WEBVTT
00:00:27.319 --> 00:00:31.879
Hey everybody, welcome back to another episode of Between Sessions with Berries.
00:00:32.119 --> 00:00:39.239
Our guest today fills a niche that we don't talk about a lot, and we're going to dig into it, but I want to introduce you to her first.
00:00:39.399 --> 00:00:42.439
I have Susan Frager here with us, MSW.
00:00:42.679 --> 00:00:47.479
She got sidetracked from her clinical career and ended up working in managed care.
00:00:47.719 --> 00:00:50.759
And as it was, as that was really getting started in the 1990s.
00:00:50.840 --> 00:00:59.399
And since then, she spent her career operating and building a credentialing service for mental health clinicians of all disciplines, serving professionals in multiple states.
00:00:59.640 --> 00:01:03.319
In late 2021, she began pivoting into coaching and training.
00:01:03.399 --> 00:01:12.760
And as of 2025, she is a full-time consultant coach and billing instructor to mental health clinicians, billers, and credentialing administrative staff.
00:01:12.920 --> 00:01:16.039
Her philosophy is you don't know what you don't know.
00:01:16.280 --> 00:01:17.399
I love that so much.
00:01:17.560 --> 00:01:18.679
You don't know what you don't know.
00:01:18.840 --> 00:01:23.319
So I'm here to help you learn in a supportive way and try to make it as easy as possible.
00:01:23.560 --> 00:01:24.679
I'm so glad you're here.
00:01:24.840 --> 00:01:29.159
You also offer support and intervention for complex claims and appeals.
00:01:29.239 --> 00:01:35.479
So if you're just like somebody that's like all of a sudden can't get an entire payer paid, you're the expert with that.
00:01:35.559 --> 00:01:37.799
You'll hop in and figure out how to get those paid.
00:01:37.879 --> 00:01:38.359
I love that.
00:01:38.439 --> 00:01:39.640
We need you so much.
00:01:39.959 --> 00:01:45.319
As well as a membership-based billing resource tool that can be accessed 24-7.
00:01:45.640 --> 00:02:01.559
Susan is especially known for helping clinicians figure out the labyrinth of Medicare enrollment and billing, trying to decide whether to opt out, and for writing strong dispute letters to top insurance executives that grab their attention and resolve complex lingering billing issues.
00:02:03.319 --> 00:02:05.799
You hold space for others every day.
00:02:06.039 --> 00:02:07.879
This space is for you.
00:02:08.120 --> 00:02:19.159
Welcome to Between Sessions with Barries, the podcast where mental health professionals have real conversations to simplify documentation, fight burnout, and reconnect with the work they love.
00:02:23.080 --> 00:02:24.599
So excited to have you here.
00:02:24.759 --> 00:02:28.439
I could just probably like have 17 episodes with you just based on that bio.
00:02:28.920 --> 00:02:29.560
Well, I'm willing.
00:02:29.719 --> 00:02:30.520
Thank you, Kim.
00:02:30.599 --> 00:02:31.159
Thanks for having me.
00:02:31.240 --> 00:02:38.280
And I'm willing to do 17 episodes, maybe not back to back, but we'll definitely need you as a recurrent guest for sure.
00:02:38.439 --> 00:02:38.680
Thank you.
00:02:38.840 --> 00:02:40.200
Thank you for being here, really.
00:02:40.360 --> 00:02:44.680
Today, the topic we want to talk about is provisionally licensed clinicians.
00:02:44.840 --> 00:02:47.800
This is a huge topic that comes up all the time.
00:02:47.960 --> 00:02:56.920
Like, what do we do with the provisionally licensed, especially if you're running a group practice and you want to be working with these clinicians, helping them get, you know, licensed and all of that.
00:02:57.159 --> 00:02:59.080
Let's dig into it.
00:02:59.400 --> 00:03:03.000
That is a much needed topic.
00:03:03.240 --> 00:03:04.040
Yes, it is.
00:03:04.280 --> 00:03:10.280
And I'll be honest, I'll do a little bit of promo off the channels too.
00:03:10.600 --> 00:03:13.640
I'm doing a webinar on this on July 17th.
00:03:13.719 --> 00:03:17.080
Hopefully, Kim will have all the registration details in the in the podcast notes.
00:03:17.800 --> 00:03:24.200
But it's probably after Medicare, the number one question I get is how do I vote for this?
00:03:24.360 --> 00:03:25.159
Is it allowed?
00:03:25.320 --> 00:03:26.840
How do I document it?
00:03:27.320 --> 00:03:28.760
How do I even know?
00:03:29.000 --> 00:03:31.800
Because of course, not all payers do the same thing.
00:03:31.960 --> 00:03:33.320
That would be too easy, right?
00:03:34.040 --> 00:03:34.280
Right.
00:03:34.439 --> 00:03:35.240
Oh my gosh.
00:03:35.480 --> 00:03:36.520
Wouldn't that be nice?
00:03:36.760 --> 00:03:37.080
Yeah.
00:03:37.400 --> 00:03:42.120
Let's define what provisionally license means because I know there's a little disconnect there too.
00:03:42.200 --> 00:03:43.320
Like, is it an intern?
00:03:43.400 --> 00:03:45.400
Like, what level are they in in the process?
00:03:45.640 --> 00:03:49.719
That's a great place to start because people use different language.
00:03:49.879 --> 00:03:51.879
I've found that a lot of it's regional.
00:03:52.200 --> 00:03:57.960
So I'll try to use different words to mean the same thing just so I don't confuse people.
00:03:58.920 --> 00:04:07.080
In my way of thinking, an intern is somebody that still is in their graduate program, not somebody who has a master's degree.
00:04:07.159 --> 00:04:15.159
Now I know that in psychology it can be a little different because psychology has postdocs where it's kind of, I think, all but dissertation.
00:04:15.320 --> 00:04:17.800
I don't know, I didn't make it that far in my PhD program.
00:04:17.879 --> 00:04:19.800
I was like, nah, I don't think dissertation.
00:04:19.879 --> 00:04:20.279
I haven't good.
00:04:20.439 --> 00:04:21.959
So that's why I got the MSW.
00:04:22.199 --> 00:04:29.319
So for the master's people, if you're doing your internship, your practicum is what we called it in my graduate program.
00:04:29.800 --> 00:04:35.159
That is not supervisory billing that is typically covered by insurance.
00:04:35.719 --> 00:04:51.400
What is sometimes covered is after you get your master's degree and in the two years or 3,000 hours or whatever your state requires, where you have a license, but it is a license to practice under supervision.
00:04:51.480 --> 00:04:57.480
I know out here on the West Coast we call them associates, but I know that term isn't always universal.
00:04:57.560 --> 00:05:04.280
So I try to be real careful, you know, provisionally licensed or you know, requiring supervision.
00:05:04.600 --> 00:05:06.280
There are, I don't know.
00:05:06.360 --> 00:05:10.199
I mean, every every time I work with somebody in a different state, they say, oh no, we call it blah, blah, blah.
00:05:10.280 --> 00:05:12.040
And I know I can't even keep it all in my head.
00:05:12.199 --> 00:05:18.439
So it is confusing because even in, you know, I've got a Facebook group, you and I have talked about this that talks about billing.
00:05:18.519 --> 00:05:20.680
And in there, there's like so many different terms.
00:05:20.840 --> 00:05:29.560
We can't even agree on like what type of billing are we actually talking about here to be able to give information to help people in this process that you're going to teach us about today.
00:05:29.800 --> 00:05:31.000
So this is a huge question.
00:05:31.160 --> 00:05:37.400
What do therapists need to know if they want to bill for provisional licensees in their practice?
00:05:37.560 --> 00:05:41.560
If they want to bring these people in, help them get licensed to that point.
00:05:41.879 --> 00:05:43.240
What what do they need to know?
00:05:43.319 --> 00:05:47.240
Like to get started if they want to start billing for this particular person?
00:05:47.480 --> 00:05:48.600
You need to know a lot.
00:05:48.680 --> 00:05:59.480
And since we started by defining terms, I'm going to define another term that people use incorrectly all the time, including and especially the insurance companies.
00:05:59.639 --> 00:06:01.879
And it's called Incident Two.
00:06:02.680 --> 00:06:04.040
You've heard that term, right?
00:06:04.360 --> 00:06:04.920
Yeah, okay.
00:06:05.160 --> 00:06:06.680
I even use it sometimes by accident.
00:06:07.000 --> 00:06:07.240
Right.
00:06:07.560 --> 00:06:08.519
And I have a blog.
00:06:08.600 --> 00:06:14.840
It's it's by the SEO numbers, it is the one that people hit on the most and link to the most.
00:06:15.079 --> 00:06:17.480
And it's from a couple of years ago.
00:06:17.639 --> 00:06:23.079
I probably have to see if I shouldn't bump it up, even though by date order it's kind of way down on my website.
00:06:23.240 --> 00:06:33.639
It's called incident, it's I I forget the exact title of it, but it was basically how incident two is not the same thing clinically as supervisory billing.
00:06:33.720 --> 00:06:38.360
And in this minute, while I'm talking, I'm wearing a very clinical hat.
00:06:38.519 --> 00:06:40.759
This is we're not talking about billing right now.
00:06:41.079 --> 00:06:41.319
Okay.
00:06:41.879 --> 00:06:50.199
Incident two, if if anybody has, and and and this is kind of an aside, it's like the generations are really different.
00:06:50.280 --> 00:06:57.400
In and when I say generations, I mean generations of clinicians, like when you came through the system, not your chronological age.
00:06:57.560 --> 00:07:07.560
But like for somebody like me who who you know graduated in the early 90s, I mean we had to work in hospitals, community mental health, whatever, or you know, substance abuse treatment.
00:07:07.800 --> 00:07:16.199
So when I say the treatment team approach, I know what I mean, but I know that there's people who go right into private practice, and I say that to them, and they're kind of like, huh?
00:07:16.439 --> 00:07:19.079
And and I I'm not here to pass judgment on it.
00:07:19.240 --> 00:07:20.439
It is what it is.
00:07:20.840 --> 00:07:46.920
But if you think about it, incident two is the treatment team approach, the classic, you're working in a multi-specialty team headed by typically either a medical doctor or a psychiatrist, who that person is doing the billing, and you are and incident two is very much a Medicare term, it's defined by Medicare.
00:07:47.400 --> 00:07:51.160
So, I mean, I don't personally like that term, but you know, I don't control CMS.
00:07:51.319 --> 00:07:55.400
They say your services are incident two, right?
00:07:56.840 --> 00:08:06.040
The psychiatrist and the psychiatrist is the treating clinician of record, not you, under incident two.
00:08:06.439 --> 00:08:09.879
Your services are just part of the overall treatment plan.
00:08:10.840 --> 00:08:22.840
So, what part of that clinically looks like billing for a provisional licensee where the provisional licensee is going to do the assessment session, not the supervisor.
00:08:23.480 --> 00:08:29.000
And just having the supervisor do the assessment session, I'm sorry, that still doesn't make an incident too.
00:08:29.079 --> 00:08:30.439
People think it does, it doesn't.
00:08:31.720 --> 00:08:37.799
From the client's perspective, it is the provisional licensee who is their therapist, not the supervisor.
00:08:37.879 --> 00:08:49.399
I mean, yes, the client knows that this person is getting supervision, and they might might have met the supervisor, but the client thinks the provisional licensee is the supervisor.
00:08:49.960 --> 00:08:50.279
Okay.
00:08:50.519 --> 00:08:50.759
Right.
00:08:51.559 --> 00:08:57.720
Provisional licensee determines the treatment plan, and the supervisor is basically just a case consultant.
00:08:58.679 --> 00:09:01.799
So clinically, these models are very, very, very different.
00:09:02.200 --> 00:09:05.879
And and I'm gonna throw shade on insurance companies right now.
00:09:06.279 --> 00:09:10.200
Please do use incident two wrong.
00:09:10.680 --> 00:09:22.680
Probably because the people that are writing these manuals are not billers, they're just and they're not clinicians, they're just executives somewhere who are like, oh, well, okay, Medicare, incident two, blah, blah, blah.
00:09:22.759 --> 00:09:24.440
All right, we'll put it in here and call it incident two.
00:09:24.680 --> 00:09:26.519
And it just confuses everybody.
00:09:26.759 --> 00:09:40.120
So that's kind of where you have to start with supervisory billing, is because getting started with it means finding out which insurance companies allow it.
00:09:40.360 --> 00:09:43.799
And I'll tell you how not to find that out.
00:09:44.120 --> 00:09:45.080
Yeah, that'd be good.
00:09:46.519 --> 00:09:48.279
Do not do that, please.
00:09:49.399 --> 00:09:51.879
You know what happens when you pick up the phone and call, right?
00:09:52.200 --> 00:09:54.200
Oh my gosh, yes, that's a nightmare.
00:09:54.360 --> 00:09:54.519
Right.
