Strategies for Choosing a Billing Platform
By Sue Coyle, MSW
Social Work Today
Vol. 22 No. 1 P. 26

By taking into account several factors, behavioral health practitioners have a better shot at finding the technology that best meets their practice’s needs.

Opening a behavioral health practice or even just restructuring an existing one comes with a lengthy to-do list for behavioral health practitioners. While none of the decisions would be considered easy, some—such as location and population served—may be made more naturally, whereas the question of billing, for example, can seem more daunting.

Billing, while vital to a successful practice, is not always something practitioners have prior knowledge of or experience in when opening their business. Even when they are familiar with it, practitioners are faced with a wide range of options for choosing their practice’s billing platform. At times, the decision can be overwhelming.

Taking the time to understand not only what’s available through various platforms but also why the platform they choose matters will help ensure that practitioners set up their behavioral health practice for success. After all, getting paid is just as important as having the skills and credentials needed to open a behavioral health practice. Without the finances required to run a business, practitioners cannot serve their clients.

Understanding the Value
First, one must recognize that a billing platform is a tool that can, when properly selected and utilized, enable a practice to run more efficiently and effectively.

“The advent of user-friendly billing platforms was transformative to the world of private practice,” says Sarah Wesch, PhD, PMH-C, a licensed psychologist in the state of Kansas who’s certified in perinatal mental health and established her own practice in 2015. “Finding the right billing platform helps individuals launch a private practice completely on their own, though many people still choose to seek some support from billing professionals.”

Mirean Coleman, LICSW, CT, NASW clinical manager, says a billing platform can enable a practitioner to streamline many of the processes involved in running a practice. “Choosing a billing platform for a clinical social worker or other behavioral health practitioner in private practice is an important step in automating the billing process by improving invoices, payment, and collection systems,” she says. “A billing platform may reduce the administrative workload of the private practice. It also centralizes office tools into one filing location, reduces administrative costs, generates faster payments and invoices, stores information in the cloud, and saves time, paper, ink, and mailing costs.”

And while a billing platform won’t replace the need for a practitioner (or appointed employee) to be aware of insurance requirements and changes, a trusted system can lighten the load with preset billing code options and the ability to appropriately route complex claims.

In short, a reliable billing platform allows a practitioner to devote more time and resources to their clients and less to the administrative tasks tied to billing.

EHRs and Billing
Most billing platforms today are integrated with electronic health records (EHRs), making them an even more important tool for a behavioral health practice. The combination of billing and EHRs further streamlines processes that when separated can slow down an office’s productivity, increase the likelihood of errors, and generally make work more difficult.

“The benefits [of a combined EHR and billing platform] are enhanced revenue cycle management, which improves the lifeblood of any business: cash flow,” says Jay Deppeler, MEd, executive vice president of program growth at Valley Youth House. “The integration of the two also helps enhance compliance and ensure quality when configured correctly.”

That’s not to say there aren’t potential complications or challenges that arise when billing platforms and EHRs are integrated. For example, Deppeler emphasizes the need for accuracy and ongoing assessment. “Making sure the behind-the-scenes matrix is configured to ensure proper notation before invoices move to billing is essential to ensure that services were in fact provided, that they are being billed under the correct codes (which also change from time to time), and that organizations are eliminating the possibility of fraudulent, wasteful, or abusive billing practices,” he says.

However, the need for quality assurance when using a tool is not a reason to keep billing and records separate. In fact, Deppeler sees little cause to do that. When pressed, he hypothesizes that “in the event that the implemented EHR does not support billing specific to a third-party insurer’s specifications, an organization might be forced to uncouple these processes. It’s hard for me to fathom any other reason to have the processes live separately. The integration allows for a more seamless and therefore efficient approach.”

As such, practitioners should be looking for a billing platform that’s capable of hosting their EHR. Knowing this ahead of time and understanding the impact this multiservice product can have on a practice adds even more weight to the task of choosing the appropriate platform.

The Selection Process
Pinpointing the best-fitting billing/EHR platform should not be taken lightly; there is a lot to be considered. The best way to approach the decision is to have a clear understanding of what is needed—what aspects of a platform are a must and which ones are somewhat less valuable or unnecessary.

This can be difficult to determine, particularly given that the individuals and companies marketing their billing platforms are trying to make a sale. They will highlight their product’s best and shiniest features while downplaying faults.

And Google isn’t much help—at least without ultraspecific search terms. Look up “behavioral health billing platform,” “how to select a behavioral health billing platform,” or a similar search, and the first page of results will be for products, not information.

It’s frustrating, but not unexpected. It is not the job of the salespeople, product developers, or the internet at large to do a practitioner’s homework.

“I think this is a two-way street,” Deppeler says. “Yes, of course, EHR peddlers want to sell all of the bells and whistles, but sometimes those processes don’t [jibe] well with the payers that an organization is most frequently utilizing. On balance, some organizations don’t strive to understand how to best leverage imbedded processes or tech in the EHR packages because everyone hates change.”

