A (3:30)

Okay, so I'm a therapist. I used to be in a brick and mortar office and I took Amber Lyda step by step course that teaches you how to be an online therapist. So I took that and I was so excited once I discovered that you could actually be an online therapist. But I had one small problem and that was insurance billing. I wasn't sure how to like be all online and bill insurances. So as I launched to go all online, I also had to figure out how to bill insurance for telehealth. So I spent the last two years figuring that out and now I'm completely online. I've been online since last June and now I've become sort of a digital nomad. So I've left my home state of Virginia and now I'm living down in Miami. We just kind of packed up everything, we sold a bunch of stuff and now we're just kind of moving around the country and the world and living as digital nomads. And I could still be a therapist and bill insurance. That's kind of what's going on with me right now.

B (4:31)

I love to hear the term digital nomad. I've never heard that before. It's very creative. And you're actually in our neck of the woods down in Miami because we're in Fort Lauderdale. Right.

A (4:42)

I was gonna talk to you about that. Yeah, we moved here in February.

B (4:45)

Fantastic. Perfect time of year to be down here. And then the whole pandemic has happened. So what's happening with your digital nomadness in the midst of the madness of the pandemic?

A (4:56)

Yeah, it's been on hold. It's totally on hold right now. So the beach has just opened up again, you probably know, on Tuesday. So we're pretty excited about that. We haven't even been able to really enjoy it. So we're going to just hang out here for a while until we decide to move on to the next place. And we don't know where that's going to be. We're thinking Alaska maybe for a little while or, you know, we're just not sure yet.

B (5:16)

How amazing to be able to have that flexibility and the freedom of being able to work anywhere.

A (5:22)

Yes. Yeah. And that's really what I want therapists to take away from this. Like, you can see clients, you can bill insurance and do whatever you want to do.

B (5:31)

That's awesome. Now let's dive into the topic about telehealth insurance billing. I know that this is a hot topic and one that Startup Nation often asks us about. Katie and I both built our six figure plus private practices from the ground up and without taking insurance. So insurance is not our specialization and another reason why we love being able to have people like yourself who are very specialized in that area onto the podcast to be able to talk about the ins and outs of insurance. And especially now with the pandemic with so many practices being primarily on telehealth, to know the ins and the outs and how all of that works is going to be great. So where should we get started?

A (6:13)

Well, I thought since you're like private practice startup, I would first start by just guiding people a little bit through a decision tree I made. I included it in the resources so you guys will have it in the show notes, but it's sort of a decision tree that walks you through if you actually want to have a telehealth practice, or if you want to have an all brick and mortar practice, or if you want like a hybrid. So there are some questions to help you along the way to make decisions about what type of practice you want to have. And I just feel like that's really important to figure out in the beginning if you do want to take insurance because you know it's going to influence which panels you get on. So some are really good about telehealth and some don't cover telehealth at all. So if you plan on being in the office only then there are different ones to choose from. So I would just recommend like go through first before you decide if you're going to take insurance of what kind. Just go through the decision tree to figure out what's best for you.

B (7:07)

And let's talk a little bit about that. I love how you have the decision tree helping people guide from the beginning to make sure that this is really the right path for them. What would be some of the main points and reasons why people would want to have an insurance based practice?

A (7:23)

Well, definitely you can get a lot of referrals that way. So almost everybody that calls me wants to use their insurance. So they asked me that in the beginning and a lot of them were really happy to hear that. You know, we, we pay a lot for insurance, so a lot of people really want to use it. You know that that in itself just is like a big draw. And then the insurance companies, they also send a lot of referrals your way, so they list you in their directories online and you'll get calls. I get emails all the time from the insurance company saying, hey, I have somebody that's got substance use issues or ptsd, which are some of my specialties. And they'll just send me clients that really fit into my niche because I've narrowed it down on their website so that's a plus for taking insurance. And I serve the substance use community, so a lot of them don't have a lot of resources to do private pay. So you want to. I want to serve like underserved populations that can't really afford like the big pride to pay out of pocket. Yeah, so those are, yeah, those are some big reasons for me. Yeah.

B (8:27)

Thank you for sharing that. And then as people guide themselves through the decision tree and make that decision that they want to have an insurance based practice or even a hybrid with some private pay and some insurance, what would the next step be?

A (8:41)

Well, first I would just encourage you to ask yourself, like, do you feel like you need to physically be in the same room with your client? Like some therapists really need to do that. They need to feel their client's energy and be in there. If you really need that, I would just go down to brick and mortar and try to stay that way. But then ask yourself other questions. Is rent in my budget? If so, great, then you're brick and mortar. But if you can't really afford rent or you feel like your quality of life would be better if you could be at home some, so that would more lead you toward a hybrid type practice and then straight up telehealth. If you don't feel like you need to be in the same room with your clients and you don't really miss that daily interaction with other clinicians, the office and you really just love being at home, then I would say go straight telehealth. So once you decide which one, if you choose telehealth, that kind of leads me into a marketing strategy that I came up with and I share in a course that I made up about insurance billing. And we could get into that if you want me to talk more about that.