00:09:54.919 --> 00:09:59.320
And then you're reading terms that they're not using, and it's like nobody even knows what you're talking about.
00:09:59.399 --> 00:09:59.879
And yeah.
00:10:00.200 --> 00:10:18.200
And after 45 minutes on hold, you're getting somebody on the other side of a big ocean who doesn't even whose first language isn't even English, much less understanding complex clinical terms, and they're reading from a script which that script has to cover all specialties, not just behavioral health, and they don't, and they don't know.
00:10:18.279 --> 00:10:24.840
And a lot of times, I mean, these people in call centers are graded on resolving calls.
00:10:25.320 --> 00:10:41.399
So their goal is to resolve your call as quickly from, you know, the minute they the person comes into your headset to the minute you hang up, that's called and they're monitored on how fast they can resolve calls.
00:10:41.480 --> 00:10:45.879
And they don't really resolution is just a matter of talk time.
00:10:46.120 --> 00:10:50.039
It's not right, is the issue really fixed or resolved?
00:10:50.919 --> 00:10:55.560
Yes, and how are they even gonna understand it when their own company can't even agree on what the term means?
00:10:56.039 --> 00:10:59.720
You know, I mean it's so so what do we do?
00:10:59.879 --> 00:11:03.639
Let them we're we're we're under agreement, like don't even call, it's not in the works.
00:11:04.759 --> 00:11:14.519
It's in the provider manual, and they come out about once a year, sometimes every six months, and there's no way to find it easily a lot of times.
00:11:14.680 --> 00:11:16.120
You just have to comb through it.
00:11:16.279 --> 00:11:27.080
I my preference is if they allow you to download a PDF, and then what I do is I use, I mean, I'm a Windows user, so it's control F.
00:11:27.159 --> 00:11:27.960
I don't know what it is on Mac.
00:11:30.039 --> 00:11:32.200
Right, and I just start putting in keywords.
00:11:32.360 --> 00:11:34.039
People are like, how do you find stuff so quickly?
00:11:34.120 --> 00:11:35.879
It's like control F, you know.
00:11:36.600 --> 00:12:04.440
Lately, AI is getting better, and I know you're the AI expert, so I don't want to say too much because I am not an AI expert, but lately I've noticed AI seems to be getting better at so if you ask one of the Clotter, there's a million of them, Chat GPT or whatever, does blow, you know, insurance company cover, I think the thing with AI is you have to make sure you define your terms very carefully.
00:12:04.759 --> 00:12:11.320
And then don't assume the AI is right, but it can be a really quick way of getting to the manual.
00:12:12.600 --> 00:12:18.440
And then you can link out from the from the AI to the source.
00:12:18.600 --> 00:12:21.480
And I always ask AI for a source, give me a source.
00:12:21.639 --> 00:12:23.480
Yeah, if you have any other tips, let me know.
00:12:23.560 --> 00:12:24.360
I mean, I'm still learning.
00:12:24.759 --> 00:12:27.320
Oh, I mean, that's totally I mean, I would upload the PDF.
00:12:27.399 --> 00:12:34.440
If you can get a PDF, upload the PDF to it and you know, use it as a source document to be able to pull that information too.
00:12:34.600 --> 00:12:34.759
Yeah.
00:12:35.000 --> 00:12:35.159
Yeah.
00:12:35.320 --> 00:12:41.399
Unfortunately, some insurance companies are getting smart and they're not doing that because they don't want people distributing it.
00:12:41.560 --> 00:12:45.320
So then what you have to do is you have to go through the HTML, and that's so much slower.
00:12:45.480 --> 00:12:49.960
It's like I mean, this is like total side note, but I do use a browser called Perplexity.
00:12:50.039 --> 00:12:56.440
It's Perplexity Comet, and it has an assistant on the side that can take over my screen and do all the dirty work for me.
00:12:56.519 --> 00:13:05.159
So I've literally probably for something like that, if I couldn't get it, I would log in and have my assistant on and tell it to go do the work and search the doc and come back and report to me.
00:13:05.240 --> 00:13:06.440
That's probably how I would do that.
00:13:06.519 --> 00:13:08.360
You know, I didn't know they had a browser.
00:13:08.440 --> 00:13:11.000
I've heard it's a great AI tool, but I didn't know it had a browser.
00:13:11.159 --> 00:13:11.879
I'm gonna check that out.
00:13:12.120 --> 00:13:12.600
Comet.
00:13:12.759 --> 00:13:13.720
Comet is the name.
00:13:13.799 --> 00:13:14.440
It's amazing.
00:13:14.519 --> 00:13:14.919
It's good.
00:13:16.279 --> 00:13:18.360
Comet like like in the sky.
00:13:18.680 --> 00:13:20.039
Yeah, Comet.
00:13:20.600 --> 00:13:20.759
Yeah.
00:13:21.159 --> 00:13:21.720
God, thank you.
00:13:21.879 --> 00:13:22.120
Yeah.
00:13:23.000 --> 00:13:35.080
I mean, I was looking yesterday at a Tricare thing, and Tri-Care has it that way, and I was looking to find out if they would if you could build a no-show to TriCare, and oh my god, it took me like 30 minutes, and I was just oh my gosh.
00:13:35.399 --> 00:13:38.360
Tri comet, get the comet browser, yeah, exactly.
00:13:38.680 --> 00:13:43.560
Okay, so so the provider manual tells you everything you need to know.
00:13:43.639 --> 00:13:45.080
No, okay.
00:13:45.399 --> 00:13:49.879
I mean, for the big companies, I can I can tell you the big three.
00:13:50.360 --> 00:13:51.399
Cigna, yes.
00:13:51.879 --> 00:13:54.919
Of course, they also don't they they pay the worst in most places.
00:13:55.080 --> 00:13:55.159
Yeah.
00:13:55.960 --> 00:13:56.440
Oh gosh.
00:13:56.759 --> 00:13:57.320
Yes.
00:13:57.560 --> 00:14:13.960
And now United Healthcare is really weird because in a few states, state legislatures have passed laws because of access issues saying we expect coverage of provisional licenses.
00:14:14.759 --> 00:14:26.360
So in those states, if you're in network with United, they will allow you to bill supervisory regardless of a special contract.
00:14:26.440 --> 00:14:28.200
And I think it's California.
00:14:28.279 --> 00:14:39.000
I know is I know California is one, I know Iowa, Massachusetts, and I'm always confused about the fourth, and there might be a fifth because I think Illinois may have passed it, but it's not yet.
00:14:40.759 --> 00:14:41.720
No, not Ohio.
00:14:41.879 --> 00:14:47.320
Iowa, oh Iowa Massachusetts Iowa, I know is one.
00:14:47.560 --> 00:14:51.560
Massachusetts, California, and anyway, I I haven't.
00:14:51.720 --> 00:14:52.279
Yeah, yeah.
00:14:52.360 --> 00:14:55.159
There it's four or five at five at the most states.
00:14:55.799 --> 00:14:58.600
But only but here's where it really gets complicated.
00:14:59.080 --> 00:15:01.320
Only four commercial clients.
00:15:01.720 --> 00:15:04.519
So you have a Medicare Advantage client, forget it.
00:15:04.759 --> 00:15:06.840
Medicaid depends on your state.
00:15:07.159 --> 00:15:17.399
So it's like you you have to know the type of plan you're billing, and that i is one of the biggest ethical issues with supervisory that comes up all the time.
00:15:17.480 --> 00:15:28.200
Is what if you get that wrong and you place a client with a supervisee, but now you can't get paid for it, but there's this clinical relationship that's been established.
00:15:28.279 --> 00:15:28.840
What do you do?
00:15:29.000 --> 00:15:30.680
That's one of the biggest problems.
00:15:31.399 --> 00:15:33.000
Yeah, what do you do?
00:15:33.320 --> 00:15:35.720
Most people find a new clinician, transition care.
00:15:36.039 --> 00:15:40.759
You know, outside of Medicaid, most people offer a choice.
00:15:40.919 --> 00:15:46.360
They say we we apologize, we found you know, we got it wrong.
00:15:46.680 --> 00:15:53.720
Sometimes they can make a case at the insurance company because the insurance company makes it so darn difficult.
00:15:53.879 --> 00:16:10.759
If they can't, if they absolutely can't, it's generally well reduced rate, self-pay, or you know, move to a licensed clinician, a fully licensed clinician, and then that of course is up kind of up to the client, and you provide transition sessions and all that.
00:16:11.000 --> 00:16:17.480
Keep in mind that, like, if you are going to dispute it with an insurance company, don't even bother if it's Medicare Advantage, you won't win.
00:16:17.720 --> 00:16:23.560
Okay, because CMS guidelines are very clear, there is no supervisory billing.
00:16:24.440 --> 00:16:34.360
There is incident two, but again, but you have to have the clinical model of incident two that I just described, documented in your notes.
00:16:34.600 --> 00:16:39.080
And if you're a master's level clinician, you cannot be the clinician of record.
00:16:39.159 --> 00:16:44.840
It's only psychologists, I believe nurse practitioners and psychiatrists.
00:16:45.080 --> 00:16:48.440
So forget about it if you're a master's level clinician.
00:16:48.919 --> 00:16:49.399
Wow.
00:16:49.560 --> 00:16:52.039
Oh it's crazy, it's just insane.
00:16:52.360 --> 00:17:02.600
So everywhere else with United Healthcare, you have to have a contract, a contract addendum that allows supervisory billing, and they don't make it easy to get.
00:17:02.840 --> 00:17:07.000
They won't even give it to you unless you're a big enough group.
00:17:07.799 --> 00:17:15.079
Please don't ask me what big enough is because it seems to depend on the phase of the moon, the tides, what state you're in, how nice you are to the person.
00:17:15.240 --> 00:17:17.240
Did they get up out of the right side of the moon in the morning?
00:17:17.879 --> 00:17:18.359
I don't know.
00:17:18.519 --> 00:17:21.799
I've heard everything from three to thirty.
00:17:22.119 --> 00:17:26.919
And sometimes only if you're multi-specialty, like only if you have a prescriber on your staff.
00:17:27.240 --> 00:17:28.519
I just heard that.
00:17:29.240 --> 00:17:42.519
And then in order to actually get, if they say you're big enough, I believe the next step is they actually pre-audit your documentation, and then you have to pass that before they'll give it to you.
00:17:43.480 --> 00:17:43.880
Yes.
00:17:44.120 --> 00:17:44.920
Oh my goodness.
00:17:45.160 --> 00:18:02.440
Which I mean, I do like to bash insurance companies, but I will say, I will say there's one good part about that with United, and that is at least you know, because Cigna and Aetna, they're playing an evil game.
00:18:02.920 --> 00:18:05.400
There's two ways to build supervisory.
00:18:05.720 --> 00:18:13.960
One way is where you, as the licensed clinician, it's as if you saw the client and the supervisee appears nowhere on the claim.
00:18:14.279 --> 00:18:16.920
That is how Aetna and Cygna want you to bill it.
00:18:17.400 --> 00:18:20.359
There's a problem with that, and the problem is math.
00:18:20.599 --> 00:18:29.160
Think about it like this insurers use AI, they've used it for years, and there's something that billers refer to as MUEs.
00:18:29.319 --> 00:18:31.720
It stands for medically unlikely edits.
00:18:32.359 --> 00:18:32.599
Okay.
00:18:32.839 --> 00:18:33.079
Wow.
00:18:33.319 --> 00:18:41.480
So if you're a group of five and you have, let's say, well, actually, let's let's move the math a little bit.
00:18:41.640 --> 00:18:51.400
Let's say you, Kim, have a soup has have four supervisees, and they and they all see two clients a day.
00:18:51.559 --> 00:18:54.359
Okay, so four supervisees times two, that's eight clients.
00:18:54.440 --> 00:18:57.000
And then Kim, let's say you see three.
00:18:57.240 --> 00:19:07.319
That's 11 claims with your name and NPI going in on the same data service, and that MUE, the Medically Unlikely edit, is going to be flagged.
00:19:07.400 --> 00:19:14.599
And it basically says, BS, Kim could not do 11 sessions in one day.
00:19:14.839 --> 00:19:17.400
And then that's an audit trigger.
00:19:17.720 --> 00:19:21.559
And so it's almost like I feel like it's setting you guys up.
00:19:21.720 --> 00:19:31.160
Whereas, I mean, yeah, United is is being jerks about it and not opening the door, but at least you're not being set up for clawbacks.
00:19:31.480 --> 00:19:32.359
Yeah, right.
00:19:32.519 --> 00:19:33.480
You know, exactly.
00:19:33.640 --> 00:19:33.880
Yeah.
00:19:34.039 --> 00:19:36.920
I mean, even if they come and they do the audit, right?
00:19:37.000 --> 00:19:42.759
And they see, like, oh, okay, I see your documentation that you're signing off on these supervisee's notes or whatever.
00:19:43.160 --> 00:19:48.839
The time involved in that, like even having to deal with that, is just, oh my gosh, exhausting.