“It’s a decision that you should take seriously,” Wesch says. “You’ll take quite a bit of time setting up an EHR, adding your own practice information with payers, etc. While it’s possible to pull your client data off one service and transfer it to another, it would require a lot of additional work, so it’s best to make the decision carefully from the start. Consider how many account holders you’ll have, if you want administrative accounts (billers, schedulers), and how you plan to bill. Check with the EHR vendor beforehand with any questions about how their product will match with your needs. And be sure to make good use of the free trials that most EHRs offer.”

Key Factors
Breaking down what is needed into different components can help practitioners better determine which platform might be suited for their practice. It will help them do their homework. “The private practitioner should first determine what tools they desire in their billing platform and take the opportunity to test several affordable billing platforms prior to purchasing one in order to learn which one best fits the needs of their practice,” Coleman says.

For most practitioners, cost is likely a top priority. A platform designed to enable a practice to get paid should not cost more than it’s worth. However, practitioners also should not aim to spend so little that they purchase an ineffective or faulty product, regardless of how tempting a small price tag might be.

Coleman says practices may be too focused on costs to the point that it leads to poor results. “Individuals may select a billing platform because it is inexpensive,” she says. “Although billing platforms may perform similar tasks, they are not all equal. Instead, functionality and desired tools should play a major role in the selection process.”

Wesch notes that when looking at the cost of a platform, practitioners need to take into account several factors to ensure the product is worthwhile. “EHRs vary both in their monthly cost but also in their cost per claim and cost on payment processing. Even small differences in per-client costs can really add up. If you are running a part-time private practice, you need to be sure you’re keeping your overhead costs in check, usually shooting for under 10% to 15% of your expected income. Do the math on how your EHR will play into those overhead costs.”

In addition to cost, practices must determine how the platform will integrate with the current system. Will it have the functionality needed to perform the requested tasks and interact with the practice’s other processes?

“Make sure that your [most used] payers communicate with the back-end reporting features that are used by the billing package. If there is not harmony there, you will have wasted the billing function,” Deppeler says. “It is also useful to ensure that the billing package speaks to your general ledger package so that [accounts receivable] can be seamlessly monitored by the fiscal department rather than requiring burdensome exporting or, worse, keying of data.”

According to Wesch, who has used the same EHR since 2015, functionality entails being able to access the platform both in the office and on the road or at home, as well as having one with integrated, HIPAA-compliant telehealth. “I also prefer to have my credit card and health savings account card processing go directly through my EHR rather than using a separate service. One feature that has kept me loyal to my current EHR … is the secure messaging feature. It’s a HIPAA-compliant way to message with clients. I wouldn’t want to do without that feature,” she says.

Security is another major consideration. A billing platform integrated with an EHR hosts a significant amount of client data. Practitioners need to ensure that they are taking all necessary precautions to keep those data safe while also accessible to both users and clients (as appropriate). While most platforms tout HIPAA compliance, what does that actually mean? What differences exist across the platforms in terms of security and encryption, and how does that impact day-to-day use?

“When I first started shopping for EHRs, I had a lot of worry about finding one that had the kind of encryption that I was comfortable with. After all, you’re trusting client data to the service,” Wesch says. “I found that many of the EHRs use a very high level of encryption. However, not all of them offer the option of securely messaging clients.”

Finally, consider the amount of support the vendor can provide. No product has ever worked seamlessly from start to finish. Practitioners need to be able to address problems as they arise. A billing/EHR platform should include a support team that can answer questions in a clear and helpful manner.

Coleman recommends that practitioners “ask questions about the terms of support and what service level agreements are available in the event assistance or training is needed in the future. Check with your colleagues to learn what billing platform they use and if they would recommend it.”

Practitioners should also pay attention to the sales presentation. If the product’s demonstrations and additional information are unclear prior to purchase, it’s likely to signal trouble down the road when it comes to obtaining assistance. While the sales team is not the support team, they are representative of the company and the platform itself.

Putting It All Together
While the process may seem overwhelming, Wesch encourages practitioners to be patient—not just through the selection and purchase but also the setup. “You’ll need to sit down and spend quite a bit of time getting your EHR up and running. Get some comfy clothes on and settle in, because it’s going to take a while to get it all set up.

“Create a ‘fake client’ so you can test out some of the features of the system, so you can start to get a hang of how it will work. But there are features that you won’t be able to fully test until you are using the platform with a real client. Start slowly, and it will be okay,” she says.

Once the system is up and running, Deppeler recommends practitioners take advantage of the vendor’s resources. “Most well-established EHRs will have user workgroups where information from end users can be exchanged to enhance the consumer experience. Also, many EHRs have ‘client success managers’ or something akin to that. Use them and challenge them to get the best out of the product you use,” he says.

In the end, selecting a billing platform is a to-do list item that won’t be crossed off easily. But if done correctly with diligence and patience, it will be a task that lays the foundation for a successful and financially stable practice.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.