B (9:43)

Perfect. Yeah, I'm sure as people are listening, especially after going through the unique aspects of the pandemic of so many people, some who didn't want to be online were forced to be online and found that they actually enjoyed it. Some just, it's too hard on their bodies and their necks and just not a great fit. And then for others it is. So for those who really enjoy being online and really want to have that practice online, talk a little bit about how to build the telehealth practice, especially an insurance based telehealth practice.

A (10:17)

Yeah, so I would recommend, before you get started, a little marketing strategy. And that is just go to Psychology Today and filter out for, you know, therapists in your area or even in your state that are seeing clients online. Sort of read through their profile and see if they actually talk about like, hey, I'm a telehealth therapist. And then I would recommend just looking for people that kind of like complement your niche a little bit. So I'm substance abuse, but I only see individual clients. I don't do family sessions or couples or anything like that. So I'm always looking for that. So I would say look for something that complements your niche and then ask for a virtual coffee meeting or something like that, but in there. Oh, and also filter out to make sure they take insurance. And in that meeting, ask them which insurances are you finding that are covering telehealth the most consistently? And would you recommend like a top three as far as like highest payers go? So, you know, it's like twofold there. You get to like market and network with people, but also you get to like get some really good insight into which insurances to go within your state. And then I would also recommend going on all these Facebook groups, there's so many now for therapists. And just like typing in the question, like, hey, who are your top three telehealth payers for insurance in your state? And just get some feedback that way. So that can really guide your decision. I would say once you get those top three, just go and start applying. Start the credentialing process.

B (11:47)

Yeah, market research can be really, really helpful. And I Love being able to not only do the market research like you suggested, but also make those referral relationships. Because you never know if the person you're connecting to and creating that referral relationship with, if they are completely full, if they're looking for someone else to be able to network with, to connect and to refer to. So it could be that double benefit there.

A (12:11)

Yeah, yeah, it's great. I do it a lot. I try to reach out like once a month at least to somebody new and make a connection.

B (12:19)

I like how you talked about the virtual coffee because if you're building an online practice and you know, you might be networking with someone who isn't so close to you, so it's convenient and safe with the whole virus situation going on right now.

A (12:34)

Absolutely. And you can, you know, choose from the whole state for referrals if you're both doing telehealth, which is great. So I hope that tip helps a little bit.

B (12:43)

What other marketing strategies have you found that have been really effective?

A (12:48)

Another thing I do is I always try to get a client to sign a PCP form for their primary care physician. And I will reach out to that physician and introduce myself and just talk about the client some and also just ask the doctor, what are they looking for? What do they see a need for in their practice? And let them know if I could help them with that. If I can't, I'll give them names of other people that I know can help them with that. So that's been really good. I've got quite a few psychiatrists and doctors that consistently refer to me just from that little marketing strategy.

B (13:24)

And just out of curiosity, I was going to ask you this earlier, but then we dove into the topic. You're currently practicing in Florida. You talked about going up to Alaska. And so how have you managed the licensure laws and needing to be licensed in the state where the client resides with your digital nomad lifestyle?

A (13:44)

Yeah. So I've got an address in Virginia that I use. They're called virtual addresses. You can Google it. There are quite a few out there now. So I use that as my mailing address and my practice address. So it looks like a suite, like a suite number. So basically, you know, the insurance companies, as far as they're concerned, that's. That's the address that I give them when I. When I get credentialed with them. So I just, I'm based out of there and my mail goes straight through there and I can just like, they scan my mail for me. A typical compliant you can look in your mail. You want them to mail it to you? They will. And as far as licensing goes, basically, as long as your client is located in the state where you're licensed, it's okay to see them. So you can be anywhere. Mm. Which is really convenient.

B (14:31)

And so you're licensed just in Virginia, or have you gotten reciprocity in other states?

A (14:37)

Just in Virginia.

B (14:38)

Okay. And that allows for you to travel around and have your full practice. Yeah. Thanks for clarifying that.

A (14:43)

Yeah, you're welcome. Yeah. Yeah, it's worked out pretty well so far.

B (14:47)

Fantastic. And I love how you're living your dream lifestyle as well. That's actually something that Katie and I talk about often in our private practice marketing E course. Being able to really build your lifestyle, your ideal lifestyle, and to create that first and foremost and to choose a business model that really complements that. And you are, like, the perfect example of how that. How you're fulfilling that. That's fantastic.

