Psych
Admin
Partners

How does it work?

You're not in my local region. Can you still do my billing?

Absolutely! Currently we bill for providers in several states. Unless there is a law in your state requiring that your billing service be in-state, we can do your billing. Note: We regret that we cannot offer services to professionals in Arizona, Louisiana, Maryland, Michigan or Nevada.

How does it work?

It's simple. You send us patient info and a copy of the insurance card. When you see the patient, you send us your charges. We have a web portal where charges can be submitted, or we can take the charge data from your EMR/EHR, or you can send us a spreadsheet. We bill charges, and do whatever research is needed either prior to submission or following denial. When you receive payments, you fax or mail the accompanying Explanation of Benefits (EOB) form to us if the EOB is not received electronically. We take care of the rest!

ARE YOU ABLE TO CHECK BENEFITS AHEAD OF TIME SO THAT I KNOW HOW MUCH TO CHARGE MY PATIENT WHEN S/HE COMES IN FOR THE FIRST TIME?

We used to offer this service on a routine basis, however, benefit verification has become problematic in recent years, largely because insurance payers have divested themselves of human (and native English speaking) staff and require the use of web-based queries either on their own portals or through multi-payer platforms like Availity or NaviNet. Results of web-based queries are only as good as the payer has made them, and frequently mental health is "the red-headed step-child." Meaning, it can be challenging, even if the results are obtained online, to actually know how much to collect at the time of service!!!

Historically, benefit verification was needed because claims were often not electronic, and even when they were, it took over 30 days to receive an adjudication. So a practice needed to know ahead of time how much to collect from patients to avoid a situation in which a patient racked up a large balance by the time it was discovered they had a deductible or a high co-payment.

In 2017, Psych Admin, in partnership with some of our long-term clients, pioneered limiting benefit verification to cases where it is judged, based on our experience, that there might be a problem or a need for thorough "pre-claims research." For routine psychotherapy claims in geographic locations where we are familiar with the payers, we are discovering that with daily submission of electronic claims, and now that we are receiving about 90% of remittances electronically, we can have an answer to the question "how much will the patient owe?" within 10 or fewer days, and, more importantly, an answer that is accurate.

This approach also encourages patients to take responsibility for understanding their own benefits. Think about it clinically for a minute. Do you want to enable your client or be codependent with him/her? Do you want to set up a situation in which you tell the patient, based on a benefit verification, that they owe $X, and then what happens if we got the wrong information because we couldn’t talk to someone at the insurance company, and then you have to come back to the patient and say, no, you actually owe $Y? That taints the therapeutic relationship and may cause resentment on the part of the patient. You are not the insurer. Nor are you responsible for knowing how much the patient has to pay, even if you are participating on the plan. Participating on the plan only means that you submit claims for the patient, accept assignment of benefits, and accept the contract rate as "payment in full." You are not responsible for telling the patient what their benefits are. Insurance companies still do offer more resources geared toward helping patients understand their benefits (whether online or telephonically), than they do helping providers understand the benefits. Ultimately, it is your patient who is a customer of the insurance company, not the practitioner.

If you still wish 100% of your benefits to be checked, however, we will be happy to do this at additional cost (see Rates page). Please note that you will be responsible for giving us complete patient and policy information at least 5 business days prior to the appointment.

HOW DO I TELL YOU WHEN CLAIMS ARE PAID?

In about 90% of the cases, we will set it up so that we receive the Explanation of Benefits electronically. Then we will tell you via email when you are getting paid. If electronic remittances are not available, then you fax or mail the Explanation of Benefits (EOB) statement that accompanies the insurance check.

HOW DO I TELL YOU WHEN MY PATIENTS PAY?

You will either enter payments in our online portal or send us a payment spreadsheet/log, or send copies of the checks/credit card receipts. We will arrive at a mutually agreed upon way that is most convenient for you, so that patient accounting can be both timely and accurate.

I AM NOT ABLE TO KEEP TRACK OF WHICH CLAIMS AREN’T PAID, AND THEN I LOSE MONEY BECAUSE THINGS AREN’T SUBMITTED "TIMELY." WILL I HAVE TO KEEP TRACK OF WHICH CLAIMS ARE PAID, OR DO YOU DO THAT?

This is what you have hired us for! Every month we generate a "Pending Claims Report." This shows us all your outstanding claims so that we know what to follow up on. We also check the clearinghouse for rejections on a weekly basis. If we have to resubmit, "timely" filing isn’t an issue when you submit claims electronically because the clearinghouse can provide proof of "timely" submission. And for this reason, insurance companies tend not to "lose" electronically submitted claims. For paper claims or EAP claims, the report allows us to follow up in enough time to resubmit, if necessary.

WHAT IS YOUR EXPERTISE?

Visit our About Us section.

CAN YOU PROCESS PATIENT CREDIT CARD PAYMENTS?

Yes. If you use a credit card vendor of your choice that has an online portal, all you have to do is give us access and we will be happy to process payments at no additional cost, if a patient calls in a payment to us.

I’M HOPELESS WITH COMPUTERS! DO I HAVE TO KNOW A LOT ABOUT COMPUTERS?

No! All you need to know how to do is operate a web browser and email.

CAN YOU BILL PATIENTS’ HEALTH SAVINGS ACCOUNTS?

Yes, although some Health Savings Accounts require that you accept major credit cards. To do this you must be linked with a merchant vendor of your choice.

THE INSURANCE COMPANY IS TRYING TO REDUCE MY CHARGE OR "NEGOTIATE" WITH ME! DO YOU TAKE CARE OF THAT?

Absolutely! We call third-party negotiation services every day to reject their offers or negotiate better ones.

THE INSURANCE COMPANY IS TRYING TO PAY ME WITH A CREDIT CARD, FORCING ME TO PAY MERCHANT FEES!! CAN YOU TAKE CARE OF THAT?

Payers will have you believe that amendments to HIPAA/HITECH require you to accept virtual credit cards (thus incurring merchant fees). This is not strictly true. Amendments to HIPAA/HITECH required payers to offer electronic solutions to remittance. Nowhere in the law does it say that provider must pay a fee to receive their money! We call these virtual credit card issuers every day and tell them they must offer a solution in which the doctor is not obligated to pay the fees associated with electronic payment.

I AM SO TIRED OF FILLING OUT CREDENTIALING & RE-CREDENTIALING APPLICATIONS! CAN YOU DO THIS FOR ME?

Certainly. We can do either paper credentialing, CAQH, or online at the payer site, as needed. The average amount of time is 1-2 hours per document after all information about you and your practice has been gathered. Note: This is a separate service from our billing package.

ARE YOU A COLLECTION AGENCY? WILL YOU WORK WITH COLLECTION AGENCIES?

No, we are not a licensed collection agency. In accordance with the Fair Debt Collection Practices Act, we can't report delinquent debt to credit reporting agencies, nor do we ever contact patients directly about past due balances. Yes, we can provide information/reports to a collection agency if you choose to employ one.

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