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What You Need to Know About Insurance (Speech Therapy Billing Toolkit)

Insurance billing seems simple at first: provide speech therapy, write up a bill, send it to the insurance company, then get paid. In reality, the process can be a lot more complicated: prior authorizations, visit limits, coding issues, figuring out deductibles vs copays vs co-insurance, and then setting up an EFT so you can actually get paid.

Here is a speech therapy guide to the basics of insurance billing that makes it less overwhelming.

Insurance Basics (For SLPs)

First, you need to know the meaning of the many acronyms you will see throughout the billing process.

The Credentialing Process

To begin billing, you first need to make sure you are credentialed with the insurance companies. They will check your licenses and practice information to decide whether they will approve you to become a provider. In order to do that, you will need to set up a free CAQH Proview account and have the following information handy:

Next, you will need to check the contract with each insurance company to see what their fee schedule is and if they have any special requirements such as mandating the session length for specific CPT codes (e.g. some companies require that 92507 be 1 hour long, even though that code is not timed). All insurance companies will have specific requirements such as which clearinghouses or specific forms they require you to use.

Once you’ve signed your contract to become a provider, you can begin accepting clients who have that insurance. Before providing therapy, you must verify a patient’s benefits through the number on their membership card or through your EMR. Fusion Web Clinic offers a free In-House Billing kit that includes a Verification Questionnaire to use when calling insurance companies, along with a Billing & Collections Checklist and 7 Tips to Help with Billing & Collections handout. (You can get this billing kit for free over on the Resource Library page)

During that call, you will collection information about the patient’s…

After you have verified the patient’s benefits, you are ready to bill! Check out Part 2 of this series to learn how to bill for your therapy so you actually get paid.

If you want an EMR that is built specifically for pediatric therapists, check out Fusion Web Clinic! It makes billing easy with one-click claim submission, auto-created claims, and an integrated credit card processor.

About the Author:

Jill Shook, MS, CCC-SLP owns a private practice in Pittsburgh, PA. She created a course for SLPs starting out in private practice, which is available through Northern Speech Services, and blogs about resources for SLPs in private practice at Private Practice SLP.  Email her at jill@privatepracticeslp.com

In-House Billing Kit

We’ve put together some resources to help you bring billing in-house. This In-House Billing Kit includes: