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Private Practice Startup Podcast
Episode 93: Myths about Insurance-Based Practices
00:30:03
Danielle Kepler
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- [00:03]
A
Welcome to the Private Practice Startup where we inspire you from startup to mastery. We chat with entrepreneurs, experts in the mental health and business arenas, and successful private practitioners to give you the tools needed to make your dream practice a reality. Visit theprivatepracticestartup.com for awesome resources, free trainings, and so much more. Here are your hosts, Dr. Kate Campbell and Katie Lemieux.
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B
Hey there, my Startup Nation superheroes. Welcome back to another episode of the Private Practice Startup Podcast. I am one of your hosts, Katie Lemieux.
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A
We're excited to be here today. Hey everybody, it's Kate Campbell.
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B
So it's another Friday and we are podcast recording today. So we wanted to say thank you to our longtime listeners, faithful, loyal listeners, we really appreciate you. And if you just happened upon our podcast today or you had a really awesome colleague say you got to listen to the Private Practice Startup podcast podcast, we wanted to welcome you. We are rolling out the virtual red carpet, embracing you and saying welcome to our Startup Nation superhero family. So last week on the Private Practice Startup podcast, we had Chorus Kaligas of Therachat and they've created a really cool app to help clinicians help their clients be accountable, do more homework, get more things done so they can achieve their goals. So you'll definitely want to listen to that podcast. And today we're actually talking to Danielle Kepler from Chi Town. How are you, Danielle?
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C
Pretty good.
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B
Awesome. And she is a licensed clinical professional counselor in Chicago. So if you guys didn't know the Chi Town reference, that is Chicago. And she also has another company, Be youe Own Biller. So she's going to be talking about the myths about insurance based practices. For those of you who want to kind of hang out with us and our thousands of therapists across the globe, please hang out with us on Facebook. Look for the Private Practice Startup, ask to be part of our group and we'll see you in there. And today our sponsor is.
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A
Yes, Danielle, we're so excited to have you here today. So thank you for being here. Today's sponsor is actually the Private Practice Startup, our attorney approved private Practice paperwork. So for those of you who are listening who have developed your paperwork from scratch, you guys know how much ridiculous time and effort goes into that. And then working with an attorney to have it reviewed is extremely costly, very expensive. So Katie and I really saw a need and we put 100 plus hours into working on the paperwork, perfecting it, combing through all the laws and ethics, and then saw many attorneys and had them review the paperwork and bring it up to the highest standards so that you don't have to go through all of that time, energy and money headache. Yes, exactly. So we have the attorney approved private practice paperwork. We've got our a la carte options and packages available. So make sure to head over to privatepracticestartup.com check out our free HIPAA. We offer a $5 release of information plus free HIPAA forms. So make sure you check that out if you want to experience the quality of the paperwork. And yeah, so that's our sponsor. So for today's episode, but you want.
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C
To head over to the private practice.
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B
Startups, the Shop tab.
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A
Yes, it's under the Shop tab. Exactly. So we're excited to have Danielle on the podcast today. I came across Danielle's information a couple months ago in one of the Facebook groups online. Who knows which one? Maybe Abundance or. I don't know, there's so many of them. I was like, yeah, I saw that she has this really cool online course. And so I connected with Danielle. We had a chance to chat, we talked for a while and Katie and I both have built our six figure plus private practices and we don't work with insurance, so we really don't have the ins and outs of insurance. So I'm so excited to have you on today to be able to share with Startup Nation what you've learned because you've built a very successful practice and it's all insurance based and now you're expanding and bringing on clinicians to expand your team because you have such a full practice and you teach clinicians how to do the same. So there's going to be a wealth of information for Startup Nation here today. So thank you for being here.
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C
You're welcome. Yeah, it's different with the private pay versus insurance for sure. I mean, most people have. And I also have a hybrid of the two. I mean, if somebody comes and wants to be self pay, I don't turn them away. Yeah. So it's, it's a hybrid. So probably I would say 99% of my clients use insurance or EAPs. Yeah. And then like 1 to 2% are self pay. Yeah.
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B
And I'm curious, Danielle, one, how did you get into the field? And two, what inspired you to help other clinicians be their own billers?
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C
So I mean, what got me into the field initially? I would say way back in middle school I was a peer mediator. I was elected as a peer mediator, which is interesting because I wasn't too popular and we did this kind of training. So I Guess it was when students would have issues with each other, they would come to these peer mediators and we would talk to them and coach them a bit about how to, you know, not. Or how to be better friends, things like that. In middle school, I'm not really sure, we did it a few times and I was like, this is pretty cool. So that was my first, like, glimpse into actually even being sort of a counselor, a peer counselor, so to speak. And then I majored it in college and then it went from there. So that's really my first, like, glimpse into the field was, I guess, way back in middle school. Gotcha.
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B
And so since middle school, had you always wanted then to be a therapist?
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C
Yeah, I mean, okay. Like for the most part. Well, and if, I mean, it swayed between therapist and actress, so that's cool.
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A
Sometimes we're acting in therapy, right?
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C
Yeah. Oh, yeah, yeah. I mean, a lot of times we.
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A
Step into a role.
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B
Well, we. The poker face is definitely something that, you know and a client tells you something that's shocking or something like that.
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C
And you're like, yeah, yeah. Especially with Catalyst therapy, there's lots of like, poker face type of stuff.
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B
Yes.
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C
Going on. For sure. Yeah.
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B
I was just thinking my own stories and I'm like, I don't know if that's really appropriate for now, but anyways. So how did you decide to help clinicians be their own billers?
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C
So with my journey, I guess out of grad school, I worked an inpatient for a couple years and got fully licensed then. And then I joined a group practice and worked there for about like two or three years. I forget now. And then I decided to go and do my own practice. And that, of course, is a very scary thing. But I knew that most of my clients at the group practice used insurance. And I knew that the group practice was constantly getting constant referrals. All the time, every day, all day. Because they took insurance. So me taking insurance was sort of a no brainer. Except the catch was the group practice did everything for us. So they did credentialing, they did billing. We basically came in, saw the clients, collected the fees, and then like, and that's it. So. So I really knew nothing outside of private practice or like the business side too, in a way. So I really had to teach myself stuff quickly. I reached out to a few people that I know had solo practices and they taught me a little bit, but it's really trial and error just billing yourself. I always tell my consultants, like, it becomes real once you finally start doing it. Yourself. So I just learned a lot of trial and error. I knew I wanted to panel with a lot of insurance companies and I knew I was good at paperwork, so I did that. And then people started noticing how successful I was and started asking me how to do insurance, how to bill insurance, how to credential. And it was actually my husband that was like, you're helping a lot of people, Danielle. Maybe you should start like charging. And so thus Beer and Biller was formed. And I also in the process started a Facebook group for insurance credentialing and billing because there wasn't one out there. That was also great. All the Facebook groups out there, had I known about them when I was doing my whole I want to do private practice thing, I might not have even joined group practice. I could have done, but I didn't even know that they were out there. That untapped resource. But what is the group?
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B
Yeah, what is the name of your Facebook group?
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C
It's. It's not very catchy because I'm not super clever with names. It's called Insurance Credentialing and Billing for Mental Health Clinicians. Okay.
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A
It tells you exactly what it is. Yeah, exactly.
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B
That's.
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A
I'm a member of it, even though I don't take insurance, just because you had invited me to be a member. And I see you guys, it's a very active group. You have how many people in there right now? Like 5,000?
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C
About 5,000, yeah.
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A
Yeah. So it's a really active, vibrant community for insurance clinicians.
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C
Well, what's great about it too is me just a lot of times with insurance, we're in our own little silos of we only really know what's going on in our region. But I feel so much well versed, well grammar. So well versed in knowing what's going on insurance wise around the nation. Just because of everybody collaborating, I know things are going on in Florida, I know things California, I know everywhere. Great. We all help each other out. I really enjoy the community there.