00:19:49.079 --> 00:19:53.559
And then God forbid you get into their cycle where they're just like on you're on their radar now, right?
00:19:54.039 --> 00:19:55.160
I would imagine that's terrible.
00:19:56.039 --> 00:20:24.599
So one of the biggest pieces of advice I can give people who want to get supervisees on board is keep the numbers small, like three or fewer per fully licensed clinician, and make them as part-time as you can, or maybe do it in such a way where you are only seeing self-pay clients so that your numbers don't go into that total and keep those numbers small.
00:20:24.839 --> 00:20:25.640
It's a setup.
00:20:25.960 --> 00:20:26.359
It is.
00:20:26.519 --> 00:20:29.640
I mean, everything the insurance companies do feel like a setup to me.
00:20:29.799 --> 00:20:30.120
I agree.
00:20:30.279 --> 00:20:33.400
I mean, I agree with it's so awful.
00:20:33.640 --> 00:20:49.079
And and what I always tell people is here's the setup reason because they can claw back, but they can't turn back time and undo the fact that you provided service to their employee, which, if they successfully claw back, is now a free service.
00:20:49.319 --> 00:20:52.279
And so then the CEO can buy his fifth yacht.
00:20:52.680 --> 00:20:53.640
Oh my gosh.
00:20:54.039 --> 00:20:54.599
Oh my god.
00:20:54.920 --> 00:20:56.759
That's how I that's how I think of it.
00:20:57.079 --> 00:20:58.680
You know, it's true.
00:20:58.839 --> 00:21:01.160
Yeah, I mean, that I that's legit.
00:21:01.319 --> 00:21:07.480
And I've always heard that, like, I mean, I don't know if this is a rumor, but I've always heard like they just deny 10% just because.
00:21:07.640 --> 00:21:10.920
Just like that's like their status or status quo.
00:21:11.000 --> 00:21:11.880
Is that a myth?
00:21:12.120 --> 00:21:13.640
I mean, I've totally heard that before.
00:21:13.880 --> 00:21:24.120
Um well, I mean, I can tell from my time working at Magellan, it wasn't, but then again, that was back in the dark ages when AI didn't actually look at claims.
00:21:24.359 --> 00:21:24.599
Yeah.
00:21:24.839 --> 00:21:32.039
When an actual person looked at claims, but then again, I only worked for one insurance company for a very short period of time.
00:21:32.200 --> 00:21:36.680
I can't say what it was like for every insurance company.
00:21:36.759 --> 00:21:43.480
But into the age of AI now, it's totally a matter of kind of like dial a denial.
00:21:43.720 --> 00:21:49.000
And by that I mean like, have you read any of the ProPublica articles that they came out with a couple of years ago?
00:21:49.480 --> 00:21:49.640
Some.
00:21:49.880 --> 00:21:52.279
It's kind of off my radar lately, but but yes.
00:21:52.519 --> 00:21:52.839
Okay.
00:21:53.079 --> 00:22:05.720
Well, some of those articles that they came out with in I think 2024 talked about they can adjust the AI to be either more lenient or more strict.
00:22:06.200 --> 00:22:08.039
And they do, and they can.
00:22:08.279 --> 00:22:13.480
For instance, I'll give you an example that is more for like the nurse practitioner crowd.
00:22:13.799 --> 00:22:17.720
Aetna and Cygna both have automatic downcoding rules now.
00:22:17.880 --> 00:22:27.079
And what that means is if they bill a level four or five, which is higher intensity, higher reimbursement, they're gonna automatically.
00:22:27.480 --> 00:22:28.839
They're not going to deny the claim.
00:22:28.920 --> 00:22:32.599
They're just going to download it to 992 and 3 and pay you at that level.
00:22:32.680 --> 00:22:40.519
And then if you feel like your documentation supports a higher level, it's on you to go fight it and initiate the appeal.
00:22:40.680 --> 00:22:46.759
And what they're doing is they're counting on the fact that like 98% of people don't appeal.
00:22:47.160 --> 00:22:47.400
Yeah.
00:22:47.720 --> 00:22:52.200
And I am now hearing that United is doing that for 908.37.
00:22:52.839 --> 00:22:54.920
I'm starting to hear rumors about that.
00:22:55.079 --> 00:22:58.599
I don't know if it's true, but I've seen it in like on social media.
00:22:59.319 --> 00:23:00.680
So for what that's worth.
00:23:01.000 --> 00:23:11.400
The other thing is keep in mind is they and this is gonna sound really, really paranoid, but they do keep profiles on providers.
00:23:11.960 --> 00:23:12.920
Oh, I believe it.
00:23:13.000 --> 00:23:13.559
No, they do.
00:23:13.720 --> 00:23:14.440
I believe they do.
00:23:14.599 --> 00:23:15.240
Yeah.
00:23:15.559 --> 00:23:28.519
And believe it or not, standing up to insurance companies and showing them that you understand the way the game is played makes them less likely to mess with you than if you just kind of roll over.
00:23:28.680 --> 00:23:30.039
It's really true.
00:23:30.359 --> 00:23:33.960
I should come back for another podcast just on provider profile.
00:23:35.079 --> 00:23:36.519
Oh my gosh, you should.
00:23:36.599 --> 00:23:39.960
And then and then your strongly worded letters on how to deal with it.
00:23:40.120 --> 00:23:40.920
Exactly.
00:23:41.319 --> 00:23:43.400
And that's that's just it.
00:23:43.640 --> 00:23:48.920
Is they can adjust the AI by tax ID and NPI.
00:23:49.240 --> 00:23:57.640
So for some people who routinely have problems, it's different than for some people who have very few problems.
00:23:58.519 --> 00:23:58.920
Right.
00:23:59.079 --> 00:23:59.240
Yeah.
00:23:59.400 --> 00:24:00.200
Oh my gosh.
00:24:00.279 --> 00:24:00.440
Yeah.
00:24:00.599 --> 00:24:01.000
Yeah.
00:24:01.240 --> 00:24:03.400
We've got multiple episodes here.
00:24:04.200 --> 00:24:05.880
So back to the back.
00:24:06.200 --> 00:24:08.759
Yeah, I want to get back to what you said about the Cigna.
00:24:08.920 --> 00:24:11.079
You said Cigna will allow you to build one of two ways.
00:24:11.240 --> 00:24:13.880
So the one way you mentioned like oh, just the one way.
00:24:14.039 --> 00:24:15.400
Signa and just let you build a way.
00:24:15.640 --> 00:24:15.799
Okay.
00:24:16.039 --> 00:24:17.400
There are two ways to bill it.
00:24:17.559 --> 00:24:24.279
Cigna and Aetna both want you to do it where that way provided the service, even though it was your supervisee.
00:24:25.240 --> 00:24:28.680
Other companies do it the way I consider correct.
00:24:29.079 --> 00:24:34.920
And the way if you really were doing incident two billing, like with Medicare, this is how you would do it.
00:24:35.000 --> 00:24:38.279
And it's box 17 in the 1500 form.
00:24:38.440 --> 00:24:42.680
You use a qualifier DQ, and I just try to remember Dairy Queen.
00:24:42.920 --> 00:24:45.799
And then you put the name of the supervising.
00:24:45.960 --> 00:24:48.519
DQ says supervising.
00:24:48.920 --> 00:25:00.200
Then you would put your name, Kim, your NPI, and then box 24J would have the name and the NPI of the actual rendering clinician who is the provisional licensee.
00:25:00.279 --> 00:25:03.640
And then it would be your group information down in 33.
00:25:04.039 --> 00:25:09.480
And that is like the right way to bill it, but not all insurance companies want it that way.
00:25:09.559 --> 00:25:11.000
And the reason is get this?
00:25:11.319 --> 00:25:16.200
They don't want to have to roster the supervisees.
00:25:16.599 --> 00:25:23.000
Meaning roster, meaning they add this person's name and MPI to your group.
00:25:23.319 --> 00:25:29.319
It's not really credentialing, it's sort of a credentialing function, but it's they just don't want to have to bother with it.
00:25:29.720 --> 00:25:30.839
That's obnoxious.
00:25:31.000 --> 00:25:34.039
It is and and that leads to the next problem, right?
00:25:34.120 --> 00:25:41.960
That we see in this population when you're trying to like, you know, do a good thing and still bill and try to help these clinicians and all that stuff.
00:25:42.039 --> 00:25:44.519
There there then becomes this lag time, right?
00:25:44.599 --> 00:25:54.279
So the clinician, you're billing under this supervisor provisional licensed rules, you're following all the rules, and then they get licensed, right?
00:25:54.440 --> 00:25:57.480
And then you have to credential them.
00:25:57.559 --> 00:26:04.440
And then there's a 90 to 120-day window where maybe, I mean, if you got a roster, I guess it goes a little quicker, maybe.
00:26:04.759 --> 00:26:15.400
But this 90 to 120 day window where I can no longer build this way, and I can't like they can't really bill for themselves because they're not fully credentialed yet.
00:26:15.640 --> 00:26:17.160
So what do we do?
00:26:17.559 --> 00:26:21.319
Yeah, what's your like do you have a workaround or like strategies or tips or anything?
00:26:21.640 --> 00:26:25.240
It really depends a lot on state law.
00:26:25.400 --> 00:26:30.599
And I really think the states are, as a general rule, starting to step up.
00:26:30.920 --> 00:26:57.480
I was just talking yesterday to a group practice here in Washington, and we are so lucky here because it's in our state law and it has been for a number of years that if you are a group with an established relationship with an insurance company and you file a credentialing application, let's say I join Kim's group and Kim files for me because I got my license today and she had everything ready.
00:26:57.640 --> 00:27:05.960
And then when the board, you know, gave me my license number, she pops it in and hits submit, then it can take 90, 120 days.
00:27:06.279 --> 00:27:14.599
But the law says my contract effective date with your group is going to be today, and so you can backbill.
00:27:15.319 --> 00:27:22.839
Which, yeah, during the interim, you still have to, I don't know, either hold your billing or bill out a network and then adjust.
00:27:23.000 --> 00:27:26.920
However, in Washington state, some of our payers are a lot nicer.
00:27:27.160 --> 00:27:30.359
Timely filing isn't 60 days, it's a year.
00:27:30.759 --> 00:27:31.960
So that helps.
00:27:32.359 --> 00:27:36.039
Nationally, not all states are so lucky.
00:27:36.279 --> 00:27:40.200
States, I think, need to put that into their legislation.
00:27:40.440 --> 00:27:53.079
You know, if your state's law isn't as kind, I I mean, and this has opened the door for another big topic, the platforms.
00:27:53.400 --> 00:27:56.599
Yeah, I want to talk about that too and hear your take on that because I know you do.
00:27:56.759 --> 00:28:01.160
We're talking about like Headway, Yama, Grow, Slendermine, all of all of those.
00:28:02.120 --> 00:28:06.759
And I get why clinicians feel like they don't have a choice because they kind of don't.
00:28:06.920 --> 00:28:07.559
Yeah.
00:28:08.200 --> 00:28:13.720
And it's I don't judge the clinicians for making the choice that they're forced into making.
00:28:13.799 --> 00:28:16.680
I judge the billionaires that have set it up that way.
00:28:17.160 --> 00:28:18.680
However, there is another option.
00:28:18.839 --> 00:28:22.599
The problem is it's exhausting and time consuming.
00:28:22.680 --> 00:28:26.519
And that is the No Surprises Act allows for continuity of care.
00:28:27.640 --> 00:28:27.960
Okay.
00:28:28.279 --> 00:28:36.759
Continuity of care says you get up to 90 days when your clinician is no longer in the network.
00:28:36.920 --> 00:28:46.200
Well, your clinician who was supervisory billing, your your provisionally licensed clinician was kind of in the network via supervisory.
00:28:46.920 --> 00:28:47.880
Now they're not.
00:28:48.200 --> 00:28:52.279
They still qualify for continuity of care for up to 90 days.
00:28:52.440 --> 00:29:01.000
And then after that, you can typically get a single case agreement for the rest of the credentialing on the grounds that you're in credentialing anyway.
00:29:01.079 --> 00:29:08.200
But the problem is it okay, you've got a caseload of how many, and you've got to do that for all of them.
00:29:08.440 --> 00:29:10.599
It's just it's unworkable.
00:29:10.920 --> 00:29:12.599
It's a lot of work.
00:29:12.920 --> 00:29:14.120
What a nightmare.
00:29:14.440 --> 00:29:21.000
So it's like researching this before you even decide to take this on if you're a group practice owner, would be really smart.
00:29:21.079 --> 00:29:26.039
Or meet with Susan and like say, what do you know about this state and this insurance company and what should I do?
00:29:26.120 --> 00:29:30.120
And give me the roadmap to make sure I do this correctly.
00:29:30.200 --> 00:29:36.759
So I'm not stuck, you know, with these clinicians that their clients can't see them, and we got to find new providers, or we can't bill and we're out of money.
00:29:37.000 --> 00:29:37.559
That whole thing.
