Podcast Summary: Private Practice Startup Podcast

Episode 93: Myths about Insurance-Based Practices

Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Danielle Kepler, LCPC (Be Your Own Biller)
Date: July 7, 2018

Episode Overview

In this episode, Dr. Kate Campbell and Katie Lemieux welcome Danielle Kepler, a Chicago-based therapist and the founder of Be Your Own Biller. Danielle demystifies common myths about insurance-based private practices, reveals the realities and advantages of accepting insurance, and shares actionable tips and personal experiences to help therapists confidently navigate insurance billing and credentialing. For practice owners exploring insurance—or deterring from it—Danielle’s insights cut through misinformation and offer essential strategies for success in insurance-based practices.

Key Discussion Points & Insights

Danielle's Background and Entry into Private Practice

• Early Interests: Danielle began as a peer mediator in middle school, which sparked her interest in counseling.

  “I was elected as a peer mediator… That was my first, like, glimpse into actually even being sort of a counselor.” (04:40)

• Path to Private Practice: After working in inpatient and group practice settings, Danielle entered solo private practice, motivated by the steady stream of clients insurance provided.

The Formation of "Be Your Own Biller"

• Danielle started teaching herself billing from scratch after leaving her group practice, relying on trial, error, and help from peers.
• Demand from peers for billing advice led to the creation of Danielle’s consultation business and her highly active Facebook group, Insurance Credentialing and Billing for Mental Health Clinicians (08:30).

Demystifying the Myths Around Insurance-Based Practices

Myth #1: "You Can’t Make Money Taking Insurance"

• Insurance reimbursement rates vary widely by region, licensure, and panel, but Danielle says:

  “I can speak for myself personally. I mean, I make six figures easily, taking insurance.” (11:19)

• Some states, like Illinois, have successfully organized for better reimbursement rates (12:13).

Myth #2: "You Can’t Negotiate Your Rates"

• Danielle highlights that, post-credentialing, clinicians can and should advocate for rate increases with insurance panels.
  • Use a compelling letter emphasizing special training, populations served, language skills, and a comparison chart of other insurers’ rates (13:39).
  • Keep specific rates confidential due to antitrust and contract rules (15:31).

  “Once you get a rate, you're stuck with that rate. And that's absolutely not true.” (13:01)

Myth #3: "You Get Audited All the Time"

• Danielle clarifies that while Medicaid does frequent audits, private insurances audit far less often.
  • Audits typically request documentation for specific clients only.
  • Keep notes legible, signed, dated; include client name/DOB, symptoms, progress, and evidence-based interventions (17:55).
  • Treatment plans should be objective and measurable (19:50).

  “[Private insurance] audit for medical necessity, it’s not as common as people think…” (16:47)

Myth #4: "Insurance Practices Are Buried in Paperwork"

• EHRs now streamline paperwork, making notes and billing faster and simpler.

  “There's really not that much paperwork. I do my notes probably in five minutes.” (20:58)

• Danielle uses Simple Practice EHR for billing and client management (22:11).

Advantages of an Insurance-Based Practice

• Steady Referrals: Accepting insurance generates high client inflow with little marketing cost.

  “…when you accept insurance, people go on the provider directories, they see that you accept insurance and they call you and that's it.” (24:59)

• Payment Efficiency: With EHR and EFT, insurance payments can arrive within days to weeks.

  “My quickest payer pays me in two days. One day.” (25:28)

• Parallels with Private Pay: For clients with deductibles, payment is received at time of service.

Notable Quotes & Memorable Moments

• On advocating for yourself:

  “You can advocate for yourself once you're on the panel…that’s also a myth.” (13:01)

• On streamlining paperwork and the magic of EHRs:

  “Whoever invented the EHR, like, they're my hero because it's so much easier.” (21:13)

• On choosing insurance vs. private pay:

  “To not fear insurance...it is really helpful initially when you're starting out a practice.” (24:59)

Danielle's Resources and Outreach

• Facebook Group: Insurance Credentialing and Billing for Mental Health Clinicians (08:30)
• Online Course: Comprehensive credentialing for solo and group practices, including transitions from group to solo and adding new clinicians (26:59).
• Freebie: BYOB CPT code cheat sheet (26:27).

Timestamps for Important Segments

• 04:32 – Danielle’s entry into counseling & journey to private practice
• 08:30 – Launch of Be Your Own Biller & Facebook group
• 10:31 – Tackling the insurance credentialing curve
• 11:19 – Myth: "You can’t make money taking insurance"
• 13:01 – Rate negotiation is possible and how to do it
• 15:31 – Confidentiality & antitrust rules on rate disclosure
• 16:47 – Myth: "Audits are constant threat"—actual audit risks explained
• 19:50 – Writing treatment plans and insurance documentation requirements
• 20:58 – Myth: "So much paperwork!"—EHRs to the rescue
• 22:11 – Danielle’s EHR of choice and why
• 24:59 – Advice for new insurance-based practices: "Do not fear insurance"
• 26:27 – CPT code cheat sheet giveaway
• 26:59 – Danielle’s credentialing online course

Closing Takeaways

• Insurance-based practice can be lucrative, sustainable, and manageable with the right systems, knowledge, and advocacy.
• EHRs and online communities make insurance billing and credentialing far less daunting.
• Clinicians considering insurance panels shouldn’t be paralyzed by myths or fear; plenty of support and resources are now readily available.

For more resources, Danielle's group, or her course links, see the show notes at www.PrivatePracticeStartup.com.