WEBVTT 00:00:00.400 --> 00:00:00.720 Alright. 00:00:00.720 --> 00:00:06.880 We're gonna go ahead and get started for the, respect to those individuals who were on time. 00:00:06.880 --> 00:00:09.940 And if other people join us, we will see that on the participants. 00:00:10.720 --> 00:00:17.515 We did introduce Ferela, on the actual invitation, but I wanna just say a couple personal things. 00:00:17.515 --> 00:00:19.675 Number one, she likes us so much. 00:00:19.675 --> 00:00:25.375 She actually referred her son, who is also now in the masters of counseling. 00:00:26.075 --> 00:00:33.720 She had a twenty year career, if you will, serving the state of Oklahoma. 00:00:34.340 --> 00:00:38.980 And this is a whole new career for her, and she's just been so excited to do it. 00:00:38.980 --> 00:00:45.195 And it wasn't it was a long journey, but as you know who are counselors and PsyD folks, it's worth it. 00:00:45.195 --> 00:00:50.395 And, she graduated with her master in science in, in what year? 00:00:50.395 --> 00:00:51.115 Let's see. 00:00:51.115 --> 00:00:53.915 You were in 2021. 00:00:53.915 --> 00:00:54.975 2021. 00:00:55.435 --> 00:01:01.380 And she has very definitely been one of my most valuable alumni advisory board folks. 00:01:01.380 --> 00:01:07.380 And for her you you that are on here, I'm always looking to add more alumni advisory folks. 00:01:07.380 --> 00:01:14.825 So, Janet, if you or anybody else who signs up on this would be interested in that, I would love to talk to you offline after this. 00:01:15.285 --> 00:01:28.105 So I am very excited that Pharrell jumped forward as an alumni advisory board person to give her experiences on getting credentialed with insurance companies to grow her practice, especially in the field of mental health. 00:01:28.460 --> 00:01:31.520 So take it away, miss Farella, and thanks for your gift of time. 00:01:32.140 --> 00:01:32.380 Alright. 00:01:32.380 --> 00:01:33.280 Thank you, Michelle. 00:01:33.340 --> 00:01:34.460 Well, good evening, everyone. 00:01:34.460 --> 00:01:36.240 I'm glad you could join me tonight. 00:01:37.260 --> 00:01:41.600 Tonight, I'm going to be giving a very riveting talk on insurance. 00:01:41.775 --> 00:01:49.955 I know most of you wanna spend, 08:00 or whatever time it is, wherever you are, thinking about insurance. 00:01:50.495 --> 00:02:01.590 Well, I thought the same thing, but I have really grown to I have really I've really grown to enjoy, learning more about insurance. 00:02:01.650 --> 00:02:07.330 And really quite honestly, as a as a sole provider, I really need to know as much as I can. 00:02:07.330 --> 00:02:10.230 So I'm hoping to share a little bit of that with you tonight. 00:02:21.525 --> 00:02:23.385 And let's see here. 00:02:24.165 --> 00:02:25.145 There we go. 00:02:26.250 --> 00:02:32.830 So as Michelle said that I am a DMU alumni, and and I am currently serving on the DMU advisory board. 00:02:33.210 --> 00:02:38.830 So although I did graduate in 2021, I have been going to DMU since 2017. 00:02:39.975 --> 00:02:47.335 I was attending DMU part time while I was finishing out my career with the state of Oklahoma in the environmental field. 00:02:47.335 --> 00:02:52.800 So it was a complete, jump and shift into a completely new field for me. 00:02:53.280 --> 00:03:05.380 I completed my internship at Catholic Charities with the Diocese of Oklahoma City, and I completed my candidacy at NorthCare, which is a certified community bay behavioral health clinic. 00:03:05.760 --> 00:03:14.155 I was part of a rapid response team helping clients who were stepping down from hospitalization due to suicidal and homicidal ideation. 00:03:14.615 --> 00:03:19.035 And then in 2024, I decided to open my own practice. 00:03:19.095 --> 00:03:22.635 And so here I am, and I've learned a lot this past year about insurance. 00:03:23.000 --> 00:03:28.220 So, hopefully, I'm gonna be able to shed some light on the, business of insurance. 00:03:31.160 --> 00:03:32.140 Just a disclaimer. 00:03:32.360 --> 00:03:38.060 The information that I'm going to provide tonight may vary depending on individual insurance company requirements. 00:03:38.985 --> 00:03:42.985 Any allowable amounts provided are estimates and subject to change. 00:03:42.985 --> 00:03:48.765 And, additionally, insurance companies and contact information may vary across states. 00:03:51.080 --> 00:04:04.940 I wanted to just put this slide up because I think it's important when you're talking in acronyms, to be able to provide an explanation of what these things mean when people are tuning in to a webinar or presentation. 00:04:05.315 --> 00:04:07.015 So these are some common ones. 00:04:07.155 --> 00:04:12.775 Maybe I don't use all of these tonight, but you will see these as you deal with insurance companies. 