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Mastering Insurance Billing for Natural Practitioners

Insurance Billing Insurance Billing
Longevity By Nature

The key to a magical patient experience.

Natural practitioners often don’t consider insurance billing when thinking about their practice management and growth. However, insurance is a crucial aspect of health care that natural practitioners also need to consider. By accepting insurance, natural practitioners can provide their patients with accessible and affordable care. Consider the fact that patients who have insurance coverage are more likely to seek the care they need when they know their expenses will be covered. They are more likely to attend more sessions and finish treatment plans when this care is partially or fully covered by insurance. This can ultimately lead to better health outcomes and increased patient satisfaction. Furthermore, as more people turn to natural and complementary medicine, it’s essential that natural practitioners have the tools and resources to effectively manage their billing processes. This includes understanding insurance coverage for natural medicine, using appropriate diagnosis codes, and staying up-to-date with industry changes. By doing so, natural practitioners can provide their patients with seamless care and focus on what they do best—promoting health and wellbeing through natural means.

However, insurance billing can be particularly challenging for natural practitioners due to several factors. One challenge is that insurance billing requires the use of specific diagnosis codes, which may not accurately reflect the holistic approach of natural medicine. This can make it difficult for natural practitioners to accurately bill for their services and receive appropriate reimbursement. A study published in the Journal of the American Board of Family Medicine found that only about half of insurance claims for integrative medicine services were paid, compared to 75 percent for conventional medicine services.

Moreover, natural practitioners often face higher rates of claim denials and lower reimbursement rates compared to conventional health care providers. These challenges highlight the importance of ongoing efforts to increase insurance coverage for natural medicine services, improve billing processes, and ensure fair reimbursement for natural practitioners.

At Soundry, we specialize in providing custom billing services and have processed thousands of claims on behalf of integrative practitioners. Below, we’ll delve into common mistakes and essential tips across the revenue cycle that health care providers, including integrative and natural medicine practitioners, should carefully consider.

Smooth Sailing Starts With Check-in

Accurate data entry during patient check-in is fundamental, yet surprisingly, many practices overlook its importance. Properly train front desk staff on the critical nature of this initial step in the billing cycle. Gathering comprehensive insurance and demographic information is crucial for proper billing and minimizing potential claim denials. Always ensure the collection of clear photos of both the front and back of the patient’s insurance card, with the latter often holding critical billing details.

Decode Your Insurance Payer Contracts

Familiarize yourself with the terms of your insurance payer contracts—a critical consideration for integrative providers. Knowing the specifics of reimbursement rates, covered services and billing guidelines helps prevent underpayment or denials. Align your billing practices not only with your license permissions but also with the specific terms outlined in each insurance contract.

Crack the Code—Symptoms vs. Diagnoses

Billing is a language, and using appropriate diagnosis codes for billing is crucial. Avoid the use of symptoms as primary codes, as insurance companies typically require specific diagnoses for proper reimbursement. Providers or their billers often make the mistake of coding for the symptom rather than the underlying diagnosis. It is also important to determine the specific diagnoses that your services may fall under so that you can maximize coverage for the patients.

Denials? Proactive Is the Name of the Game

Actively follow up on denied claims to avoid financial complications and decreased revenue. Incorporate denials management into standard, weekly claims and payment posting processes. Analyze denial patterns, rectify errors promptly and proactively communicate with insurance payers to prevent recurring issues.

Documentation Is Your Superpower

Maintain detailed and accurate medical records for each patient. Poor documentation not only affects patient care but can also lead to audit risks and billing disputes. Even if not audited yet, be prepared for potential future audits by ensuring proper documentation, which is required under your insurance payer contract and state license.

Secondary Insurance: Navigating the Maze

Secondary insurance is particularly crucial for natural practitioners. Often it provides coverage when the primary doesn’t, especially for our specialties. Understand the procedures for filing claims with secondary insurance providers, considering coordination of benefits. Educate patients on primary vs. secondary insurance and gather necessary physical documentation for secondary claims. Despite added complexities, having a patient with access to multiple insurance plans can benefit both patients and providers.

Medicare: Play by the Rules

Follow the guidelines set by Medicare’s Local Coverage Determinations (LCDs) when billing for services. Non-compliance could lead to denied claims and financial penalties. Know your Medicare provider status (Par, Non-Par, or Non-Participating) and ensure access to your PTAN number for efficient communication with Medicare.

Access Is Key

Ensure access to the online portals of all insurance providers you work with. This will help you track claims, check eligibility and communicate efficiently. Practice owners should always retain administrative access to the portals. While it’s necessary to provide access to these portals to your billing and front desk teams, promptly deactivate access for terminated employees to ensure data security.

Rolling out these billing tips isn’t just about fixing errors; it’s about sprinkling some magic on the patient experience. When billing is streamlined, patients benefit from a hassle-free experience. They can focus on their health and well-being, confident that their financial obligations are being managed effectively. This fosters trust and loyalty, helping to build a strong patient base for your practice.

Furthermore, when billing is under control, practitioners can devote more time and energy to patient care. This contributes to better health outcomes and a more positive experience for everyone involved. By mastering insurance billing, natural practitioners can create a flourishing practice that is beloved by patients and respected in the health care community.

So, let’s embrace the magic of streamlined billing and take your natural medicine practices to new heights!

Tina Hsiao is the COO of Soundry Health. Soundry is focused on delivering an all-in-one insurance billing service and EHR for integrative practitioners. Prior to joining Soundry, Hsiao was chief operating officer of WePay. She has also scaled and launched several businesses at Intuit and QuickBooks. Hsiao graduated from Columbia University with a BA and an MBA from Harvard Business School. For more information, visit www.soundryhealth.com.