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A
That's great.
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B
We'll add that to the show notes page so people can find it easily.
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A
Yeah, definitely. I would imagine that there's a huge learning curve when it comes to getting credentialed with a different paneled and the credentialing and the billing and all of that. So tell us a little bit about your experience with that learning curve.
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C
For me, it wasn't like it was. Wasn't that hard. Like I said, I'm good at paperwork and a lot of the credentialing is Just filling out paperwork. It's, you know, copying and pasting things. It's all. Lots of things are online. I realized I had, like, a knack for billing, and I can't do math, but there's really not that much math involved with it. But it's just about being, like, organized. And I'm pretty type A, I guess you would say. So. Like, it's really. As long as you stay on top of it and stay organized, it's not super hard. But what's great is the Facebook group. People come in, and they're completely new to credentialing and everything, and we all help each other out.
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A
That's awesome.
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B
That's great.
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A
So I guess this is a good time to jump right into your topic. Tell us a little bit about some of the myths with billing insurance.
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C
Well, so the first myth I often hear is that you don't make any money. And I mean, so insurance rates do vary throughout the country. So it depends on, you know, your licensure status, if master's level versus doctoral level. It also depends on your region where you live, and it also depends on the insurance company itself. A lot of you have one insurance company that pays one rate. Another insurance company can pay, like, a double that rate. So it really depends on the insurance company on what you can make. But I can speak for myself personally. I mean, I make six figures easily, taking insurance. Gotcha.
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A
That's awesome.
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B
Where are some of, like, the best regions for, like, high rates of insurance? And then.
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C
Yeah, like, overall, like, if. So if you really want to, like, move to be in a better.
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A
Or if you just are listening and happen to be in this area and you go, oh, wow, I didn't know that. I'm lucky.
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C
Yeah. It's interesting because it has a lot to do with just what people can advocate for themselves as far as rates and everything. In Illinois, I know specifically we have a task force in Illinois that is about insurance and getting rate increases. And a while maybe I think 12 years ago or something, they went to our Blue Cross Blue Shield of Illinois and basically not demanded, but negotiated a rate increase. So our rates jumped up significantly to basically.
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B
That's great.
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C
Almost my full fee rate.
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A
Wow, that's amazing.
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C
I would say that Chicagoland has pretty good rates for most of the insurance companies. Other places, I would say, like D.C. area. So like Maryland, Virginia, I can tell you specifically, like, where rates are lower.
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B
Well, that was my next question.
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C
Those jump in more in my mind because people complain a lot more. The rates, for whatever reason, California, the Rates are lower than other places in the nation, which doesn't make any sense to me because it's expensive to live in California. But like I said, the rates really do vary. A lot of people I know got their rates increased in California because they've asked and they've negotiated higher rates. So really just you can advocate for yourself once you're on the panel. And I think that's also a myth that you know, once you get a rate, you're stuck with that rate. And that's absolutely not true.
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A
How do you go about that process of advocating for a rate increase once you are paneled?
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B
Sharing the same brain as always?
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A
Of course we always do. I saw your face.
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C
Yep, I saw your face. Yeah, I knew.
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A
I.
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C
It's a bit of a process. What you would do is you would reach out to your. When you're in network, you get like a network representative and insurance from the insurance company or provider relations and basically write a compelling letter.
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B
What does that mean, a compelling letter?
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C
What are the, what you would do is you would feature if you've got any specialties, they always like evidence based specialties. So emdr, dbt, if you work with any more like a specialized population, so children, if you've got pure registered play therapist, if you got have autism specialty training, type of things like that say others like elderly things that would set you apart. Then I would also any, any second language, third languages, they really like that less. So but if you work evenings and weekends, they also appreciate that I would also make a, like just give some statistics so that you would make a table that would say your full fees. Then I would say your highest, your highest paying panel and then their fees. So kind of compare like okay, here's what, here's my full fee. Here's what another insurance company in the same region that I'm also credentialed with is paying me and here's what you're paying me.
