually like a big deal breaker for a lot

And going back to our negotiation tactics at the beginning, or not tactics,

but like, what do you consider, what would you recommend negotiating for

A year, 365 days. Okay, all right. Like

imagine you have a biller who's not doing their job. That's

a big problem, right? And you

Oh, really? Okay. So they kind of give you a lot of leeway there. Otherwise they're

They're going to shorten that as much as they can. Right. Right.

Totally. Yeah. A hundred percent. Yeah. And like a clause

that you'd want to look at in your contract, kind of answering that question some more. Take

a look at how long the insurance company has to

do a clawback, right? Like some of

those clauses are like indefinite. The insurance company has

an indefinite amount of time to go back and take their money back. And

you want to say 12 to 18 months. right?

Because you don't want to have to pay the insurance company back. What

UnitedHealthcare did with all the loans they made was they just said, we'll keep

your reimbursement. You'll serve our members still, but if you can't pay

the loan, we'll just keep the money we were going to pay you. Shocking.

We'll just keep the money. Insane. So

that whole thing was a disaster. I mean, it was a disaster for a

I know. I'm laughing just because I can't believe it. I mean, I

They're very smart. I mean, if you want a masterclass in like taking a bad situation

and making a lot of money off of it, that's the case study right

there, for sure. Um, but yeah,

getting back to denial reasons. So timely filing duplicate claim

or, and this is like a credentialing issue, but provider not found

in the network. So yeah, for a group practice, that's

like you didn't credential your provider, your therapist. And

so now you've submitted a claim and you, you will likely

not be able to get that claim paid because

Um, can I ask a question a little related

to that? I'm just curious now. You

used to be, let's say a PhD

psychologist was able to have interns and people work under

them, and then they bill underneath their psychology credentialing, which

usually is a higher reimbursement rate. Is that still the

same? Can people do that? Or is there, have insurance

companies been cracking down on that because they're like, oh, actually it's costing

The answer to this question depends on the state that you're in

and the insurance company that you work with. There are some states that allow

you to do supervised billing. There

are some states and some payers that will not allow you to

do this, right? So like I know in Pennsylvania, you can't do that. That's

like not allowed. So and that's a that's

a moving target because some states are trying to get more access to

mental health care. So there are loosening the regulation there. So

it's not a question I can answer in a black and white sense, although,

yeah, that's like something you'd need to check with your. the

insurance company you network with and the state that you're in to make sure you can do

that. Otherwise, it could be, depending on the state you're in, it could be considered fraudulent

billing. And you don't want that. Because the folks that enforce

fraudulent billing is the FBI. So you really don't

want them looking at your practice. You want to make sure you're doing everything from

a compliant perspective. And the

latest trend right now is not necessarily supervised billing. But

when you look at like a psychologist, a lot of times claims

deny for lack of prior authorization. And there's a lot of movement right

now among the insurance companies to try to renovate the

prior authorization process. It's like a nationwide commitment

from almost every major payer to figure out this process

because the prior authorization process is a total disaster. But

you also can't not have it, right? Can

I tell you like a history lesson on prior authorization that a lot of people don't know?

All right. So in 2014, North

Carolina made a decision that they were

going to throw out the prior authorization process. because

the prior authorization process was getting blamed for folks

not getting access to care, especially care that they needed, like

physical or mental health. So North Carolina said, we'll just

get rid of it. If it's preventing all this health care from

getting delivered, let's just throw out the whole thing. And

what happened was so much fraudulent billing

entered the market because they got rid of it, that the

state ran up a

$500 million budget deficit. And I think the

attorney general in North Carolina is still prosecuting cases

of fraudulent billing from that period. And from the time

they said no prior authorization to the time they reinstituted it

was nine months. So they ran up a $500 million deficit in

And so you have- I'm

just thinking at a great like Medicare, Medicaid, if

that's just one state in nine months. Yeah. That's

So it gets us like this process gets a bad rap, right?

Because you have people that like get denied cancer treatment because

of prior authorization and the public perception is. this

process is like a way for the insurance companies to control

the spend. And there are cases in which that is true. But

there are also. It's also a fraud preventative

activity, due diligence type of process. Totally. And

it gets messed up, but it also serves as a protection. And

so you have this like, you know, we can't get rid of it.

But what we have here is not good. And so there's this like broad sweeping.