A (15:13)

Thank you. I'm loving it. It's. It's very exciting to just be able to go wherever you want. I love to travel. We used to travel about eight weeks a year. So doing it this way, I can still work and I'm not having to, like, take time off without pay, you know, all of that. So it's working out really well. I'm saving a lot of money too. No office rent, you know, all that stuff.

B (15:35)

Very true. And just out of curiosity, how many. About how many clients on average do you see per week?

A (15:42)

35 to 40.

B (15:44)

Okay.

A (15:45)

I'm definitely cutting back. I know that's a lot right now. I just, like, implemented a waiting list because I'm just getting way too many calls right now. But my goal, I'd like to get down to 25, especially now that I'm not having to, like, take off vacation time and pay rent and all that stuff. So that's what I'm looking for right now.

B (16:02)

Yeah. So that. That's a lot to handle.

A (16:04)

Yeah, it is a lot.

B (16:05)

35 to 40. And your goal is to get down to about 20, 25 a week.

A (16:11)

Yeah, that's what I'm hoping for.

B (16:12)

Okay. And tell us a little bit about how you're managing all of the ins and outs of having an online business with, you know, doing the paperwork for your sessions and the billing for the insurance and all of that. How do you. How do you manage all of those roles and responsibilities on top of your caseload?

A (16:29)

Yeah, well, I use an ehr, so that's very helpful. I use simple practice it has simplified things so much. Part of my story is I used to have a biller, an insurance biller that did everything. And I basically found out one day that they weren't collecting a lot of like back balances. They weren't giving me the correct information about deductibles and co pays and all that stuff. So I did not know anything about billing insurance. I counted on them for like 10 years. And once I discovered this like back balance report, I was like, oh my gosh. Yeah, that's what prompted me to learn all this insurance stuff. And I was taking my practice online at the same time, so it sort of all evolved at the same time. But yeah, so I'm used. I figured out how to bill insurance and then I went to an EHR and I'm just using simple practice. And once you get it figured out, it's pretty streamlined. You know, it's literally the click of a button once you figure out who covers telehealth, what modifiers to use, what location code to use, you know, how many sessions are covered. And then you could just literally click a button once it's all set up. So it's pretty easy. I'd say maybe on a really bad week with insurance, I'd spend five hours a week dealing with like, you know, a denial or, you know, having to call and check benefits and just getting the run around, that kind of thing. But on a good week, it's maybe like 30 minutes. So.

B (17:56)

Wow. Okay. Thank you for sharing that with us.

A (17:59)

Yeah, you're welcome.

B (18:00)

Yeah, it's about 30 minutes and it sounds like the EHR helps a lot in terms of the billing. And once you figure out the system for all of that and you create the system, which can be kind of time consuming in the beginning. It really streamlines things though, to be able to free up so much of your time.

A (18:15)

It does. It's amazing. And once I learned how insurance actually works, now I've got it, like I know what to call and ask for, you know, as far as benefits go. And you know, like I was saying, the modifiers and the location codes for different companies are different expectations. So once you figure all that out, you're good to go.

B (18:32)

And how has Covid affected your practice with everything with the insurance billing and just ins and outs of the pandemic and how that's affected things?

A (18:44)

Yeah, you know, I got lucky because I took it all online as I was saying like last year, so I only have accepted clients that I knew their policy covered. Anyway, I'm seeing A lot of problems now with people that, you know, have been forced obviously to be at home with COVID and they're like trying to figure out the telehealth billing. And it's weird right now because all the insurance companies, they've changed everything. So it used to be like location code 02 for telehealth and now they want you to use location code 11 for telehealth and different modifiers. So the whole thing has totally been switched up right now. Luckily for me, I'm just acting as if these are just regular telehealth clients. So I haven't really been affected by it that much. But I have a telehealth insurance billing Facebook group and in there every day people are like, oh my gosh, like Anthem Blue Cross Blue Shield of Texas, you know, they want location 11 and modifier 95, but they're denying my claims. So it's kind of been a big mess for people. It has affected me in that a lot of the insurance companies are waiving deductibles and copays right now. So my like streamlined system where I was like, oh, this client owes $25. I know they always owe $25, is now the claims are coming back paid in full. So I'm having credits for clients and it's kind of causing a big mess that I think in about six months I'm going to have to really straighten out and maybe issue some credits to people or the insurance companies might come back and say, we didn't mean to pay that much. So it's kind of a mess for people right now. But it's not normally like that.

B (20:23)

And it sounds like your Facebook group that you have is a wonderful place for people to get support. So tell us where people can find that.