00:04:13.155 --> 00:04:25.380 The ones that I think would be beneficial for you to know for tonight for for the purpose of tonight's presentation is NPI, which is the national provider identifier, and cash, which is a provider data portal. 00:04:28.080 --> 00:04:32.420 So tonight, we will be exploring benefits and challenges of taking insurance. 00:04:33.215 --> 00:04:35.475 We will learn about credentialing requirements. 00:04:35.855 --> 00:04:43.475 We will explore workflow from provider, which is us, to the payer, and we'll also explore some ethical considerations. 00:04:43.695 --> 00:04:49.075 And I have, actually an example that happened to me recently, so I wanna share that with you. 00:04:49.430 --> 00:05:01.130 And then I also have some helpful links, and I would be happy to send those out to you if you I I don't know if you're able to get those from this presentation, but I would happy I would be happy to send those out to you separately. 00:05:04.095 --> 00:05:11.315 So in the mental health field, we have the ability to either accept insurance or accept private pay. 00:05:11.695 --> 00:05:16.995 Just as medical costs can start to pile up, so can the cost of mental health. 00:05:17.390 --> 00:05:24.610 Some people are able to afford private pay, but many people rely on insurance to help mitigate cost. 00:05:25.390 --> 00:05:31.170 Insurance can help increase your client load and allow you to help serve a more diverse population. 00:05:32.325 --> 00:05:42.745 Accepting insurance can help reduce financial burden for clients, and it can also increase cash flow and create a more stable income for you, for the provider. 00:05:43.685 --> 00:05:46.940 Well, there are also some challenges to accepting insurance. 00:05:47.080 --> 00:05:51.820 For example, the claim submission process can be very difficult to navigate. 00:05:52.600 --> 00:05:55.500 And I I subscribe to a software. 00:05:55.560 --> 00:06:03.265 It's called therapy appointment, which, helps me to send the claim out to to the clearing house, which we'll discuss in just a little bit. 00:06:05.005 --> 00:06:09.665 Well, no one likes denials, and this is a this is a reality when you're dealing with insurance. 00:06:10.205 --> 00:06:12.045 Sometimes your claim is denied. 00:06:12.045 --> 00:06:15.420 Well, that requires, you have to go back. 00:06:15.420 --> 00:06:17.520 Maybe you have to do some additional work. 00:06:17.820 --> 00:06:21.760 And so nobody likes denials, but it is a reality of accepting insurance. 00:06:22.460 --> 00:06:28.985 Some insurances, require authorization, so this can also involve extra paperwork. 00:06:29.925 --> 00:06:34.905 And if you take insurance, you are subject to audits, especially Medicare and Medicaid. 00:06:36.405 --> 00:06:44.990 Some insurance companies may be slow to reimburse, and this is what I'll talk about a little bit later too, And it's also an ethical consideration. 00:06:47.690 --> 00:06:53.770 Also, with insurance companies, they they may have multiple payers including third parties. 00:06:53.770 --> 00:06:57.865 So it just gets it just gets very complicated, in the end. 00:06:57.865 --> 00:07:03.325 It's just good to know what the workflow is, and the more you can know about insurance, the better. 00:07:03.945 --> 00:07:11.485 So if you were to weigh the benefits and challenges, it might look like the challenges, you know, the cons outweigh the benefits. 00:07:12.360 --> 00:07:16.200 However, you also have to consider the weight of each of the pros and cons. 00:07:16.200 --> 00:07:19.880 So for example, one pro may be equivalent to two cons. 00:07:19.880 --> 00:07:25.340 So you just kinda have to weigh that out as you're discerning whether or not you wanna take insurance. 00:07:28.025 --> 00:07:28.345 Okay. 00:07:28.345 --> 00:07:32.845 So let's get into the process of credentialing, but first things first. 00:07:33.385 --> 00:07:40.125 Whether you're going into private practice or not, you will have to obtain appropriate licensure in your state. 00:07:42.360 --> 00:07:45.160 This is regardless of whether you're going into private practice. 00:07:45.160 --> 00:07:48.300 Just if you're practicing, you're gonna have to, get your license. 00:07:49.080 --> 00:07:54.600 If you plan to go into private practice, then you will need to also obtain an EIN number. 00:07:54.600 --> 00:07:56.460 This is a federal ID number. 00:07:56.975 --> 00:08:01.455 You will also have to obtain a national provider identifier number. 00:08:01.455 --> 00:08:04.835 So this is mostly for billing purposes. 00:08:05.295 --> 00:08:11.395 If you already work for an agency, then more than likely, you have applied for an individual MPI number. 00:08:11.720 --> 00:08:16.620 Your agency, on the other hand, has applied for a group NPI number. 00:08:17.160 --> 00:08:27.735 So the important thing is when you do go into private practice, especially if you're transitioning from an agency to private practice, you'll wanna make sure that you update your NPI. 00:08:30.915 --> 00:08:39.015 I happen to have both because I set my business up as an s corp, so that allows me to expand later on down the road. 00:08:40.890 --> 00:08:48.190 You will also need to complete a uniform provider data, UPD, and this is done through Cash ProView. 00:08:48.970 --> 00:08:54.030 And this is this is actually key, and we're gonna talk about this in just a moment. 00:08:57.775 --> 00:09:01.235 So now I'm gonna go over just some general requirements for credentialing. 00:09:01.855 --> 00:09:08.355 So you can go ahead and get the ball rolling, and I would suggest getting the ball rolling and rolling just as quickly as you can. 00:09:08.690 --> 00:09:13.510 If you are working for an agency, just make sure that you're not violating their policy. 00:09:14.130 --> 00:09:22.150 So just make sure that you know, you don't want to, you know, end your employment before you're ready. 00:09:22.955 --> 00:09:26.255 So I would go ahead and update your CV or your resume. 00:09:26.955 --> 00:09:34.815 Make sure that you have current copies of all certifications and license for each state and any specialties that you might have obtained. 00:09:36.000 --> 00:09:46.980 Make sure that you have updated copies of your malpractice insurance and malpractice claims information, and make sure that all of your tax information is updated. 00:09:48.445 --> 00:09:56.385 Something new this year or actually in 2024 is you are required to register with the Financial Crimes Enforcement Network. 00:09:58.605 --> 00:10:01.345 Is that true in all states, Ferella? 00:10:02.480 --> 00:10:06.980 I believe that is true in all states because that is not yet a federal requirement. 00:10:07.040 --> 00:10:07.440 Yes. 00:10:07.440 --> 00:10:12.320 And that and we will welcome your questions at the end, by the way, but that was one that I know. 00:10:12.320 --> 00:10:14.960 It's a little different in some states, but I thought that was everywhere. 00:10:14.960 --> 00:10:16.160 I just read that recently. 00:10:16.160 --> 00:10:16.875 Thank you. 00:10:17.035 --> 00:10:17.535 Mhmm. 00:10:17.595 --> 00:10:17.995 Yes. 00:10:17.995 --> 00:10:18.655 Of course. 00:10:24.395 --> 00:10:30.975 So there are some things that you just wanna make sure that you're gonna have that you have access to before you start the credentialing process. 00:10:31.740 --> 00:10:35.260 Again, your updated national provider identifier number. 00:10:35.260 --> 00:10:40.640 Make sure it's updated, especially if you worked at an agency prior to going into private practice. 00:10:41.100 --> 00:10:47.285 Make sure you have your Social Security number, your EIN number, your completed w nine. 00:10:47.905 --> 00:11:02.980 And for EFT enrollment and claims payment, you will need to have a letter from the bank, and that's a letter just stating basically, proving that you have a checking account at that bank and also a voided check. 00:11:03.760 --> 00:11:11.060 You'll also want to make sure that you have a letter from your licensing board that you are in good standing. 00:11:16.385 --> 00:11:24.245 To begin the credentialing process, you will need to request an application from the insurance company for behavioral health. 00:11:24.790 --> 00:11:37.610 Keep in mind, credentialing is based on cert certificates, licensure, registration to practice, academic background and training, and also assessment of professional competence and conduct. 00:11:42.585 --> 00:11:49.885 And all of this information is part of your cash profile, which most insurance companies will access. 00:11:50.185 --> 00:11:57.570 It is important that you maintain your cash profile, and you will actually have to attest every every three months. 00:11:58.590 --> 00:12:02.850 Additional information may also be required like rosters and contracts. 00:12:03.070 --> 00:12:05.890 Contracts are required for all insurance companies. 00:12:06.365 --> 00:12:10.545 Some insurance companies require what rosters even if you're not a group. 00:12:18.300 --> 00:12:21.840 And I wanna say something also about the cat your cash profile. 00:12:24.060 --> 00:12:28.060 This is the thing that has all of your information in it. 00:12:28.060 --> 00:12:35.705 And since most of the insurance companies will access that, It's important that you get started on that and that it's accurate. 00:12:35.705 --> 00:12:37.805 It does take a little while to complete. 00:12:41.065 --> 00:12:46.125 So there are considerations when choosing which insurance companies to accept. 00:12:48.610 --> 00:12:52.230 The important thing to remember is you don't have to accept all insurance. 00:12:53.330 --> 00:12:59.270 And I would encourage you to do your research and choose insurance companies that are in alignment with your needs. 00:12:59.970 --> 00:13:23.660 Some considerations include current reimbursement rates, the popularity of the insurance company, whether or not the authorization process is easy, hassle free, And do does the insurance company allow unlimited visits, or do you have a limited number of visits that you're able to provide? 00:13:25.160 --> 00:13:30.700 And, also, you want to consider how how quick turnaround is for payment. 00:13:34.635 --> 00:13:38.795 So this is a copy of or an example of different insurance rates. 00:13:38.795 --> 00:13:46.335 These are just some of the the popular, insurance companies that, that I'm credentialed with. 00:13:46.820 --> 00:13:53.080 But I wanted to take a look at Blue Cross Blue Shield, for example, and I've circled that in red. 00:13:53.940 --> 00:13:58.980 And, again, these are estimated rates, so these, you know, don't use these for anything. 00:13:58.980 --> 00:14:01.640 They're just estimated rates, and they could easily change. 00:14:02.075 --> 00:14:04.635 But let's take a look at Blue Cross Blue Shield. 00:14:04.635 --> 00:14:10.875 And so over on the left, you'll see, a sample provider fee is, like, a $175. 00:14:10.875 --> 00:14:16.015 You know, whatever your provider fee is, maybe it's a 150, maybe it's 180. 00:14:16.830 --> 00:14:22.770 The maximum that you're gonna get for an intake is gonna be $124.75. 00:14:23.310 --> 00:14:30.685 For a fifty three to sixty minute session, then you will receive $105.33. 00:14:30.685 --> 00:14:33.265 And that's so that that's the allowable rate. 00:14:33.805 --> 00:14:45.750 So when establishing your rate, you wanna make sure that it's more than, like, the allowable rate for insurance companies because that's the maximum that you're going to get. 00:14:49.270 --> 00:14:49.590 Get. 00:14:49.590 --> 00:14:58.490 So I wanna shift for just a moment and talk about Medicare, specifically, since the credentialing process is just a little bit trickier. 00:14:59.295 --> 00:15:05.475 So effective 01/01/2024, LPCs were able to accept Medicare. 00:15:05.535 --> 00:15:12.175 And prior to that, only psychologists and licensed clinical social workers were able to accept Medicare. 00:15:12.175 --> 00:15:23.050 So this is pretty big because this changes this this change actually opens the door for more of our older population to be seen for their mental health needs. 00:15:23.910 --> 00:15:25.990 So let's take a look at what we have here. 00:15:25.990 --> 00:15:35.025 So when you click on the link that the cms.gov link, it's gonna take you to, a page like what you see here on the screen. 00:15:35.725 --> 00:15:37.345 So just follow these steps. 00:15:38.045 --> 00:15:43.600 And if you get stuck, feel free to reach out to your MAC, which is the Medicare administrative contractor. 00:15:43.600 --> 00:15:45.380 They're actually here to help you. 00:15:46.400 --> 00:15:52.240 Once you get into the enrollment application, this is the part that takes a little while, so be patient. 00:15:52.240 --> 00:15:59.745 If you know somebody that has experience with Medicare enrollment, then I would definitely reach out to them. 00:16:01.325 --> 00:16:12.820 So just in general, I wanted to talk about what Medicare what what the whole, like, process looks like with Medicare, once you get credentialed. 00:16:12.960 --> 00:16:24.500 So clients generally have to meet a $257 deductible, and many people have a secondary insurance that will pay for the remaining $22.51. 00:16:25.095 --> 00:16:27.735 So it's a $112.55 per session. 00:16:27.735 --> 00:16:31.655 That's for a sixty minute session, and then that doesn't pay for it all. 00:16:31.655 --> 00:16:34.395 The $22.51 is what is left over. 00:16:34.455 --> 00:16:39.035 If they don't have a secondary insurance, then they're responsible for that payment. 00:16:39.520 --> 00:16:48.260 Well, the good news is for us, for the provider, is that we don't have to be credentialed with the secondary insurance company in order to receive payment. 00:16:48.800 --> 00:16:57.295 And Medicare, if it's traditional Medicare, will forward that claim on to the secondary insurance company. 00:16:57.295 --> 00:17:06.815 So it just means a lot less paperwork for you, and you don't have to file the claim with the secondary insurance company unless it's not traditional Medicare. 00:17:06.815 --> 00:17:09.075 And then that's a little bit of a different story. 00:17:09.790 --> 00:17:22.930 So it can be very confusing for the provider and the client when they enroll in their in other Medicare plans, so not traditional Medicare, which are really which are really which is really like Medicare in disguise. 00:17:23.175 --> 00:17:26.615 So as a provider, you wanna make sure that you are in network. 00:17:26.615 --> 00:17:27.815 And I'll give you an example. 