00:29:37.799 --> 00:29:38.120
Right.
00:29:38.599 --> 00:29:49.240
And in in some cases, it's it's already, I mean, we were we we've always been in healthcare in this country, a society where haves, have nots.
00:29:49.480 --> 00:30:01.960
It's sort of also because most state Medicaid plans allow supervisory billing and have done for years because they pay so little in most cases.
00:30:02.200 --> 00:30:07.319
What happens is the supervisees get a lot of Medicaid clients.
00:30:07.400 --> 00:30:09.240
And I'm not saying that that's bad.
00:30:09.400 --> 00:30:22.839
I mean, a lot of times a fresh clinician who's not dealing with burnout and really eager to learn is is going to be a really great clinician, but it's still a segregation kind of yeah, thing.
00:30:23.079 --> 00:30:23.319
Yeah.
00:30:23.559 --> 00:30:41.799
And then when the clinician gets licensed, okay, they've got their student loan payment, they've got a million bills, they've got to earn a living, and now all of a sudden the Medicaid and reimbursement rate, especially when you're working for a group and the group is taking a split, it's not that great.
00:30:41.960 --> 00:30:42.920
So what happens?
00:30:43.079 --> 00:30:47.799
Your wonderful, eager new clinician is like, I'm sorry, I can't afford to see you anymore.
00:30:48.200 --> 00:30:48.839
Right.
00:30:49.240 --> 00:30:49.559
Yeah.
00:30:49.799 --> 00:30:51.160
Or I've got to go out on my own.
00:30:51.240 --> 00:30:53.240
I can't, you know, I can't work for this practice anymore.
00:30:53.319 --> 00:30:53.480
Right.
00:30:53.559 --> 00:30:55.960
I've got to take you with me, or get credentialed separately.
00:30:56.120 --> 00:30:56.200
Right.
00:30:56.359 --> 00:30:57.799
It's like a whole thing, right?
00:30:58.039 --> 00:30:58.920
Oh my goodness.
00:30:59.079 --> 00:30:59.400
Yeah.
00:30:59.640 --> 00:30:59.880
Okay.
00:31:00.039 --> 00:31:02.440
So let's let's talk about the platforms for a minute.
00:31:02.519 --> 00:31:06.920
Maybe you could just, I know that's a whole nother, like I said, we need 17 episodes.
00:31:07.240 --> 00:31:08.599
That's a whole other podcast.
00:31:09.319 --> 00:31:19.079
Could you touch on well so when we say platforms, Trema, Headway, Alma, Gross, Undermine, all of these like venture capitalist platforms that will credential you, they'll bill for you.
00:31:19.319 --> 00:31:22.519
You just kind of show up, see your clients, and they do the rest for you.
00:31:22.839 --> 00:31:28.920
What like what do you mean when you say like, like, of course, clinicians are doing this?
00:31:29.079 --> 00:31:34.680
They it's like what you need to do because otherwise you're screwed, kind of like what you didn't say that, but that's my paraphrasing.
00:31:35.000 --> 00:31:35.319
I'll know.
00:31:35.480 --> 00:31:37.720
I I'm trying to keep my language clean.
00:31:38.039 --> 00:31:38.359
Okay.
00:31:39.480 --> 00:31:47.079
In some areas, to be perfectly honest, let's say you are supervisory billing.
00:31:47.240 --> 00:31:53.400
I get I you're you're billing for me, I get my license, and then I want to join that same network.
00:31:53.559 --> 00:31:58.759
In some areas, clinicians are now being told, nope, the only way you can join is through headway.
00:31:59.079 --> 00:32:01.079
You can't join independently anymore.
00:32:01.400 --> 00:32:01.559
Right.
00:32:02.839 --> 00:32:03.640
So now what?
00:32:03.880 --> 00:32:06.680
What are my options if I want to keep seeing these clients?
00:32:07.799 --> 00:32:08.759
Bill through Headway.
00:32:08.839 --> 00:32:09.000
Yeah.
00:32:09.319 --> 00:32:15.160
I mean, unless they can afford to self-pay, which that's a shrinking population right now.
00:32:15.480 --> 00:32:15.799
Yeah.
00:32:16.039 --> 00:32:18.839
And why would you if if your insurance covers therapy?
00:32:19.079 --> 00:32:20.519
I mean, that's a whole other thing.
00:32:20.839 --> 00:32:23.000
You're paying so much for your insurance.
00:32:23.319 --> 00:32:23.880
It's true.
00:32:24.039 --> 00:32:36.120
And you know, I saw a graph the other day, I can't remember where I saw it, but the insurance companies that are associated with each of the the platforms, like they're they they're part owners now.
00:32:36.279 --> 00:32:41.000
And I can't remember who goes with who, but I document it in some of my blogs.
00:32:41.160 --> 00:32:42.599
I try to keep current on it.
00:32:42.759 --> 00:32:45.720
It's yeah, it's it's a moving target.
00:32:45.880 --> 00:32:57.480
There is, I think, one of my recent newsletters has a link out to somebody that's following it even more closely than I do, and it all shows the interrelationships.
00:32:57.559 --> 00:32:58.359
It's very sick.
00:32:58.519 --> 00:33:20.039
And then there's a whole generation of up-and-coming platforms that you've never heard about that just feature like one specific like there's eating disorder, there's a couple for kids, there's substance use, then there's something called inner well, which I haven't seen that one that I I just I was like, how can that even be safe?
00:33:20.200 --> 00:33:28.519
Because what it is is it's ketamine assisted through telehealth, and at a distance I'm going, how is it even safe?
00:33:29.240 --> 00:33:29.720
Wow.
00:33:29.880 --> 00:33:30.200
Yeah.
00:33:30.359 --> 00:33:30.519
Yeah.
00:33:30.599 --> 00:33:31.240
And it's a platform.
00:33:33.079 --> 00:33:33.880
Interesting.
00:33:34.039 --> 00:33:34.599
Yeah.
00:33:35.160 --> 00:33:36.759
And no one even heard of that.
00:33:37.079 --> 00:33:46.519
What's also making me just crazy is you know how they talk about all the time like they want medical behavioral integration and how that's a great thing.
00:33:47.160 --> 00:33:48.440
I think it's a wonderful thing.
00:33:48.839 --> 00:33:50.039
You know why it doesn't work?
00:33:50.200 --> 00:33:51.000
Contracting.
00:33:51.240 --> 00:33:55.640
Because credentialing and contracting, because behavioral health is still segregated.
00:33:55.799 --> 00:33:59.720
I'm sorry, what was that about mental health parity and not discriminating or segregating?
00:33:59.960 --> 00:34:02.359
It doesn't seem to apply to credentialing and contracting.
00:34:02.519 --> 00:34:09.319
That needs to be addressed legislatively on the state level until we can get a federal government that's going to pay attention to this.
00:34:09.639 --> 00:34:16.359
The other thing, though, is that the model that I like is called COCM.
00:34:17.000 --> 00:34:19.159
I'm forgetting the acronym all of a sudden.
00:34:19.239 --> 00:34:23.400
But anyway, there are platforms now devoted just to COCM.
00:34:23.559 --> 00:34:30.599
And it's so hard to get contracted for that because of this divide between medical and behavioral.
00:34:31.000 --> 00:34:32.839
I know you don't know the acronym, but what is COCM?
00:34:33.239 --> 00:34:36.039
COCM is a really good model.
00:34:36.599 --> 00:34:36.839
Clini.
00:34:37.239 --> 00:34:38.919
And I'm going to talk clinically again.
00:34:39.159 --> 00:34:39.479
Okay.
00:34:39.639 --> 00:34:46.119
And I think clinicians would love it because it takes all this administrative nightmare off of their plates.
00:34:46.519 --> 00:34:57.639
If you can get together with a primary care physician, not a psychiatrist, a primary care physician, and work with them to set up this.
00:34:57.879 --> 00:34:59.239
It's like a triangle.
00:34:59.479 --> 00:35:01.079
You've got the primary care.
00:35:01.159 --> 00:35:16.039
And and the whole the whole rationale here is that primary psychiatric medications are much more prescribed in primary care settings than in psychiatry because psychiatry nurse practitioners are so few and don't take insurance.
00:35:16.439 --> 00:35:18.599
So it's a it's a it's a triangular model.
00:35:18.679 --> 00:35:25.399
You have the primary care who is who owns, I guess, the patient.
00:35:25.559 --> 00:35:35.879
Then you have a psychiatric consultant who is a psychiatrist or a nurse practitioner, and then the therapist, psychologist or master's level, or even provisionally licensed.
00:35:36.199 --> 00:35:38.839
I was gonna say, did you bill incident to this?
00:35:39.239 --> 00:35:40.199
That's incident too.
00:35:40.439 --> 00:35:41.239
That's incident two.
00:35:41.959 --> 00:35:42.359
Yeah.
00:35:42.679 --> 00:35:47.319
You can you are the case manager, but you can also do therapy with this person.
00:35:47.399 --> 00:36:00.919
And it is all managed by the primary care office and billed by the primary care office, which means it's incident two and you're getting reimbursed more because it's going through a medical rate, higher rates.
00:36:01.159 --> 00:36:10.599
So trying to set that up from our end is almost impossible because of the segregation of credentialing and contracting.
00:36:10.759 --> 00:36:12.519
So guess who's coming into this?
00:36:12.759 --> 00:36:13.959
The platforms.
00:36:14.199 --> 00:36:19.399
And now I've found platforms that you want to do COCM, oh, sign up with us.
00:36:20.199 --> 00:36:22.039
Ah, I have not even seen that.
00:36:22.119 --> 00:36:22.679
That's interesting.
00:36:23.000 --> 00:36:24.119
I'll have to get you the names.
00:36:24.199 --> 00:36:27.079
It's it's it's in my kind of ever research.
00:36:27.319 --> 00:36:32.679
I've got this research file of emerging platforms and who invests in who.
00:36:32.759 --> 00:36:38.279
And and yeah, I mean, Cygna even owns outright a platform.
00:36:38.359 --> 00:36:39.479
It's called Octave.
00:36:40.039 --> 00:36:41.559
Um, right, right, right.
00:36:43.639 --> 00:36:45.639
I think Headway and maybe Alma.
00:36:45.799 --> 00:36:47.959
I I don't remember the specifics, but I think so.
00:36:48.119 --> 00:36:48.279
Yeah.
00:36:48.439 --> 00:36:50.839
I mean, it's like that that has to be illegal.
00:36:52.119 --> 00:36:58.679
Unfortunately, I you would just think that I don't know what you would call that, but like antitrust laws, or you know, I don't know what that is, but if too much.
00:36:58.919 --> 00:37:01.000
Don't even get me started if it makes sense.
00:37:01.319 --> 00:37:01.559
Okay.
00:37:01.799 --> 00:37:08.039
It's like we're told that you and I can't converse about rates because we're somehow colluding.
00:37:08.199 --> 00:37:15.959
And like that, like that's gonna make a difference if if people on your Facebook page talk about rates, like that's somehow illegal.
00:37:16.279 --> 00:37:23.799
But this whole platform thing, and and this gets into another big area of mind, which is price transparency.
00:37:24.199 --> 00:37:24.679
Yeah.
00:37:24.919 --> 00:37:39.000
Um, there are tools where I can find out when anybody is reimbursed by insurance down to the tax ID and NPI level, and I have the tax IDs and NPIs of Alma, Edway, Brula, blah, blah, blah.
00:37:39.399 --> 00:37:41.799
Whoa! And I know what they're getting paid.
00:37:42.039 --> 00:37:43.319
And here's the a lot.
00:37:43.479 --> 00:37:44.759
And here's the thing.
00:37:45.000 --> 00:37:48.759
What they're getting paid is a heck of a lot more than what you're getting paid.
00:37:49.000 --> 00:37:49.159
Right.
00:37:49.399 --> 00:37:55.879
They may like$10 more than what you would be paying if you contracted independently.
00:37:56.119 --> 00:37:58.759
But I've seen them making a lot more.
00:37:58.919 --> 00:38:05.639
And here's the thing: if your client has a deductible, your client is paying what they're making, not what you're making.
00:38:05.879 --> 00:38:06.199
Right.
00:38:06.439 --> 00:38:19.639
And honestly, it's legal money laundering because they're taking the money from Blue Cross's pocket on the right hand and they're putting it in Blue Cross's pocket on the left hand, and then they're making a little DU for your trouble.
00:38:20.199 --> 00:38:22.599
And it should be illegal, but it's not.
00:38:22.759 --> 00:38:23.719
Not yet anyway.
00:38:23.959 --> 00:38:24.519
It's so crazy.
00:38:24.599 --> 00:38:24.759
Yeah.
00:38:24.919 --> 00:38:26.119
When you really start thinking about it.
00:38:26.279 --> 00:38:26.759
Oh my gosh.
00:38:27.000 --> 00:38:27.559
It's disgusting.
00:38:27.799 --> 00:38:28.039
Okay.