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B
So yeah, that's a super ninja tip.
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A
I know, that's really helpful ninja tip. That's amazing. I bet people listening are going, wow, I had no idea I could do that. And they're probably getting ready to sit down and write that letter right now.
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C
Yeah, I mean it's like I wouldn't say specifically what insurance company is paying you a higher rate, but just say like, you know, an in network rate is this and that you're, you know, so basically like make a, make a comparison and is there, is there some.
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A
Sort of ethical or legal thing around not disclosing what rates Your insurance is actually pay you. Because I asked someone, the other like couple.
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B
Maureen actually.
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A
Was it Maureen?
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C
Yeah.
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A
And she's like, I can't tell you that. And you're like, what? I had no idea.
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C
There is so news to me. There's, there's a bunch of like antitrust laws around it. And each when you sign your insurance contracts, you agree to keep your, your specific rate confidential. Yeah.
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B
Antitrust law. That's an interesting name.
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C
I forget what it's called.
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B
Antitrust. That just sounds funny.
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C
They don't trust creates like competition between the insurance companies and whatnot. But you know, people do off record discuss which, which payers pay more and whatnot.
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B
Or they, or they say things like, it's kind of close to my closer.
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C
Yeah. Yeah.
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B
It's between the numbers of 50 and 75.
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C
In my Facebook group we have a strict like don't disclose your. Your contracted rates in the Facebook group. So if people are wondering like, oh, I can get it and I can find out all the contracted rates. No, we delete all those comments and you can say like make up imaginary numbers. There's really no reason why you would need to share your contracted rates in the Facebook group. But some people do because they don't, they don't necessarily know, which is fine.
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A
What are some other myths about using insurance?
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C
So another myth would be, and I hear this a lot, that you get audited all the time. And the only thing or the only company that I would know or not company. But Medicaid does a lot more audits than private insurance companies do. Medicaid is not private insurance. It's an entitlement plan, which I hate that word, but it's a government entitlement plan based on your income and whatnot. So private insurance, while they do audit for medical necessity, it's not as common as people think. And when they do, you know, they specifically ask for certain clients charts. They don't just say, give me all of your charts. The insurance company can only have access to the client charts that they have that they are members of. So they have no access of other charts.
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A
And if someone were auditing an insurance company, what would they be looking for if they were to say, hand me, you know, Julie Smith's chart. What would need to be in Julie Smith's chart so that you could pass your audit?
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C
Well, in my Facebook group, just a caveat, I uploaded a bunch of insurance companies audit tools. So it's a clear look at. They're all online too. They make it pretty easy in a way. To like know what a note should include. But basically some common, common sense type of things. If you're going to be writing handwritten notes, they should be legible in this day and age. A lot of people have EHRs, but that's kind of a common thing, you know. You know, notes should be signed and dated and whatnot. The client's name and the date of birth should be on the note. Pretty regular things that you would get automatically if you use ehr. As far as basically like listing the client's symptoms to. What's the word? Like to. Wow. I can't think right now like to justify the diagnosis. So say somebody that has an adjustment disorder, anxiety, like okay, what is the stressor that perpetuated the symptoms? What you know, what's their history? All those types of things. You would put in an assessment to do a diagnostic assessment.
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B
So you're talking about an assessment or in the notes?
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C
In an assessment. And then the notes would be more so, okay, like what are their ongoing symptoms that meet medical necessity? What are you doing to reduce their symptoms as far as intervention wise? They like evidence based treatment treatments of course, as like most people would use and then the progress towards their treatment, towards their goals, any medication changes, things like that.
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A
And then would you also need to do a treatment plan as well in addition to the notes?
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C
In addition to the notes? Yeah.
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B
Okay.
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A
I don't miss writing those.
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B
Nope, don't miss anything.
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A
I don't miss writing those.
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C
I write very vague treatment. Probably not the best, but of course like they want, you know, objective types of measurable things, you know, client will report three coping skills to reduce anxiety, things like that.