00:17:27.815 --> 00:17:29.115 This happened to me recently. 00:17:29.495 --> 00:17:32.715 I had a client with Medicare Advantage through UnitedHealthcare. 00:17:33.815 --> 00:17:40.310 Although I was in network with UnitedHealthcare, I was not in network with the Medicare Advantage Plan. 00:17:40.850 --> 00:17:46.450 So it it was an easy enough fix, but I definitely was kinda caught off guard. 00:17:46.450 --> 00:17:55.605 So that would be what I would suggest to you is just making sure that you know the difference between traditional Medicare and then other Medicare plans. 00:17:57.265 --> 00:17:59.045 You know, Medicare in disguise. 00:18:00.865 --> 00:18:01.665 But you know what? 00:18:01.665 --> 00:18:06.570 There are other masters of disguise, and this includes Medicaid. 00:18:06.710 --> 00:18:15.290 And I don't know what it's like in your state, but in Oklahoma, Medicaid now uses third party insurance companies like Aetna and Humana. 00:18:16.070 --> 00:18:26.665 And even though I am credentialed with Aetna, I'm not a Medicaid provider, so I can't accept that insurance or I can't, you know, help that client with that insurance. 00:18:27.365 --> 00:18:33.145 To become a Medicaid provider, you have to sign a separate contract and then agree to certain requirements. 00:18:38.700 --> 00:18:39.340 So okay. 00:18:39.340 --> 00:18:45.680 Now that you are credentialed, it is important to understand how the claim submission process works. 00:18:45.980 --> 00:18:50.095 The more you know about this, the less stress you're going to have. 00:18:53.275 --> 00:18:56.735 So let's take a look at this this flowchart. 00:18:57.275 --> 00:19:04.800 So from you, the provider, the claim goes to a clearinghouse, and we'll talk about clearinghouses here in just a minute. 00:19:05.180 --> 00:19:08.400 From there, the claim is sent to various insurance companies. 00:19:09.580 --> 00:19:14.080 And, included in here I also included Avedi and PECOS. 00:19:14.140 --> 00:19:25.175 And the reason why is because these are considered, they're multi payer provider portals, and they manage claims for several insurance companies or payers. 00:19:25.955 --> 00:19:27.975 PECOS is specific to Medicare. 00:19:29.850 --> 00:19:32.490 So on the bottom layer, you'll see payer. 00:19:32.490 --> 00:19:37.930 Well, some insurances insurance in some insurance companies use a third party payer. 00:19:37.930 --> 00:19:52.785 So for example, Optum Financial is a third party payer, and they manage payments for, in Oklahoma, Health Choice, and then probably all over the nation, VA Community Care Network and UnitedHealthcare. 00:19:54.685 --> 00:19:57.800 VA Community Care Network is actually kind of a cool thing. 00:19:57.800 --> 00:20:01.740 So this is the in the this is, part of the VA system. 00:20:02.280 --> 00:20:13.735 And if they can't accommodate the mental health needs of a of a of a patient or of a client, then they are able to send them or refer them out to the community. 00:20:14.435 --> 00:20:21.335 And so that's really that's really cool and a great way to be able to to serve their to to serve their patients. 00:20:25.750 --> 00:20:28.330 So let's talk about what a clearinghouse is. 00:20:29.030 --> 00:20:30.650 For example, I use OfficeAlly. 00:20:30.870 --> 00:20:38.730 There are different clearinghouses out there, and it acts as an intermediary between health care providers and insurance companies or the payer. 00:20:39.355 --> 00:20:45.215 It ensures it it ensures claims meet industry standards and payer specific requirements. 00:20:46.315 --> 00:20:57.080 A clearinghouse allows for submission of claims in one location, and therefore, it increases the accurate it it increases accurate submission rates. 00:20:57.620 --> 00:21:02.840 A clearinghouse also helps to reduce claim rejections and helps with timely reimbursements. 00:21:07.615 --> 00:21:09.375 So how does all of this work? 00:21:09.375 --> 00:21:14.355 So this this is an example of what a clearinghouse can do. 00:21:14.895 --> 00:21:27.620 So it starts with claim scrubbing, and claim scrubbing is a process of reviewing and validating medical claims that includes mental health claims before they are submitted to insurance payers for reimbursement. 00:21:28.480 --> 00:21:37.725 The process ensures that claims are accurate, complete, and in compliance with the specific requirements of each of the payers or the insurance companies. 00:21:38.825 --> 00:21:48.480 The process helps ensure that medical practices, including us, including mental health providers, receive timely and accurate payments. 00:21:49.660 --> 00:21:51.680 So then let's take a look at adjudication. 00:21:52.300 --> 00:21:57.680 Claim adjudication is the insurance company's review process for the claims you submit. 