00:38:28.599 --> 00:38:31.319
So, do you want to tell us that tool is or is that top secret?
00:38:31.399 --> 00:38:32.839
Is that secret?
00:38:32.919 --> 00:38:35.000
The problem is it's extremely pricey.
00:38:35.399 --> 00:38:40.519
I subscribe to it, and and every month I go over with my accountant because it's about$2,000.
00:38:43.559 --> 00:38:46.439
Why would I charge for price transparency data dips?
00:38:46.679 --> 00:38:47.639
Because I love that.
00:38:47.959 --> 00:38:54.839
I have to, I, and I call it PTSD, price transparency strategy data dive.
00:38:55.079 --> 00:38:59.399
And so I sit there and I meet with you, and you tell me your goals.
00:38:59.559 --> 00:39:01.239
Who do you want to get a better rate from?
00:39:01.319 --> 00:39:19.079
And we do a deep dive into your market, and I advise you on the feasibility, and then we craft like a customized rate increase letter, which does a heck of a lot better than a template, dear insurance.
00:39:19.319 --> 00:39:21.959
I deserve more money because blah blah blah.
00:39:22.119 --> 00:39:25.719
I make this much, and the going rate is this much, and yeah, I know.
00:39:26.119 --> 00:39:27.079
I have all this trading.
00:39:27.319 --> 00:39:28.039
I know it works.
00:39:28.279 --> 00:39:34.199
I have the statistics and the research, and I make it very research-based, and that's what they eat up.
00:39:34.439 --> 00:39:38.519
And so I've been able to do better than average.
00:39:39.239 --> 00:39:43.719
But then there's times when I look at the data and I'm just like, mm-mm, it's not happening for you.
00:39:43.879 --> 00:39:44.679
It's just not mad.
00:39:44.919 --> 00:39:45.159
Yeah.
00:39:45.479 --> 00:39:46.519
But it's not a thing.
00:39:46.839 --> 00:39:48.199
At least you know.
00:39:48.599 --> 00:39:48.919
Yeah.
00:39:49.079 --> 00:39:53.799
And don't beat your head against the wall, and you can look at other options for your practice.
00:39:54.039 --> 00:39:55.639
You know, amazing.
00:39:55.719 --> 00:39:55.799
Yeah.
00:39:55.959 --> 00:39:58.919
Or like deep panel, like this is what I'm never gonna get a raise from.
00:39:59.000 --> 00:40:00.199
Maybe I need to get off this panel.
00:40:00.279 --> 00:40:01.079
Maybe that makes more sense.
00:40:01.479 --> 00:40:01.879
Exactly.
00:40:02.039 --> 00:40:02.439
Yeah.
00:40:02.679 --> 00:40:04.199
Wow, that is so cool.
00:40:04.519 --> 00:40:06.039
What a what an awesome service.
00:40:06.279 --> 00:40:06.839
Yeah, yeah.
00:40:07.000 --> 00:40:09.719
That is that is one that's becoming ever more popular.
00:40:09.879 --> 00:40:26.919
And and so, but to get back onto the policy level, it's like your question about how is this legal is like so in an in a in an era where price transparency is a thing, yeah, like how is it that we can't share rates?
00:40:27.079 --> 00:40:32.839
And I've pretty much figured out that the sharing rates is not illegal.
00:40:32.919 --> 00:40:37.079
It's the all right, let's get together and boycott Cigna until they pay better rates.
00:40:37.239 --> 00:40:38.279
That's the illegal part.
00:40:38.519 --> 00:40:42.519
But then again, they're still you know colluding.
00:40:42.839 --> 00:40:44.679
I mean, they collude through CAQH.
00:40:45.000 --> 00:40:47.639
CAQH is all owned by the payers.
00:40:48.039 --> 00:40:53.159
Oh, the board of directors reads this insurance company, that insurance company, the other insurance company.
00:40:53.639 --> 00:40:54.279
Oh my god.
00:40:54.519 --> 00:40:57.559
And CAQH has other tools that people don't know about.
00:40:57.799 --> 00:41:03.399
For instance, you know how you get these clawbacks two years later.
00:41:04.039 --> 00:41:11.000
Oh, I'm sorry, this person really had Aetna primary, and so United is clawing back the money and now go bill Aetna.
00:41:11.559 --> 00:41:12.039
Yeah.
00:41:12.279 --> 00:41:20.199
The tool that they use to identify that was invented by CAQH, and it's a subscription tool that the insurance companies have.
00:41:20.359 --> 00:41:30.039
They all share their data of who's insured, and then they go query it via like an API after a certain length of time, and then that's how they know to call back from you.
00:41:30.279 --> 00:41:32.039
Oh my god, that makes me want to puke.
00:41:32.439 --> 00:41:33.079
Yeah.
00:41:33.639 --> 00:41:35.559
Because then you're out of the timely filing window.
00:41:35.959 --> 00:41:37.079
Oh, it can be it can be disputed.
00:41:37.559 --> 00:41:38.039
Can you still?
00:41:38.119 --> 00:41:38.679
It can be disputed.
00:41:38.919 --> 00:41:43.879
Oh, it's it's absolutely disputable and winnable, but the problem is they're counting on you not because it's a lot of work.
00:41:44.199 --> 00:41:44.439
Right.
00:41:44.679 --> 00:41:44.919
Right.
00:41:45.000 --> 00:41:45.799
And that's where you come in.
00:41:45.959 --> 00:41:46.519
That's where it comes in.
00:41:46.919 --> 00:41:47.079
Yeah.
00:41:47.479 --> 00:41:47.959
I love it.
00:41:48.119 --> 00:41:48.679
Oh my gosh.
00:41:48.839 --> 00:41:49.719
Thank you for being here.
00:41:49.959 --> 00:41:54.679
And tell people where to find you, how do they work with you, winter training, and all that good stuff?
00:41:54.919 --> 00:41:57.479
So psychbuildingcoach.com is the main website.
00:41:57.639 --> 00:41:59.639
There's a lot there, a lot free.
00:41:59.879 --> 00:42:01.479
I have a newsletter.
00:42:01.559 --> 00:42:05.639
I try to keep people up to date on what affects you.
00:42:06.439 --> 00:42:11.239
I try to, if where possible, report good news as well as bad news.
00:42:11.479 --> 00:42:24.759
You know, like, you know, congratulations to let's say Illinois, because in Illinois, you it's a new state law, January 1, 2027, 141% of Medicare guaranteed for Illinois clinicians.
00:42:25.000 --> 00:42:26.039
That's a huge jump.
00:42:26.519 --> 00:42:31.079
And the insurance companies are already circling the wagons trying to find a way around that.
00:42:31.159 --> 00:42:33.319
And I'm probably going to be reporting on that here shortly.
00:42:33.479 --> 00:42:39.000
So psychbillingcoach.com, there's a free newsletter, free blog, free.
00:42:39.319 --> 00:42:42.359
I have like a news blog as well as like a blog blog.
00:42:42.439 --> 00:42:48.119
And the difference is kind of one's more my opinion and more in-depth, and one is more just all right, you know, Dr.
00:42:48.359 --> 00:42:51.719
Oz said that you know Medicaid is going to be revalidating.
00:42:51.879 --> 00:42:54.919
So here's what you need to know, and much more factual.
00:42:55.239 --> 00:43:03.399
And then hit on schedule, and you can schedule a consultation or the price transparency session, or my my tool that you mentioned.
00:43:03.479 --> 00:43:09.159
It's it's not like your tool, your tool is more like billing 101, like getting people into it.
00:43:09.479 --> 00:43:15.239
My tool is a little harder, and it's still not done after how many two and a half years?
00:43:15.559 --> 00:43:18.599
Because I'm literally being a it's never done.
00:43:18.759 --> 00:43:20.919
Well, it's never done, but it's not done.
00:43:21.079 --> 00:43:31.639
But I'm literally building a resource of everything you need so that if you want to know, hey, does Blue Cross of Texas allow supervisory billing?
00:43:31.879 --> 00:43:33.079
You can come find it.
00:43:33.159 --> 00:43:36.519
Or hey, can I charge a no-show for Tricare?
00:43:36.839 --> 00:43:39.159
You know, or how do I credential with this or that?
00:43:39.239 --> 00:43:42.599
Or what what's the deal with this like champ VA?
00:43:43.159 --> 00:43:51.639
You know, just all those rules, manuals, like one place where you can dig into it, but I am not AI.
00:43:52.039 --> 00:44:02.599
I'm only using AI to find the citations, and then everything else is you know, infographic done by me, video done by me, text written by me.
00:44:02.839 --> 00:44:06.839
And I have no venture capital funding either, so I have to earn a living.
00:44:07.639 --> 00:44:09.879
So that's why it's going really slowly.
00:44:10.039 --> 00:44:15.559
And but I'm about, I guess 65, 75, 65-ish percent done, I think.
00:44:15.639 --> 00:44:18.599
And so I do have beta subscribers, and that's what it is.
00:44:18.679 --> 00:44:23.399
And there's a lot of like form templates and things like that that that I offer as well in there, too.
00:44:23.479 --> 00:44:27.959
So and subscribers get 15% off of everything else that I that I offer.
00:44:28.039 --> 00:44:30.759
So that's kind of my services in a nutshell.
00:44:31.079 --> 00:44:31.639
I love it.
00:44:31.719 --> 00:44:33.639
Yeah, thank you so much for being a guest today.
00:44:33.799 --> 00:44:36.359
And of course, we're gonna have to have you back for some of these other topics.
00:44:36.439 --> 00:44:38.919
I'm sure people are gonna be like, but you didn't talk about this enough.
00:44:39.639 --> 00:44:41.559
We touched on so many things.
00:44:41.799 --> 00:44:48.679
And oh, I forgot to mention I also give webinars once a month, they're generally on Fridays, Friday mornings about once a month.
00:44:48.839 --> 00:44:51.879
The one in July is gonna be on supervisory billing.
00:44:52.199 --> 00:44:52.599
Love it.
00:44:52.679 --> 00:44:53.079
Yeah, yeah.
00:44:53.159 --> 00:44:56.759
And we're gonna have links to all of that that you guys can check out the show notes.
00:44:57.000 --> 00:44:57.799
And thank you.
00:44:58.039 --> 00:44:58.679
Thank you for being here.
00:44:58.919 --> 00:45:00.039
This is so helpful.
00:45:00.199 --> 00:45:06.199
You're gonna save a lot of people from a lot of pain, you know, by just suggesting that we research the stuff ahead of time.
00:45:06.439 --> 00:45:07.000
That's the goal.
00:45:07.159 --> 00:45:08.599
I like I I know I'm weird.
00:45:08.679 --> 00:45:13.639
I like the research, and you don't have time, you don't have time to research.
00:45:13.879 --> 00:45:16.279
Yeah, and you, I mean, we need people like you.
00:45:16.439 --> 00:45:17.639
Your blog is amazing.
00:45:17.719 --> 00:45:21.639
I've looked at it many times for different because the SEO is so good.
00:45:21.799 --> 00:45:25.079
Anytime I put I type in a search, like your blog pops up.
00:45:25.159 --> 00:45:25.719
It's really great.
00:45:25.799 --> 00:45:29.959
So you want to tell my website person that because super realmers for real.
00:45:30.519 --> 00:45:31.799
That's happened multiple times.
00:45:31.879 --> 00:45:37.159
I mean, I think that's the first time I ever heard of you, you know, was just like randomly finding one of your blog posts about something.
00:45:37.239 --> 00:45:39.479
I don't remember what it was, it was something with Medicare, probably.
00:45:39.719 --> 00:45:40.839
Thank you for everything that you do.
00:45:41.079 --> 00:45:41.879
Oh, you're very welcome.
00:45:41.959 --> 00:45:43.879
And thanks, thanks again for having me.
00:45:48.359 --> 00:45:53.799
Between sessions is brought to you by Barries because clinicians deserve support too.
00:45:54.039 --> 00:46:01.399
To learn how berries can help you streamline your notes, reduce stress, and make space for what matters most, visit hayberries.com.
00:00:27.319 --> 00:00:31.879
Hey everybody, welcome back to another episode of Between Sessions with Berries.
00:00:32.119 --> 00:00:39.239
Our guest today fills a niche that we don't talk about a lot, and we're going to dig into it, but I want to introduce you to her first.
00:00:39.399 --> 00:00:42.439
I have Susan Frager here with us, MSW.
00:00:42.679 --> 00:00:47.479
She got sidetracked from her clinical career and ended up working in managed care.
00:00:47.719 --> 00:00:50.759
And as it was, as that was really getting started in the 1990s.
00:00:50.840 --> 00:00:59.399
And since then, she spent her career operating and building a credentialing service for mental health clinicians of all disciplines, serving professionals in multiple states.
00:00:59.640 --> 00:01:03.319
In late 2021, she began pivoting into coaching and training.