Like, how do we fix How do we fix this thing? And

so it's the ideas have been thrown around or are really interesting. But

But I'm sure I to play in this, too. I mean, but

it's also like how much, you know, you got to just give. You

just gotta give away all your biometrics, everything

about you into a massive database. You know what I

mean? You're right. It's probably very clunky because it's so segmented

Totally. Then you have other issues. You

know, one of the one of the ideas been thrown around is like a gold card program

or certain providers that are known to be high high

integrity providers are given this gold card, so they get they have fewer

prior authorization requirements. How are you making that

decision? Who gets what? It's

the same problem with value-based care or value-informed

care. This idea that the better grades you

get, the better outcomes you have among your patient population, the more money

Yeah. Well, we were talking to that one guy, I think

I'm pretty sure that they're owned by United Healthcare, one of their subsidiaries, but

using AI to do that, right, like the value, like reimbursement rates

go up, if you're able to demonstrate all

these different types of metrics that they can track inside

their own database to get to get the data that

Right the here's like a common problem with that idea like

that makes some amount of sense on paper like the better grades you get

the more money you make. Your papers never got

up and had a burger after your session right or

they never like lived outside of what you're trying to work

on here's the other problem you have. disparity

in economic outcome or in a healthcare outcome,

depending on the locality that you live, right? So you're going

to punish a provider that's in downtown Detroit because

they're in downtown Detroit versus like a wealthy suburb. Like,

That's a great point. I mean, another one, when you're working with kids, how

can you, you can, you know, Susan talks about this all the time. She

can only take a child so far because the circumstances at

home, are so bad that like,

you know what I mean? Like the parents actually need to do their own work in

order for the child. So if the parents get healthier, the child's going to

get healthier too in the mental health world, but she can only take a child so far. So

if there was like a value-based care, she's like, we've hit a roadblock for

six months because the parents have been going through a toxic divorce.

Right. Right. You know, whatever. Right. So that another case in point with how

that may not be the value-based reimbursement it

might fall apart unless they create caveats for

And this is why working with insurance and getting paid requires the

right orientation, because you have these shifts in

trends and in priorities. Right.

And you have to stay up on this stuff or have somebody in your office

or outsourced that's really paying attention to

this stuff, because like, can you imagine Susan taking a 10% decrease

on the reimbursement rate because of the toxic divorce, because the kiddo is

not getting better. I mean, that's what would happen. And so

being involved in this conversation and helping private practices navigate

the vicissitudes of insurance companies

is extremely important because it changes all the time. And

being able to strategize how you're going to navigate that is

very important. So like going back to the Indiana example, my advice

to a lot of those providers is you have two choices. One,

you could kind of like unionize a little bit and tell Caroline we're

out, we're all out if you don't bring the reimbursement rates back. Or

two, you leave. You leave the network and

you figure out a way to either take cash clients

or you credential with another payer that's paying higher, right?

But just taking a 50% cut is not a

And I think most clients would understand, be like, look, I

can't do Zoom or I can't sustain my life.

the fifth It's

like I'm horrified and I'm really glad that we're recording this too,

because I just imagine there's going to be so many therapists who are getting

a lot right. They have to like, what is my mission? And

doing all the work for insurance and all these different things

on variables that are out of my control. Is

yeah, okay, where are we even at in this conversation now? Because we talked about common road, oh

yeah, denials, right? We did a clearinghouse, tangent

denial, you know, valuables care, failure-based care, so yeah,

denials. And then we can like, I'll let you wrap it

I think the best way to land the plan on this in navigating reimbursement

and actually getting paid is to

sit down and instead of just seeing more patients, planning

out your insurance relationships, right?

Are the rates you're getting paid, are they keeping you in business or are they not? Like

that's a good place to start. Is your pricing model

keeping you in business? Or like for the Indiana folks, a

lot of those folks have been bubbling up in our emails lately for

good reason. You know, we've had to ask questions like, if

you went out of network, One, would your clients follow you

out of network and pay cash, right? The data shows that mental

health clients are four times more likely to follow

a therapist out of network than find an

That's so true. And I've helped clinicians transition

out of insurance companies and went private pay, and they were terrified. And

they were shocked by how many people actually follow them and shocked

That's right. So can you convert the same for you, Indiana people,

can you convert the same hour that's now going to pay you 50 bucks

an hour to an hour that's going to pay you 120. Right.

And then, so now you've cut out administration, administrative hassle and

you make more like that's, those are two really good

I would also argue Jeremy that, you know, it depends on

where you are too because of the cost

of living, but one 20 is even really low. It

could be. Yeah. Like just, just to be able to run. If

you're a group practice that is dangerously low. If

you're a solo practitioner, you may be able to make that work. Okay. But when

you're, when you're growing a group practice that is dangerously low. I

mean, I'm always thinking like at minimum, like the baseline is like one

50. Yeah, that's a good last couple, you know, I mean, how,

how, how many, how's the insurance rates? How much have they've actually increased

It depends on the payer, right? If you have like

one payer, that's, that's, this

is tough, but like the Medicare Advantage payers, particularly

in Humana, Humana raised its rates by

five and a half percent for the Medicare Advantage plans because

everybody left the network. So they're trying to incentivize folks

to getting back on the network because there's

reasons why health systems left the

Medicare Advantage network. And it's actually one of those products that

is sort of bleeding UnitedHealthcare for a

variety of reasons. You can go look up why that particular population

is not profitable anymore. Um, but

you have to plan for some of this stuff. So if you're going to get

paid by insurance companies, first, you have to strategize why you're going to take

insurance. What purpose does it serve and is it economically viable?

And if it's not economically viable and you still want to serve that population, how

are you solving for that? You can, you can solve for

that, but you need to solve for it to, you need a process.