A (20:31)

It's telehealth insurance billing on Facebook. If you just Google that or look it up, search it in Facebook, you'll be able to find it. And also we put it in the show notes. So you can just click the link and go there.

B (20:44)

Exactly. I was just about to say that we add the links to the show notes. So that's perfect. You said it for me. Yes. That's fantastic. So what else do we need to know about building the telehealth insurance based practice online?

A (21:01)

So I actually created an entire course for this. It just in my investigation and research and getting it all set up, you know, I was taking notes. I had a notebook full of information and I'm like, I need to make a course for this because nobody really knows how to do this. And especially like in my situation where, you know, I was just counting on these billers, like my head was in the sand, I wasn't paying attention. And then I was like shocked with like a $12,000 back balance. Yeah, it was a nightmare. So I was like, I want to put a course together for people. So I made a course that literally like walks you through that decision tree I told you about all the way to the end where you're like, you know, streamlined with all your systems. You understand CPT codes and you know which diagnostic codes to use and location codes. You know, if you want to go all telehealth, it's a really deep dive into that too, like how to get your virtual address parity laws, you know, how to live in different states, if that's what you want to do, you know, so it covers everything you can literally think of. So I'd recommend that if anybody's interested in learning more about it, about how.

B (22:09)

Long does it take for people to go through your course and to implement what they're learning, to really get there. If they're starting from scratch with building a brand new telehealth practice, about what would be the timeline for that, just out of curiosity?

A (22:20)

Well, I would say give yourself six months. Just because the credentialing process can be anywhere from 30 to 90 days just to get credentialed with an insurance company. And there's a little bit of setup before that. So there's like filling out a caqh, the CAQH database, where you put all your information in so the insurance companies can pull from that. You know, you got to decide if you want to get an MPI number, not an MPI number, but, you know, if you want to be an llc, a pllc, you know, there's all these decisions to make in the beginning, so a lot of that's in the course. I don't go that deeply into it because I know it's covered in a lot of other places, but there's a little bit of an investigation part and then there's some action that's going to take about 90 days and then there's getting the systems in place. So I'd say like six months, you're probably good to go.

B (23:09)

Fantastic. Yeah, that's great. Well, I appreciate you sharing with us about your journey and getting your telehealth practice all set up and transition from your brick and mortar to online for your digital, digital nomad. Right? Yes. I was like, what is the term? What is the term? It just left my brain for just a moment. It's so unique, the digital nomad lifestyle. This is something you've got to coin.

A (23:35)

Oh yeah.

B (23:36)

Really?

A (23:36)

Yeah. I think there's lots of people doing it out there, but yeah, I'm like wanting to live that life. I love it.

B (23:42)

Yeah. Well, what else would you want Startup Nation to take away from your message today?

A (23:47)

Just really think about if you want to take insurance because I think it is important, even if it's just one panel you want to get on to be there for the clients that can't always afford the private pay. And I would also say like, get started now because like I said, it takes a while to get paneled and get all, all the way up and going. So if you want to do that, you want to get your private practice going, you want to take insurance, like just take action now. Even if it's like making that post in a Facebook group and just asking like who the highest insurance payers are in your state for telehealth, that's what you want to do. And also feel free to go to the Facebook group, you know, and research it in there because everybody's got great advice in there about telehealth in their states.

B (24:31)

Fantastic. Kim, thank you so much for coming on today. And just to do a quick recap, we started by talking about how, how to determine with your decision tree whether telehealth is the best practice for you and whether you're going to take insurance or be self pay. And then also you talked about effective marketing strategies for how to find the insurance companies that really pay for telehealth and then how to start billing for telehealth with the modifiers and location codes. And that's something that your course and your Facebook group really help people with. So we will put all of the notes and resources that you've talked about in today's show in our show notes. So definitely make sure to check that out. And to let you know about next week, next week we will be having Elizabeth Olivarez on to hear about her journey from registered intern into private practice this past year and how she has a thriving, successful, full fee private practice. We'll be hearing her success story and we just want to thank you again for listening. We hope that you enjoyed this episode today with Kim as much as we did and if you did, definitely let us know. You can subscribe, rate and review our show. We always love when we get emails randomly from Startup Nation saying hey, this episode was great or hey, I would love to have an episode on this particular topic that we haven't talked about yet, so definitely let us know because we always want to make sure we're creating this content to meet your needs. We will look forward to seeing you on our next episode and in the meantime, stay inspired. Thanks so much. Kim thanks.

A (26:02)

Thanks for having me.

B (26:03)

Thanks for joining us on the Private Practice Start Startup. Visit the private practices startup.com for awesome resources, free trainings, attorney approved private practice paperwork, and so much more. Sam.