00:01:03.399 --> 00:01:12.760
And as of 2025, she is a full-time consultant coach and billing instructor to mental health clinicians, billers, and credentialing administrative staff.
00:01:12.920 --> 00:01:16.039
Her philosophy is you don't know what you don't know.
00:01:16.280 --> 00:01:17.399
I love that so much.
00:01:17.560 --> 00:01:18.679
You don't know what you don't know.
00:01:18.840 --> 00:01:23.319
So I'm here to help you learn in a supportive way and try to make it as easy as possible.
00:01:23.560 --> 00:01:24.679
I'm so glad you're here.
00:01:24.840 --> 00:01:29.159
You also offer support and intervention for complex claims and appeals.
00:01:29.239 --> 00:01:35.479
So if you're just like somebody that's like all of a sudden can't get an entire payer paid, you're the expert with that.
00:01:35.559 --> 00:01:37.799
You'll hop in and figure out how to get those paid.
00:01:37.879 --> 00:01:38.359
I love that.
00:01:38.439 --> 00:01:39.640
We need you so much.
00:01:39.959 --> 00:01:45.319
As well as a membership-based billing resource tool that can be accessed 24-7.
00:01:45.640 --> 00:02:01.559
Susan is especially known for helping clinicians figure out the labyrinth of Medicare enrollment and billing, trying to decide whether to opt out, and for writing strong dispute letters to top insurance executives that grab their attention and resolve complex lingering billing issues.
00:02:03.319 --> 00:02:05.799
You hold space for others every day.
00:02:06.039 --> 00:02:07.879
This space is for you.
00:02:08.120 --> 00:02:19.159
Welcome to Between Sessions with Barries, the podcast where mental health professionals have real conversations to simplify documentation, fight burnout, and reconnect with the work they love.
00:02:23.080 --> 00:02:24.599
So excited to have you here.
00:02:24.759 --> 00:02:28.439
I could just probably like have 17 episodes with you just based on that bio.
00:02:28.920 --> 00:02:29.560
Well, I'm willing.
00:02:29.719 --> 00:02:30.520
Thank you, Kim.
00:02:30.599 --> 00:02:31.159
Thanks for having me.
00:02:31.240 --> 00:02:38.280
And I'm willing to do 17 episodes, maybe not back to back, but we'll definitely need you as a recurrent guest for sure.
00:02:38.439 --> 00:02:38.680
Thank you.
00:02:38.840 --> 00:02:40.200
Thank you for being here, really.
00:02:40.360 --> 00:02:44.680
Today, the topic we want to talk about is provisionally licensed clinicians.
00:02:44.840 --> 00:02:47.800
This is a huge topic that comes up all the time.
00:02:47.960 --> 00:02:56.920
Like, what do we do with the provisionally licensed, especially if you're running a group practice and you want to be working with these clinicians, helping them get, you know, licensed and all of that.
00:02:57.159 --> 00:02:59.080
Let's dig into it.
00:02:59.400 --> 00:03:03.000
That is a much needed topic.
00:03:03.240 --> 00:03:04.040
Yes, it is.
00:03:04.280 --> 00:03:10.280
And I'll be honest, I'll do a little bit of promo off the channels too.
00:03:10.600 --> 00:03:13.640
I'm doing a webinar on this on July 17th.
00:03:13.719 --> 00:03:17.080
Hopefully, Kim will have all the registration details in the in the podcast notes.
00:03:17.800 --> 00:03:24.200
But it's probably after Medicare, the number one question I get is how do I vote for this?
00:03:24.360 --> 00:03:25.159
Is it allowed?
00:03:25.320 --> 00:03:26.840
How do I document it?
00:03:27.320 --> 00:03:28.760
How do I even know?
00:03:29.000 --> 00:03:31.800
Because of course, not all payers do the same thing.
00:03:31.960 --> 00:03:33.320
That would be too easy, right?
00:03:34.040 --> 00:03:34.280
Right.
00:03:34.439 --> 00:03:35.240
Oh my gosh.
00:03:35.480 --> 00:03:36.520
Wouldn't that be nice?
00:03:36.760 --> 00:03:37.080
Yeah.
00:03:37.400 --> 00:03:42.120
Let's define what provisionally license means because I know there's a little disconnect there too.
00:03:42.200 --> 00:03:43.320
Like, is it an intern?
00:03:43.400 --> 00:03:45.400
Like, what level are they in in the process?
00:03:45.640 --> 00:03:49.719
That's a great place to start because people use different language.
00:03:49.879 --> 00:03:51.879
I've found that a lot of it's regional.
00:03:52.200 --> 00:03:57.960
So I'll try to use different words to mean the same thing just so I don't confuse people.
00:03:58.920 --> 00:04:07.080
In my way of thinking, an intern is somebody that still is in their graduate program, not somebody who has a master's degree.
00:04:07.159 --> 00:04:15.159
Now I know that in psychology it can be a little different because psychology has postdocs where it's kind of, I think, all but dissertation.
00:04:15.320 --> 00:04:17.800
I don't know, I didn't make it that far in my PhD program.
00:04:17.879 --> 00:04:19.800
I was like, nah, I don't think dissertation.
00:04:19.879 --> 00:04:20.279
I haven't good.
00:04:20.439 --> 00:04:21.959
So that's why I got the MSW.
00:04:22.199 --> 00:04:29.319
So for the master's people, if you're doing your internship, your practicum is what we called it in my graduate program.
00:04:29.800 --> 00:04:35.159
That is not supervisory billing that is typically covered by insurance.
00:04:35.719 --> 00:04:51.400
What is sometimes covered is after you get your master's degree and in the two years or 3,000 hours or whatever your state requires, where you have a license, but it is a license to practice under supervision.
00:04:51.480 --> 00:04:57.480
I know out here on the West Coast we call them associates, but I know that term isn't always universal.
00:04:57.560 --> 00:05:04.280
So I try to be real careful, you know, provisionally licensed or you know, requiring supervision.
00:05:04.600 --> 00:05:06.280
There are, I don't know.
00:05:06.360 --> 00:05:10.199
I mean, every every time I work with somebody in a different state, they say, oh no, we call it blah, blah, blah.
00:05:10.280 --> 00:05:12.040
And I know I can't even keep it all in my head.
00:05:12.199 --> 00:05:18.439
So it is confusing because even in, you know, I've got a Facebook group, you and I have talked about this that talks about billing.
00:05:18.519 --> 00:05:20.680
And in there, there's like so many different terms.
00:05:20.840 --> 00:05:29.560
We can't even agree on like what type of billing are we actually talking about here to be able to give information to help people in this process that you're going to teach us about today.
00:05:29.800 --> 00:05:31.000
So this is a huge question.
00:05:31.160 --> 00:05:37.400
What do therapists need to know if they want to bill for provisional licensees in their practice?
00:05:37.560 --> 00:05:41.560
If they want to bring these people in, help them get licensed to that point.
00:05:41.879 --> 00:05:43.240
What what do they need to know?
00:05:43.319 --> 00:05:47.240
Like to get started if they want to start billing for this particular person?
00:05:47.480 --> 00:05:48.600
You need to know a lot.
00:05:48.680 --> 00:05:59.480
And since we started by defining terms, I'm going to define another term that people use incorrectly all the time, including and especially the insurance companies.
00:05:59.639 --> 00:06:01.879
And it's called Incident Two.
00:06:02.680 --> 00:06:04.040
You've heard that term, right?
00:06:04.360 --> 00:06:04.920
Yeah, okay.
00:06:05.160 --> 00:06:06.680
I even use it sometimes by accident.
00:06:07.000 --> 00:06:07.240
Right.
00:06:07.560 --> 00:06:08.519
And I have a blog.
00:06:08.600 --> 00:06:14.840
It's it's by the SEO numbers, it is the one that people hit on the most and link to the most.
00:06:15.079 --> 00:06:17.480
And it's from a couple of years ago.
00:06:17.639 --> 00:06:23.079
I probably have to see if I shouldn't bump it up, even though by date order it's kind of way down on my website.
00:06:23.240 --> 00:06:33.639
It's called incident, it's I I forget the exact title of it, but it was basically how incident two is not the same thing clinically as supervisory billing.
00:06:33.720 --> 00:06:38.360
And in this minute, while I'm talking, I'm wearing a very clinical hat.
00:06:38.519 --> 00:06:40.759
This is we're not talking about billing right now.
00:06:41.079 --> 00:06:41.319
Okay.
00:06:41.879 --> 00:06:50.199
Incident two, if if anybody has, and and and this is kind of an aside, it's like the generations are really different.
00:06:50.280 --> 00:06:57.400
In and when I say generations, I mean generations of clinicians, like when you came through the system, not your chronological age.
00:06:57.560 --> 00:07:07.560
But like for somebody like me who who you know graduated in the early 90s, I mean we had to work in hospitals, community mental health, whatever, or you know, substance abuse treatment.
00:07:07.800 --> 00:07:16.199
So when I say the treatment team approach, I know what I mean, but I know that there's people who go right into private practice, and I say that to them, and they're kind of like, huh?
00:07:16.439 --> 00:07:19.079
And and I I'm not here to pass judgment on it.
00:07:19.240 --> 00:07:20.439
It is what it is.
00:07:20.840 --> 00:07:46.920
But if you think about it, incident two is the treatment team approach, the classic, you're working in a multi-specialty team headed by typically either a medical doctor or a psychiatrist, who that person is doing the billing, and you are and incident two is very much a Medicare term, it's defined by Medicare.
00:07:47.400 --> 00:07:51.160
So, I mean, I don't personally like that term, but you know, I don't control CMS.
00:07:51.319 --> 00:07:55.400
They say your services are incident two, right?
00:07:56.840 --> 00:08:06.040
The psychiatrist and the psychiatrist is the treating clinician of record, not you, under incident two.
00:08:06.439 --> 00:08:09.879
Your services are just part of the overall treatment plan.
00:08:10.840 --> 00:08:22.840
So, what part of that clinically looks like billing for a provisional licensee where the provisional licensee is going to do the assessment session, not the supervisor.
00:08:23.480 --> 00:08:29.000
And just having the supervisor do the assessment session, I'm sorry, that still doesn't make an incident too.
00:08:29.079 --> 00:08:30.439
People think it does, it doesn't.
00:08:31.720 --> 00:08:37.799
From the client's perspective, it is the provisional licensee who is their therapist, not the supervisor.
00:08:37.879 --> 00:08:49.399
I mean, yes, the client knows that this person is getting supervision, and they might might have met the supervisor, but the client thinks the provisional licensee is the supervisor.
00:08:49.960 --> 00:08:50.279
Okay.
00:08:50.519 --> 00:08:50.759
Right.
00:08:51.559 --> 00:08:57.720
Provisional licensee determines the treatment plan, and the supervisor is basically just a case consultant.
00:08:58.679 --> 00:09:01.799
So clinically, these models are very, very, very different.
00:09:02.200 --> 00:09:05.879
And and I'm gonna throw shade on insurance companies right now.
00:09:06.279 --> 00:09:10.200
Please do use incident two wrong.
00:09:10.680 --> 00:09:22.680
Probably because the people that are writing these manuals are not billers, they're just and they're not clinicians, they're just executives somewhere who are like, oh, well, okay, Medicare, incident two, blah, blah, blah.
00:09:22.759 --> 00:09:24.440
All right, we'll put it in here and call it incident two.
00:09:24.680 --> 00:09:26.519
And it just confuses everybody.
00:09:26.759 --> 00:09:40.120
So that's kind of where you have to start with supervisory billing, is because getting started with it means finding out which insurance companies allow it.
00:09:40.360 --> 00:09:43.799
And I'll tell you how not to find that out.
00:09:44.120 --> 00:09:45.080
Yeah, that'd be good.
00:09:46.519 --> 00:09:48.279
Do not do that, please.
00:09:49.399 --> 00:09:51.879
You know what happens when you pick up the phone and call, right?
00:09:52.200 --> 00:09:54.200
Oh my gosh, yes, that's a nightmare.
00:09:54.360 --> 00:09:54.519
Right.
00:09:54.919 --> 00:09:59.320
And then you're reading terms that they're not using, and it's like nobody even knows what you're talking about.
00:09:59.399 --> 00:09:59.879
And yeah.
00:10:00.200 --> 00:10:18.200
And after 45 minutes on hold, you're getting somebody on the other side of a big ocean who doesn't even whose first language isn't even English, much less understanding complex clinical terms, and they're reading from a script which that script has to cover all specialties, not just behavioral health, and they don't, and they don't know.
00:10:18.279 --> 00:10:24.840
And a lot of times, I mean, these people in call centers are graded on resolving calls.
00:10:25.320 --> 00:10:41.399
So their goal is to resolve your call as quickly from, you know, the minute they the person comes into your headset to the minute you hang up, that's called and they're monitored on how fast they can resolve calls.
00:10:41.480 --> 00:10:45.879
And they don't really resolution is just a matter of talk time.
00:10:46.120 --> 00:10:50.039
It's not right, is the issue really fixed or resolved?