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A
Yes, we have some of those templates to offer if anybody listening and listening is thinking, oh man, I need to know exactly what needs to go in a treatment plan or a progress note. We definitely have some of those templates in the attorney approved private practice paperwork that we.
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B
Mental status exam and all that stuff. Yeah, exactly. All leads to the diagnosis. Yeah, it's not that we actually you worked in hospital and I worked in community mental health, which we build Medicaid. So we're well aware of this stuff. But not, not in our private practice. We kind of let go a lot of it was funny. I had dinner at my favorite place last night, which is ethos here. And it was actually three therapists and I don't even know how we got started talking about notes. And they said to me like, well Katie, like when do you do your notes? I was like at the end of each session I never leave the office without finishing my notes. I get when people bill insurance or they work for, you know, an addiction recovery place, there's so much paperwork, so.
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C
But I know that's another myth, actually. There's really not that much paperwork. I do my notes probably in five minutes.
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B
Well, too. In the ease of the ehr or if you have like a checkbox thing and you know the way to do your notes.
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C
Exactly.
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B
Super easy.
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C
Like whoever invented the ehr, like, they're my hero because it's so much easier. I'm in hospitals. I remember toting around all these charts and everything and like the binders popping open and the papers were everywhere.
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B
I remember those days. I think I told this story before and I don't know which podcast it was on, so. Oh, my gosh. When I moved down here to Florida back in 2001, I started out as a case manager while I was going to grad school and you know, paper charts back in 2001. And so a lot of times the supervisor would take an audit the charts or whatever, and she had this like, pile of charts in her room and one day the bathroom outside of her office, it flooded. It flooded. And it wasn't number one flooding, it was number two. And guess whose chart was on the bottom. That was disgusting.
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A
Yes, that is disgusting. Officially, yes.
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B
So ehr. What, What EHR do you use?
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C
I use simple practice.
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B
Gotcha. And have you used others?
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C
I have used others, yeah.
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B
Okay, gotcha. Can you share? I know this is a little bit off topic, but I'm just curious about, like, the different features that you like or things like that.
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C
Oh, about with civil practice.
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A
Yeah.
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B
Like how does it help you, especially insurance wise.
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C
Oh yeah. Well, so when I was shopping for EHRs, what I really wanted out of an EHR was a few things. One was an electron, like an electronic intake portal, like for paperwork. So. And that's really helpful. So when a new client comes, comes in, they already have their paperwork done for me because they can send their paperwork electronically through the civil practice client portal.
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A
Nice.
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C
That's what I really wanted that because, like, I just don't want any papers. It just keeps everything streamlined. As far as insurance. I also wanted. And other EHRs have these features as well, but initially a lot of them did not. When. So when you, when you bill an insurance company or even like when you use your own insurance, you get what's called an explanation of benefits and eob and it's in the mail usually and it says, you know, like what the service was the, you know, the allowed amount, what you would potentially owe even though that's not a bill and providers get those as well in the mail. But what's nice with an EHR is you can link up with the insurance company so they actually get deposited right into the ehr. So then it all is streamlined and it's all automatically like the payments all entered for you. And so Simple Practice had that at least initially when I was EHR shopping. So it just streamlines the whole thing. So when you get you bill an insurance company, then the insurance company pays you and they send the error era electronic or maintenance advice. So it's an electronic copy of it, they send it right to Simple Practice and then you get an email that says pay.
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B
Those are always fun emails. Emails in our, in our email regarding paperwork or whatever else.
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C
Yeah, yeah, Paid. Yeah.
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B
So then I think ours says sale notification.
- [24:21]
A
Yes, yes.
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C
Oh yeah, I like those too. And then it's all just streamlined. So that was really important for me. So just on the accounting side because it's a little more difficult accounting wise when you do not accounting but like accounts receivable.
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B
Yeah, of course.
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C
Payment wise and everything versus self pay. Yeah, gotcha.