You need a, an articulated written down standard

operating procedure, or you need to outsource to somebody who has that already.

to manage this process. And three, you need

to be aware of if the variables change, because they will, what

is your next move, right? It's one of the reasons why they have a chessboard in

the back, right? Because you have to think three or four moves

ahead in order to play this game and win. But if

you have a strategy, you have a plan, you

can win the revenue cycle management game every week. And

we see it all the time. Right. Private practices winning

at scale because they have a plan, they have the right

people, they have the right processes. If you're running

at insurance companies with the idea that if the

more insurance companies I get a network with, the more successful

I'll be, that's a plan to fail. Right. It's more

administrative. Like we had a practice recently that we started working with 30 payers,

30 patients. that's not sustainable for

sure. And that's like a client that we're actively working with

to try to say, if we limit this down to your top three,

you're going to do better over the long-term, but you cannot have one payer per

patient. That's not sustainable. You'll

end up hating. You'll end up building a practice that

Yeah. Just one, one insurance payer almost feels like a prison to

me in some way. I

mean, clearly, I mean, clearly you are good at your job and your

businesses provides a lot of value. And

so as a way kind of wrapping up, I would love for you to be able to share, I'm

going to put this on our screen here. It's practice SOL.com,

practice soul.com. And if you do Brand Your Practice, slash

Brand Your Practice, there's a cool little landing page there that you

can get some resources, right? Do you want to talk about those resources? And then I'd

love for you to just share a little bit about, well, the things that

you do, where you actually do billing. for practices, but you

also have resources that you are launching for people who

may not be a good fit for your practice, but already have a biller. Those billers

need to be trained. And I'm thinking they need a system, whatever

that is, they need a system. If they don't have a system, they need one. If

they do have one, this might be a good way to audit that system and see

So I'll try to answer this as succinctly as I can. If

you think about mental health care, the mental health care market

and the organizations that serve clients in our country, think

about them in like a pyramid like that. They're the

big MSOs at the top, the managed service organizations. And

then you have sort of mid-level providers, those larger groups.

And then if you were to draw a red line and go below that red line, you

have solo practices, supervised clinicians, graduate

students, maybe like smaller groups. And

the folks below that red line, there are very

few companies that are building products and services for

those providers. There's a lot of reasons for that. But

one of the reasons that, you know, we looked at the market

from a size stratified perspective, and we said, you

know, there's this whole group of practices that just

are underserved. And so we built out in our launching on

August 1st, our learning hub, which is our playbook

with our tools and our resources that you can go

and learn and download and implement in your practice right now

to do billing really well in

house. So if you're a provider who doesn't

necessarily wanna make the jump into outsourcing your billing, you don't wanna hire

somebody, you wanna kind of DIY at first, That's a great resource

for you. Or if you're a bigger group and your billers keep turning

over, which happens, uh, or you have a biller who

you, you trust the person, but the person doesn't know how to do

the process. That's the place to go. So hourglass learning hub

launches August 1st. Uh, we also have a segment in their hourglass,

the hourglass learning hub. Yeah. Yeah. So our

logo is an hourglass and we're here to save you time. So that's

the, that's the connection. There you go. So yeah.

And then we have a section in there, ask the biller. You can ask questions and

then one, somebody from our team will answer your questions. So your

biller has support, like actual support and

actual process. So that's launching August 1st.

That is like the lowest touch way to work with us. So that's

a good subscription-based resource over there. Then

we do billing for you. So if you want us to handle

the billing with an out-of-the-box solution, we have a whole billing

team that would love to work with you. And

then we have our, I don't know, what's a luxury brand?

Our Maserati of services, I suppose. I don't

Yeah, Corvette. Where

we do billing audits and then we build out

billing departments and help you hire, train, retain billing,

billers and billing departments. That's a, that's a very

high touch, white glove service. And

so wherever you are in the strata of

mental health care, we can help you at whatever stage of practice

you're at. So, and whatever budget you have. So

that's what's there. But yeah, we would love to work with private

practices that are looking to grow. We think independent private practice is

where quality care happens. So you need you

Well, they're seeing practice, but at least around here outside of the mental health

world, you know, they're getting bigger hospitals. I mean,

It is another discussion. And, you know, I have a I have a friend of a friend that

sold their practice to Optum on a promise that, you

know, they'd have this like really great life if they did that. They

didn't end up being that great. And so I

would say like independent private practice is the

Oh yeah, Optum is owned by UnitedHealthcare. They own a

lot of stuff. I

appreciate you having me on, for sure. I always love

Yeah, I really enjoy it. And I love laughing with you, too. So

thank you, Jeremy, for joining me today. Go to Practice Solutions, just

Google that, or PracticeSoul.com, and you can find all the different

ways you can engage with them and get their resources. And

just a reminder, all the content on the Brand Your Practice website, podcast,

and other media reflects my own opinions and should not be taken as legal advice,

financial advice, or investment advice. So please seek out

the guidance of professionally trained and licensed individuals before

making any decisions. And some links in the description may be affiliate links.

All right, folks, thanks for listening. And if you found this conversation useful, subscribe

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