00:10:50.919 --> 00:10:55.560
Yes, and how are they even gonna understand it when their own company can't even agree on what the term means?
00:10:56.039 --> 00:10:59.720
You know, I mean it's so so what do we do?
00:10:59.879 --> 00:11:03.639
Let them we're we're we're under agreement, like don't even call, it's not in the works.
00:11:04.759 --> 00:11:14.519
It's in the provider manual, and they come out about once a year, sometimes every six months, and there's no way to find it easily a lot of times.
00:11:14.680 --> 00:11:16.120
You just have to comb through it.
00:11:16.279 --> 00:11:27.080
I my preference is if they allow you to download a PDF, and then what I do is I use, I mean, I'm a Windows user, so it's control F.
00:11:27.159 --> 00:11:27.960
I don't know what it is on Mac.
00:11:30.039 --> 00:11:32.200
Right, and I just start putting in keywords.
00:11:32.360 --> 00:11:34.039
People are like, how do you find stuff so quickly?
00:11:34.120 --> 00:11:35.879
It's like control F, you know.
00:11:36.600 --> 00:12:04.440
Lately, AI is getting better, and I know you're the AI expert, so I don't want to say too much because I am not an AI expert, but lately I've noticed AI seems to be getting better at so if you ask one of the Clotter, there's a million of them, Chat GPT or whatever, does blow, you know, insurance company cover, I think the thing with AI is you have to make sure you define your terms very carefully.
00:12:04.759 --> 00:12:11.320
And then don't assume the AI is right, but it can be a really quick way of getting to the manual.
00:12:12.600 --> 00:12:18.440
And then you can link out from the from the AI to the source.
00:12:18.600 --> 00:12:21.480
And I always ask AI for a source, give me a source.
00:12:21.639 --> 00:12:23.480
Yeah, if you have any other tips, let me know.
00:12:23.560 --> 00:12:24.360
I mean, I'm still learning.
00:12:24.759 --> 00:12:27.320
Oh, I mean, that's totally I mean, I would upload the PDF.
00:12:27.399 --> 00:12:34.440
If you can get a PDF, upload the PDF to it and you know, use it as a source document to be able to pull that information too.
00:12:34.600 --> 00:12:34.759
Yeah.
00:12:35.000 --> 00:12:35.159
Yeah.
00:12:35.320 --> 00:12:41.399
Unfortunately, some insurance companies are getting smart and they're not doing that because they don't want people distributing it.
00:12:41.560 --> 00:12:45.320
So then what you have to do is you have to go through the HTML, and that's so much slower.
00:12:45.480 --> 00:12:49.960
It's like I mean, this is like total side note, but I do use a browser called Perplexity.
00:12:50.039 --> 00:12:56.440
It's Perplexity Comet, and it has an assistant on the side that can take over my screen and do all the dirty work for me.
00:12:56.519 --> 00:13:05.159
So I've literally probably for something like that, if I couldn't get it, I would log in and have my assistant on and tell it to go do the work and search the doc and come back and report to me.
00:13:05.240 --> 00:13:06.440
That's probably how I would do that.
00:13:06.519 --> 00:13:08.360
You know, I didn't know they had a browser.
00:13:08.440 --> 00:13:11.000
I've heard it's a great AI tool, but I didn't know it had a browser.
00:13:11.159 --> 00:13:11.879
I'm gonna check that out.
00:13:12.120 --> 00:13:12.600
Comet.
00:13:12.759 --> 00:13:13.720
Comet is the name.
00:13:13.799 --> 00:13:14.440
It's amazing.
00:13:14.519 --> 00:13:14.919
It's good.
00:13:16.279 --> 00:13:18.360
Comet like like in the sky.
00:13:18.680 --> 00:13:20.039
Yeah, Comet.
00:13:20.600 --> 00:13:20.759
Yeah.
00:13:21.159 --> 00:13:21.720
God, thank you.
00:13:21.879 --> 00:13:22.120
Yeah.
00:13:23.000 --> 00:13:35.080
I mean, I was looking yesterday at a Tricare thing, and Tri-Care has it that way, and I was looking to find out if they would if you could build a no-show to TriCare, and oh my god, it took me like 30 minutes, and I was just oh my gosh.
00:13:35.399 --> 00:13:38.360
Tri comet, get the comet browser, yeah, exactly.
00:13:38.680 --> 00:13:43.560
Okay, so so the provider manual tells you everything you need to know.
00:13:43.639 --> 00:13:45.080
No, okay.
00:13:45.399 --> 00:13:49.879
I mean, for the big companies, I can I can tell you the big three.
00:13:50.360 --> 00:13:51.399
Cigna, yes.
00:13:51.879 --> 00:13:54.919
Of course, they also don't they they pay the worst in most places.
00:13:55.080 --> 00:13:55.159
Yeah.
00:13:55.960 --> 00:13:56.440
Oh gosh.
00:13:56.759 --> 00:13:57.320
Yes.
00:13:57.560 --> 00:14:13.960
And now United Healthcare is really weird because in a few states, state legislatures have passed laws because of access issues saying we expect coverage of provisional licenses.
00:14:14.759 --> 00:14:26.360
So in those states, if you're in network with United, they will allow you to bill supervisory regardless of a special contract.
00:14:26.440 --> 00:14:28.200
And I think it's California.
00:14:28.279 --> 00:14:39.000
I know is I know California is one, I know Iowa, Massachusetts, and I'm always confused about the fourth, and there might be a fifth because I think Illinois may have passed it, but it's not yet.
00:14:40.759 --> 00:14:41.720
No, not Ohio.
00:14:41.879 --> 00:14:47.320
Iowa, oh Iowa Massachusetts Iowa, I know is one.
00:14:47.560 --> 00:14:51.560
Massachusetts, California, and anyway, I I haven't.
00:14:51.720 --> 00:14:52.279
Yeah, yeah.
00:14:52.360 --> 00:14:55.159
There it's four or five at five at the most states.
00:14:55.799 --> 00:14:58.600
But only but here's where it really gets complicated.
00:14:59.080 --> 00:15:01.320
Only four commercial clients.
00:15:01.720 --> 00:15:04.519
So you have a Medicare Advantage client, forget it.
00:15:04.759 --> 00:15:06.840
Medicaid depends on your state.
00:15:07.159 --> 00:15:17.399
So it's like you you have to know the type of plan you're billing, and that i is one of the biggest ethical issues with supervisory that comes up all the time.
00:15:17.480 --> 00:15:28.200
Is what if you get that wrong and you place a client with a supervisee, but now you can't get paid for it, but there's this clinical relationship that's been established.
00:15:28.279 --> 00:15:28.840
What do you do?
00:15:29.000 --> 00:15:30.680
That's one of the biggest problems.
00:15:31.399 --> 00:15:33.000
Yeah, what do you do?
00:15:33.320 --> 00:15:35.720
Most people find a new clinician, transition care.
00:15:36.039 --> 00:15:40.759
You know, outside of Medicaid, most people offer a choice.
00:15:40.919 --> 00:15:46.360
They say we we apologize, we found you know, we got it wrong.
00:15:46.680 --> 00:15:53.720
Sometimes they can make a case at the insurance company because the insurance company makes it so darn difficult.
00:15:53.879 --> 00:16:10.759
If they can't, if they absolutely can't, it's generally well reduced rate, self-pay, or you know, move to a licensed clinician, a fully licensed clinician, and then that of course is up kind of up to the client, and you provide transition sessions and all that.
00:16:11.000 --> 00:16:17.480
Keep in mind that, like, if you are going to dispute it with an insurance company, don't even bother if it's Medicare Advantage, you won't win.
00:16:17.720 --> 00:16:23.560
Okay, because CMS guidelines are very clear, there is no supervisory billing.
00:16:24.440 --> 00:16:34.360
There is incident two, but again, but you have to have the clinical model of incident two that I just described, documented in your notes.
00:16:34.600 --> 00:16:39.080
And if you're a master's level clinician, you cannot be the clinician of record.
00:16:39.159 --> 00:16:44.840
It's only psychologists, I believe nurse practitioners and psychiatrists.
00:16:45.080 --> 00:16:48.440
So forget about it if you're a master's level clinician.
00:16:48.919 --> 00:16:49.399
Wow.
00:16:49.560 --> 00:16:52.039
Oh it's crazy, it's just insane.
00:16:52.360 --> 00:17:02.600
So everywhere else with United Healthcare, you have to have a contract, a contract addendum that allows supervisory billing, and they don't make it easy to get.
00:17:02.840 --> 00:17:07.000
They won't even give it to you unless you're a big enough group.
00:17:07.799 --> 00:17:15.079
Please don't ask me what big enough is because it seems to depend on the phase of the moon, the tides, what state you're in, how nice you are to the person.
00:17:15.240 --> 00:17:17.240
Did they get up out of the right side of the moon in the morning?
00:17:17.879 --> 00:17:18.359
I don't know.
00:17:18.519 --> 00:17:21.799
I've heard everything from three to thirty.
00:17:22.119 --> 00:17:26.919
And sometimes only if you're multi-specialty, like only if you have a prescriber on your staff.
00:17:27.240 --> 00:17:28.519
I just heard that.
00:17:29.240 --> 00:17:42.519
And then in order to actually get, if they say you're big enough, I believe the next step is they actually pre-audit your documentation, and then you have to pass that before they'll give it to you.
00:17:43.480 --> 00:17:43.880
Yes.
00:17:44.120 --> 00:17:44.920
Oh my goodness.
00:17:45.160 --> 00:18:02.440
Which I mean, I do like to bash insurance companies, but I will say, I will say there's one good part about that with United, and that is at least you know, because Cigna and Aetna, they're playing an evil game.
00:18:02.920 --> 00:18:05.400
There's two ways to build supervisory.
00:18:05.720 --> 00:18:13.960
One way is where you, as the licensed clinician, it's as if you saw the client and the supervisee appears nowhere on the claim.
00:18:14.279 --> 00:18:16.920
That is how Aetna and Cygna want you to bill it.
00:18:17.400 --> 00:18:20.359
There's a problem with that, and the problem is math.
00:18:20.599 --> 00:18:29.160
Think about it like this insurers use AI, they've used it for years, and there's something that billers refer to as MUEs.
00:18:29.319 --> 00:18:31.720
It stands for medically unlikely edits.
00:18:32.359 --> 00:18:32.599
Okay.
00:18:32.839 --> 00:18:33.079
Wow.
00:18:33.319 --> 00:18:41.480
So if you're a group of five and you have, let's say, well, actually, let's let's move the math a little bit.
00:18:41.640 --> 00:18:51.400
Let's say you, Kim, have a soup has have four supervisees, and they and they all see two clients a day.
00:18:51.559 --> 00:18:54.359
Okay, so four supervisees times two, that's eight clients.
00:18:54.440 --> 00:18:57.000
And then Kim, let's say you see three.
00:18:57.240 --> 00:19:07.319
That's 11 claims with your name and NPI going in on the same data service, and that MUE, the Medically Unlikely edit, is going to be flagged.
00:19:07.400 --> 00:19:14.599
And it basically says, BS, Kim could not do 11 sessions in one day.
00:19:14.839 --> 00:19:17.400
And then that's an audit trigger.
00:19:17.720 --> 00:19:21.559
And so it's almost like I feel like it's setting you guys up.
00:19:21.720 --> 00:19:31.160
Whereas, I mean, yeah, United is is being jerks about it and not opening the door, but at least you're not being set up for clawbacks.
00:19:31.480 --> 00:19:32.359
Yeah, right.
00:19:32.519 --> 00:19:33.480
You know, exactly.
00:19:33.640 --> 00:19:33.880
Yeah.
00:19:34.039 --> 00:19:36.920
I mean, even if they come and they do the audit, right?
00:19:37.000 --> 00:19:42.759
And they see, like, oh, okay, I see your documentation that you're signing off on these supervisee's notes or whatever.
00:19:43.160 --> 00:19:48.839
The time involved in that, like even having to deal with that, is just, oh my gosh, exhausting.
00:19:49.079 --> 00:19:53.559
And then God forbid you get into their cycle where they're just like on you're on their radar now, right?
00:19:54.039 --> 00:19:55.160
I would imagine that's terrible.
00:19:56.039 --> 00:20:24.599
So one of the biggest pieces of advice I can give people who want to get supervisees on board is keep the numbers small, like three or fewer per fully licensed clinician, and make them as part-time as you can, or maybe do it in such a way where you are only seeing self-pay clients so that your numbers don't go into that total and keep those numbers small.
00:20:24.839 --> 00:20:25.640
It's a setup.
00:20:25.960 --> 00:20:26.359
It is.
00:20:26.519 --> 00:20:29.640
I mean, everything the insurance companies do feel like a setup to me.
00:20:29.799 --> 00:20:30.120
I agree.
00:20:30.279 --> 00:20:33.400
I mean, I agree with it's so awful.