00:21:58.155 --> 00:22:05.355 So when you send in a claim for services provided to a client, the insurer doesn't just automatically pay it. 00:22:05.355 --> 00:22:07.435 They don't just say, well, you sent in the claim. 00:22:07.435 --> 00:22:08.475 We're just gonna pay it. 00:22:08.475 --> 00:22:15.670 Instead, they take a closer look to decide whether to approve it, deny it, or maybe they need to request additional information. 00:22:16.370 --> 00:22:20.850 So what the clearinghouse does, it kind of does all of this prep work ahead of time. 00:22:20.850 --> 00:22:29.365 So once it goes to the payer, then the adjudication process goes a lot smoother, and it reduces the risk of denials. 00:22:35.025 --> 00:22:40.130 So the other benefit of a clearinghouse is that well, one, it saves you time. 00:22:40.190 --> 00:22:49.890 So instead of going to each website for insurance companies, you can view responses and track claims in only one place, and this saves a lot of time. 00:22:50.665 --> 00:22:56.045 A clearinghouse can also reduce errors, prevent denials, and it helps you to get paid faster. 00:22:56.265 --> 00:22:57.485 And let's face it. 00:22:57.545 --> 00:23:01.805 When you're in private practice, you wanna keep that that cash flow coming. 00:23:07.100 --> 00:23:15.760 So the efficiency of the clearinghouse also allows you to spend more time with your clients instead of dealing with claims and billing. 00:23:15.900 --> 00:23:17.740 So that's really what it's about, isn't it? 00:23:17.740 --> 00:23:19.420 We wanna make room for our clients. 00:23:19.420 --> 00:23:25.895 We don't wanna spend all of our time doing paperwork, dealing with claims, dealing with denials. 00:23:26.595 --> 00:23:28.355 We wanna spend time with our clients. 00:23:28.355 --> 00:23:31.015 That's why we're doing what we're doing. 00:23:31.715 --> 00:23:38.900 A clearinghouse identifies claim errors and and tools to fix the problem before the adjudication process. 00:23:39.600 --> 00:23:48.420 So it in it improves your cash flow because you're gonna deal with fewer errors, and it increases and it just makes for quicker payments. 00:23:48.795 --> 00:23:53.295 A clearinghouse stays ahead of frequent changes that occur in the insurance industry. 00:23:53.355 --> 00:23:56.395 And this is pretty important because that's another thing too. 00:23:56.395 --> 00:24:04.440 We don't have time to stay up on all of the different changes that may occur in the insurance industry, and there are a lot. 00:24:04.520 --> 00:24:06.140 It it changes pretty frequently. 00:24:09.320 --> 00:24:18.860 And then, of course, the clearinghouse can generate useful reports that increase an understanding of the billing process and can highlight opportunities for improvement. 00:24:24.005 --> 00:24:32.585 And now let's talk about ethical considerations that might come up from time to time when accepting insurances or when accepting insurance. 00:24:32.725 --> 00:24:37.220 So best practice is to be proactive and prepare for the unforeseen. 00:24:38.480 --> 00:24:52.935 Be active in planning and getting clients to services else elsewhere if needed and specify insurance changes or lack of reimbursement in your informed consent, including a disclaimer about what transitioning might look like. 00:24:55.395 --> 00:25:08.870 For example, if something happens and insurance will not reimburse, then a client can pay out of pocket and send in their claims directly to their insurance company, or they can be referred out to another provider. 00:25:09.410 --> 00:25:13.910 So you will need to decide as the provider if you wanna continue taking the insurance. 00:25:14.735 --> 00:25:21.295 And but remember that you are under contract to accept clients, and, also, it's not ethical just to abandon your clients. 00:25:21.295 --> 00:25:25.475 So you can't just say, well, the insurance isn't paying, so I'm just not gonna see you. 00:25:26.255 --> 00:25:32.530 And that's why you need to be prepared and make sure that that that make sure that you have that discussion with your client. 00:25:33.710 --> 00:25:40.210 If you choose to continue taking a specific insurance, then you may want to limit your caseload for that insurance. 00:25:41.325 --> 00:25:44.285 You can become credentialed with many insurance companies. 00:25:44.285 --> 00:25:49.185 It doesn't have to be just one or two, so that way your eggs are not all in one basket. 00:25:50.845 --> 00:25:56.545 This dilemma is most common when insurance companies undergo a transition to another payer. 00:25:57.300 --> 00:26:08.200 And so I'm gonna tell you, I experienced this very recently, and I had a an insurance company that was not reimbursing me, since January. 00:26:09.455 --> 00:26:19.555 They they did finally pay, but it was it was not until March, that I received any kind of reimbursement from this insurance company. 