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A
You've given us a lot of great information today, Danielle, about the myths.
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C
Hopefully I'm not talking too fast. Oh, not at all.
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A
It's been great. It's been really valuable. And what would you say is the most important thing that you want our listeners to take away from your message today?
- [25:00]
C
To not fear insurance. I mean a lot of people do not fear insurance and it is really helpful initially when you're starting out a practice you have to do very little marketing when you accept insurance. People go on the provider directories, they see that you accept insurance and they call you and that's it. And that doesn't cost you anything. Which that being said, I, I still recommend having like a bomb website. Great website. A lot of insurance companies kind of have spots where you can upload a picture in the directory and a little bio. So it's kind of like a free Psychology Today. Cool. Yeah, that's really neat. And also, let's see, I mean it's not as scary as people think, especially with all the EHRs and all the electronic capabilities. We're not there writing paper claims and like mailing them out. I've never sent a paper claim in my life. And you actually also do get paid fairly quickly too. Again with electronic like EFT direct deposit, you get paid two weeks. My quickest payer pays me in two days. One day. So it's. And also in a way it's sort of like self pay because if a client has deductible, they're paying you the full contracted rate, the same date of service. So you're getting that money right away.
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B
Nice. And I know that you have a giveaway for Startup Nation and it is the BYOB CPT code cheat sheet and that is. Or booze. No, it's actually be your own biller.
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C
But something be your own biller. My mom was like BYOB Danielle. I'm like, it's funny.
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B
It is funny.
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A
If I was taking insurance, I'd be by o be in it and with some sort of beverage.
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B
And you do have an online course. Why don't you share about your online course?
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C
I do, yeah. So I'm developing a few actually. But my first one that I rolled out is specifically for credentialing. And it goes. It's not just for credentialing from a solo practice. It goes through credentialing. If you're just starting out from the ground up, credentialing wise, I'm getting, you know, getting your ein, getting all of that, your caqh. It also talks about switching your credentialing from a group practice to a solo practice. So say you're currently working in a group practice. This is a question I get a lot. It's like I want to leave my group practice. How do I switch my insurances to my solo practice? And it goes over that. And it also goes over credentialing for group practice and adding clinicians to your group practice credentialing too.
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B
Awesome.
- [27:46]
C
Through all those facets of credentialing, they're all similar but a little different depending on where you're starting out and what you want to achieve.
- [27:56]
B
That's great. Well, we really appreciated having you here today. I know that we've learned things and I know that Startup Nation sure has as well. So next week we are having Perry Rosenblum back from Brighter Vision.
- [28:09]
A
Yes. Back for round two.
- [28:10]
B
If you guys know, we do love Brighter Vision. We don't keep that. So Perry is going to be talking about SEO. How to get Google to love you.
- [28:21]
C
Yes.
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B
We want some Google love that is important.
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C
Some Googleicious love that's good for self pay. And insurance.
- [28:28]
A
And insurance. Exactly. For all practices. Gotta be Googleicious.
- [28:33]
B
That's right. So, Startup Nation, thank you so much for tuning in today. We hope that you really got a lot of ninja chips, value bombs. We really appreciate Danielle being here and we look forward to seeing you guys next week. And as always, we always want to know how are these podcasts going for you? Are you enjoying them? What are your thoughts? We love to get your little emails. We love for you to subscribe, rate and review on itunes or share on Facebook. And more importantly, you know what, you probably have a colleague that is either going into private practice or maybe like Danielle said, they have been a part of a group practice and they're ready to break solo. So I am sure that they would love for you to actually share this podcast with them. So post in their Facebook group, send them a message, maybe just an email or tell them where they can check it out. So you guys have an amazing and inspired day and thank you guys so much for allowing us to inspire you.
- [29:22]
C
From Startup to mastery.
- [29:23]
A
See you next time guys. Thanks for joining us on the Private practice startup. Visit theprivatepracticestartup.com for awesome resources, free trainings, attorney approved private practice paperwork and so much more.