00:26:19.695 --> 00:26:27.270 And this was primarily because they were they were transitioning from one company to or one payer to another. 00:26:27.570 --> 00:26:32.710 And in that process, they just weren't able to process all of the claims. 00:26:33.970 --> 00:26:35.430 But they did finally pay. 00:26:35.635 --> 00:26:44.295 And I did continue to see my clients, but it did affect about 20% of my caseload and and, therefore, about 20% of my cash flow. 00:26:49.850 --> 00:26:53.870 So getting credential can be a lot. 00:26:54.810 --> 00:26:56.110 No doubt about it. 00:26:57.290 --> 00:27:00.990 I would recommend that you get help from designated staff. 00:27:01.255 --> 00:27:05.195 Many agencies and groups will have staff that can work on credentialing. 00:27:06.135 --> 00:27:10.315 If you are doing it alone, then reach out to the insurance companies. 00:27:10.455 --> 00:27:12.075 They will help you. 00:27:12.455 --> 00:27:14.155 They'll be happy to help you. 00:27:14.460 --> 00:27:17.200 And be intentional when choosing insurance companies. 00:27:17.260 --> 00:27:19.520 Consider quality over quantity. 00:27:20.780 --> 00:27:26.800 Understanding insurance workflow can also be helpful and can assist you in making ethical decisions. 00:27:27.715 --> 00:27:29.735 So be prepared for the unforeseen. 00:27:30.435 --> 00:27:34.375 When it comes to insurance, be proactive rather than reactive. 00:27:38.195 --> 00:27:41.495 So I just wanted to acknowledge a couple of people. 00:27:41.955 --> 00:27:50.470 Maricar is our account specialist and credentialing liaison, and she has helped me immensely with the credentialing process. 00:27:50.470 --> 00:27:52.490 She also helps me with my billing. 00:27:52.870 --> 00:28:02.535 And then also Amy Shipman, who is my old boss at Catholic excuse me, at Catholic Charities, and she helped me work through the ethical considerations. 00:28:05.875 --> 00:28:06.195 K. 00:28:06.195 --> 00:28:13.380 And this is the these are the helpful links that I think most of these would be helpful for you. 00:28:13.380 --> 00:28:15.480 There's some that are, state specific. 00:28:15.940 --> 00:28:19.080 But if you would like a copy of this, I can get that to you. 00:28:19.700 --> 00:28:24.840 Well, actually, I will probably since we're recording this, Pharrell, I'll be able to send it to them. 00:28:25.435 --> 00:28:25.935 Okay. 00:28:26.075 --> 00:28:30.895 And if you all have any specific questions, please put those in the chat. 00:28:31.115 --> 00:28:44.260 I just wanna say thank you because I've talked to people who graduate and they, you know, they hear these kind of stories, but yet if you're a practitioner on your own, yes, indeed, some places will only take cash. 00:28:44.260 --> 00:28:48.760 But as we know, that shuts out a lot of individuals who could indeed use counseling. 00:28:49.140 --> 00:28:50.920 So I think this will be very valuable. 00:28:50.980 --> 00:28:59.855 I'm gonna send it up line to counseling and see if they wanna if they wanna use it at the end of maybe when a person's about to go out and be licensed and open their practice. 00:29:00.395 --> 00:29:04.635 Do either of you who are on the call have any questions you'd like to put in the chat? 00:29:04.635 --> 00:29:06.415 That was so well done, Pharrella. 00:29:06.555 --> 00:29:07.295 Thank you. 00:29:07.520 --> 00:29:08.000 Thank you. 00:29:08.000 --> 00:29:08.500 Yes. 00:29:08.880 --> 00:29:10.580 And this is my contact information. 00:29:10.880 --> 00:29:18.000 If anyone needs to get ahold of me, feel free to reach out to me either through email or my phone number is there as well. 00:29:18.000 --> 00:29:20.660 (405) 314-3757. 00:29:23.715 --> 00:29:24.035 K. 00:29:24.035 --> 00:29:31.575 Janet says one of the mistakes I made was to transition to private practice before I was credentialed. 00:29:32.275 --> 00:29:35.255 So that was a learning curve for her, it sounds like. 00:29:36.940 --> 00:29:37.420 Yes. 00:29:37.420 --> 00:29:39.840 And, yeah, I would agree. 00:29:40.700 --> 00:29:47.500 I and and and the reason I said, you know, check with your policy if you are working for an agency or, you know, well, an agency. 00:29:47.500 --> 00:29:56.335 So, like, when I was working for Northcare, because I I did have a cash profile because I had set one up because I started credentialing with them. 00:29:57.755 --> 00:30:08.030 But then I transitioned out of Northcare to private practice, now my cash profile has them as the rendering agency. 00:30:08.030 --> 00:30:09.790 And so that was a little bit of a mess. 00:30:09.790 --> 00:30:11.890 I had to make sure that that was updated. 00:30:12.510 --> 00:30:18.195 But, also, there's a policy that they have that you can't, like, go into private practice while working for them. 00:30:18.515 --> 00:30:21.575 So I wanted to make sure that I was being ethical there. 00:30:22.755 --> 00:30:29.315 So I kind of you know, I had a end date, and then I had a start date of, like, you know, fifteen days later. 00:30:29.315 --> 00:30:37.810 But, I had help going ahead and getting that ball rolling with some of the But, indeed, it takes a while sometimes, doesn't it, Janet? 00:30:40.270 --> 00:30:49.490 So one of the things that I hope comes from this also is that when I do distribute it to the other people who did sign up, they probably didn't realize it was this late because we have time differences. 00:30:50.135 --> 00:31:02.715 But I wanna see if there are other subject matter that our alumni can deliver from their their backgrounds, from what has happened to them in the real world after they finally get licensed and they finish everything. 00:31:04.135 --> 00:31:10.370 But I do hope that any of you who have any suggestions on that will let me know, and I'll send you a side email. 00:31:10.510 --> 00:31:13.390 So Maria says, not at this time. 00:31:13.390 --> 00:31:15.650 We can be private practice in Texas. 00:31:16.350 --> 00:31:22.285 I am although as an LPC associate, we can only credential with a couple of insurance companies. 00:31:22.665 --> 00:31:25.545 It doesn't pay to do it as an LPC associate. 00:31:25.545 --> 00:31:27.485 And, again, it is different everywhere. 00:31:27.625 --> 00:31:36.210 But let me also give you the fact that we are working a lot closer with the Catholic Psychotherapy Association. 00:31:36.270 --> 00:31:39.010 In fact, I'm gonna be going to the event in Philadelphia. 00:31:39.870 --> 00:31:47.090 And there's not a day that goes by that they don't ask for referrals from all over the world. 00:31:47.645 --> 00:31:52.685 And one of the things that I did, as I think both of you know I know I know Maurice in there. 00:31:52.685 --> 00:31:55.425 I'm not sure you are, but we have an alumni directory. 00:31:55.885 --> 00:32:07.750 And one of the things I'm encouraging people to do is to put in either their website or down in the notes the insurances that they do take because that's very important. 00:32:07.810 --> 00:32:18.475 Sometimes a referral will come from this person, you know, needs this criteria for treatment, and they need to be able to accept, you know, Blue Cross Blue Shield. 00:32:18.475 --> 00:32:22.955 So, I definitely want to encourage everyone to do that. 00:32:22.955 --> 00:32:39.240 So for both of you on this call, and I think when I send this out to the other people who registered or use it for training, I wanna know what other subjects that as an alumni advisory board group that we might be able to, do these kind of webinars. 00:32:39.380 --> 00:32:50.645 I think the next one might be from another advisory board member named Jerome Placido who wants says he could talk about the IT part and setting up offices and doing those kinds of things. 00:32:50.645 --> 00:33:02.300 Because one of the things we wanna continue to do as an alumni association is be present in your life and help you with things that will help you grow your practice and knowledge of Divine Mercy University. 00:33:05.080 --> 00:33:08.060 Again, thank you so much, Marie and Janet. 00:33:08.120 --> 00:33:12.940 If you have, any other questions, I'll we'll be happy to answer them. 00:33:13.715 --> 00:33:20.935 Janet has one that says budgeting, setting rates, cash rates, and sliding scales. 00:33:21.635 --> 00:33:26.055 So is that a topic that you might like to see discussed in a webinar, Janet? 00:33:29.540 --> 00:33:30.040 Okay. 00:33:30.100 --> 00:33:34.820 Well, that's good to know, and I will, follow-up with both of you all tomorrow. 00:33:34.820 --> 00:33:38.180 And like I say, we'll just get this recording out. 00:33:38.500 --> 00:33:46.555 That's we have a wonderful communications person online here with us, and they can actually, record this, and we can get it out. 00:33:46.555 --> 00:33:48.715 Thank you both for your gift of time. 00:33:48.715 --> 00:33:53.835 We have about seven or eight that were signed up, but you know how it is at the end of the day of treating customers. 00:33:53.835 --> 00:33:57.470 And, again, I can't thank you enough, Varela, for for all this. 00:33:57.470 --> 00:33:58.930 It was a great presentation. 00:33:59.710 --> 00:34:00.030 Yes. 00:34:00.030 --> 00:34:00.930 You are welcome. 00:34:01.550 --> 00:34:02.050 Anytime. 00:34:02.270 --> 00:34:05.250 I'm glad I could I'm glad I could share some of my experiences. 00:34:05.870 --> 00:34:08.750 You set the bar real high for the next one who does that. 00:34:08.750 --> 00:34:09.810 So thanks again. 00:34:10.779 --> 00:34:11.019 Alright. 00:34:11.019 --> 00:34:11.838 You're welcome. 00:34:11.979 --> 00:34:13.279 Have a good night, ladies. 00:34:13.419 --> 00:34:13.738 Alright. 00:34:13.738 --> 00:34:14.479 Thank you. 00:34:14.539 --> 00:34:14.858 Uh-huh. 00:34:14.858 --> 00:34:15.454 Bye bye.