00:20:33.640 --> 00:20:49.079
And and what I always tell people is here's the setup reason because they can claw back, but they can't turn back time and undo the fact that you provided service to their employee, which, if they successfully claw back, is now a free service.
00:20:49.319 --> 00:20:52.279
And so then the CEO can buy his fifth yacht.
00:20:52.680 --> 00:20:53.640
Oh my gosh.
00:20:54.039 --> 00:20:54.599
Oh my god.
00:20:54.920 --> 00:20:56.759
That's how I that's how I think of it.
00:20:57.079 --> 00:20:58.680
You know, it's true.
00:20:58.839 --> 00:21:01.160
Yeah, I mean, that I that's legit.
00:21:01.319 --> 00:21:07.480
And I've always heard that, like, I mean, I don't know if this is a rumor, but I've always heard like they just deny 10% just because.
00:21:07.640 --> 00:21:10.920
Just like that's like their status or status quo.
00:21:11.000 --> 00:21:11.880
Is that a myth?
00:21:12.120 --> 00:21:13.640
I mean, I've totally heard that before.
00:21:13.880 --> 00:21:24.120
Um well, I mean, I can tell from my time working at Magellan, it wasn't, but then again, that was back in the dark ages when AI didn't actually look at claims.
00:21:24.359 --> 00:21:24.599
Yeah.
00:21:24.839 --> 00:21:32.039
When an actual person looked at claims, but then again, I only worked for one insurance company for a very short period of time.
00:21:32.200 --> 00:21:36.680
I can't say what it was like for every insurance company.
00:21:36.759 --> 00:21:43.480
But into the age of AI now, it's totally a matter of kind of like dial a denial.
00:21:43.720 --> 00:21:49.000
And by that I mean like, have you read any of the ProPublica articles that they came out with a couple of years ago?
00:21:49.480 --> 00:21:49.640
Some.
00:21:49.880 --> 00:21:52.279
It's kind of off my radar lately, but but yes.
00:21:52.519 --> 00:21:52.839
Okay.
00:21:53.079 --> 00:22:05.720
Well, some of those articles that they came out with in I think 2024 talked about they can adjust the AI to be either more lenient or more strict.
00:22:06.200 --> 00:22:08.039
And they do, and they can.
00:22:08.279 --> 00:22:13.480
For instance, I'll give you an example that is more for like the nurse practitioner crowd.
00:22:13.799 --> 00:22:17.720
Aetna and Cygna both have automatic downcoding rules now.
00:22:17.880 --> 00:22:27.079
And what that means is if they bill a level four or five, which is higher intensity, higher reimbursement, they're gonna automatically.
00:22:27.480 --> 00:22:28.839
They're not going to deny the claim.
00:22:28.920 --> 00:22:32.599
They're just going to download it to 992 and 3 and pay you at that level.
00:22:32.680 --> 00:22:40.519
And then if you feel like your documentation supports a higher level, it's on you to go fight it and initiate the appeal.
00:22:40.680 --> 00:22:46.759
And what they're doing is they're counting on the fact that like 98% of people don't appeal.
00:22:47.160 --> 00:22:47.400
Yeah.
00:22:47.720 --> 00:22:52.200
And I am now hearing that United is doing that for 908.37.
00:22:52.839 --> 00:22:54.920
I'm starting to hear rumors about that.
00:22:55.079 --> 00:22:58.599
I don't know if it's true, but I've seen it in like on social media.
00:22:59.319 --> 00:23:00.680
So for what that's worth.
00:23:01.000 --> 00:23:11.400
The other thing is keep in mind is they and this is gonna sound really, really paranoid, but they do keep profiles on providers.
00:23:11.960 --> 00:23:12.920
Oh, I believe it.
00:23:13.000 --> 00:23:13.559
No, they do.
00:23:13.720 --> 00:23:14.440
I believe they do.
00:23:14.599 --> 00:23:15.240
Yeah.
00:23:15.559 --> 00:23:28.519
And believe it or not, standing up to insurance companies and showing them that you understand the way the game is played makes them less likely to mess with you than if you just kind of roll over.
00:23:28.680 --> 00:23:30.039
It's really true.
00:23:30.359 --> 00:23:33.960
I should come back for another podcast just on provider profile.
00:23:35.079 --> 00:23:36.519
Oh my gosh, you should.
00:23:36.599 --> 00:23:39.960
And then and then your strongly worded letters on how to deal with it.
00:23:40.120 --> 00:23:40.920
Exactly.
00:23:41.319 --> 00:23:43.400
And that's that's just it.
00:23:43.640 --> 00:23:48.920
Is they can adjust the AI by tax ID and NPI.
00:23:49.240 --> 00:23:57.640
So for some people who routinely have problems, it's different than for some people who have very few problems.
00:23:58.519 --> 00:23:58.920
Right.
00:23:59.079 --> 00:23:59.240
Yeah.
00:23:59.400 --> 00:24:00.200
Oh my gosh.
00:24:00.279 --> 00:24:00.440
Yeah.
00:24:00.599 --> 00:24:01.000
Yeah.
00:24:01.240 --> 00:24:03.400
We've got multiple episodes here.
00:24:04.200 --> 00:24:05.880
So back to the back.
00:24:06.200 --> 00:24:08.759
Yeah, I want to get back to what you said about the Cigna.
00:24:08.920 --> 00:24:11.079
You said Cigna will allow you to build one of two ways.
00:24:11.240 --> 00:24:13.880
So the one way you mentioned like oh, just the one way.
00:24:14.039 --> 00:24:15.400
Signa and just let you build a way.
00:24:15.640 --> 00:24:15.799
Okay.
00:24:16.039 --> 00:24:17.400
There are two ways to bill it.
00:24:17.559 --> 00:24:24.279
Cigna and Aetna both want you to do it where that way provided the service, even though it was your supervisee.
00:24:25.240 --> 00:24:28.680
Other companies do it the way I consider correct.
00:24:29.079 --> 00:24:34.920
And the way if you really were doing incident two billing, like with Medicare, this is how you would do it.
00:24:35.000 --> 00:24:38.279
And it's box 17 in the 1500 form.
00:24:38.440 --> 00:24:42.680
You use a qualifier DQ, and I just try to remember Dairy Queen.
00:24:42.920 --> 00:24:45.799
And then you put the name of the supervising.
00:24:45.960 --> 00:24:48.519
DQ says supervising.
00:24:48.920 --> 00:25:00.200
Then you would put your name, Kim, your NPI, and then box 24J would have the name and the NPI of the actual rendering clinician who is the provisional licensee.
00:25:00.279 --> 00:25:03.640
And then it would be your group information down in 33.
00:25:04.039 --> 00:25:09.480
And that is like the right way to bill it, but not all insurance companies want it that way.
00:25:09.559 --> 00:25:11.000
And the reason is get this?
00:25:11.319 --> 00:25:16.200
They don't want to have to roster the supervisees.
00:25:16.599 --> 00:25:23.000
Meaning roster, meaning they add this person's name and MPI to your group.
00:25:23.319 --> 00:25:29.319
It's not really credentialing, it's sort of a credentialing function, but it's they just don't want to have to bother with it.
00:25:29.720 --> 00:25:30.839
That's obnoxious.
00:25:31.000 --> 00:25:34.039
It is and and that leads to the next problem, right?
00:25:34.120 --> 00:25:41.960
That we see in this population when you're trying to like, you know, do a good thing and still bill and try to help these clinicians and all that stuff.
00:25:42.039 --> 00:25:44.519
There there then becomes this lag time, right?
00:25:44.599 --> 00:25:54.279
So the clinician, you're billing under this supervisor provisional licensed rules, you're following all the rules, and then they get licensed, right?
00:25:54.440 --> 00:25:57.480
And then you have to credential them.
00:25:57.559 --> 00:26:04.440
And then there's a 90 to 120-day window where maybe, I mean, if you got a roster, I guess it goes a little quicker, maybe.
00:26:04.759 --> 00:26:15.400
But this 90 to 120 day window where I can no longer build this way, and I can't like they can't really bill for themselves because they're not fully credentialed yet.
00:26:15.640 --> 00:26:17.160
So what do we do?
00:26:17.559 --> 00:26:21.319
Yeah, what's your like do you have a workaround or like strategies or tips or anything?
00:26:21.640 --> 00:26:25.240
It really depends a lot on state law.
00:26:25.400 --> 00:26:30.599
And I really think the states are, as a general rule, starting to step up.
00:26:30.920 --> 00:26:57.480
I was just talking yesterday to a group practice here in Washington, and we are so lucky here because it's in our state law and it has been for a number of years that if you are a group with an established relationship with an insurance company and you file a credentialing application, let's say I join Kim's group and Kim files for me because I got my license today and she had everything ready.
00:26:57.640 --> 00:27:05.960
And then when the board, you know, gave me my license number, she pops it in and hits submit, then it can take 90, 120 days.
00:27:06.279 --> 00:27:14.599
But the law says my contract effective date with your group is going to be today, and so you can backbill.
00:27:15.319 --> 00:27:22.839
Which, yeah, during the interim, you still have to, I don't know, either hold your billing or bill out a network and then adjust.
00:27:23.000 --> 00:27:26.920
However, in Washington state, some of our payers are a lot nicer.
00:27:27.160 --> 00:27:30.359
Timely filing isn't 60 days, it's a year.
00:27:30.759 --> 00:27:31.960
So that helps.
00:27:32.359 --> 00:27:36.039
Nationally, not all states are so lucky.
00:27:36.279 --> 00:27:40.200
States, I think, need to put that into their legislation.
00:27:40.440 --> 00:27:53.079
You know, if your state's law isn't as kind, I I mean, and this has opened the door for another big topic, the platforms.
00:27:53.400 --> 00:27:56.599
Yeah, I want to talk about that too and hear your take on that because I know you do.
00:27:56.759 --> 00:28:01.160
We're talking about like Headway, Yama, Grow, Slendermine, all of all of those.
00:28:02.120 --> 00:28:06.759
And I get why clinicians feel like they don't have a choice because they kind of don't.
00:28:06.920 --> 00:28:07.559
Yeah.
00:28:08.200 --> 00:28:13.720
And it's I don't judge the clinicians for making the choice that they're forced into making.
00:28:13.799 --> 00:28:16.680
I judge the billionaires that have set it up that way.
00:28:17.160 --> 00:28:18.680
However, there is another option.
00:28:18.839 --> 00:28:22.599
The problem is it's exhausting and time consuming.
00:28:22.680 --> 00:28:26.519
And that is the No Surprises Act allows for continuity of care.
00:28:27.640 --> 00:28:27.960
Okay.
00:28:28.279 --> 00:28:36.759
Continuity of care says you get up to 90 days when your clinician is no longer in the network.
00:28:36.920 --> 00:28:46.200
Well, your clinician who was supervisory billing, your your provisionally licensed clinician was kind of in the network via supervisory.
00:28:46.920 --> 00:28:47.880
Now they're not.
00:28:48.200 --> 00:28:52.279
They still qualify for continuity of care for up to 90 days.
00:28:52.440 --> 00:29:01.000
And then after that, you can typically get a single case agreement for the rest of the credentialing on the grounds that you're in credentialing anyway.
00:29:01.079 --> 00:29:08.200
But the problem is it okay, you've got a caseload of how many, and you've got to do that for all of them.
00:29:08.440 --> 00:29:10.599
It's just it's unworkable.
00:29:10.920 --> 00:29:12.599
It's a lot of work.
00:29:12.920 --> 00:29:14.120
What a nightmare.
00:29:14.440 --> 00:29:21.000
So it's like researching this before you even decide to take this on if you're a group practice owner, would be really smart.
00:29:21.079 --> 00:29:26.039
Or meet with Susan and like say, what do you know about this state and this insurance company and what should I do?
00:29:26.120 --> 00:29:30.120
And give me the roadmap to make sure I do this correctly.
00:29:30.200 --> 00:29:36.759
So I'm not stuck, you know, with these clinicians that their clients can't see them, and we got to find new providers, or we can't bill and we're out of money.
00:29:37.000 --> 00:29:37.559
That whole thing.
00:29:37.799 --> 00:29:38.120
Right.
00:29:38.599 --> 00:29:49.240
And in in some cases, it's it's already, I mean, we were we we've always been in healthcare in this country, a society where haves, have nots.
00:29:49.480 --> 00:30:01.960
It's sort of also because most state Medicaid plans allow supervisory billing and have done for years because they pay so little in most cases.
00:30:02.200 --> 00:30:07.319
What happens is the supervisees get a lot of Medicaid clients.
00:30:07.400 --> 00:30:09.240
And I'm not saying that that's bad.
00:30:09.400 --> 00:30:22.839
I mean, a lot of times a fresh clinician who's not dealing with burnout and really eager to learn is is going to be a really great clinician, but it's still a segregation kind of yeah, thing.
00:30:23.079 --> 00:30:23.319
Yeah.
00:30:23.559 --> 00:30:41.799
And then when the clinician gets licensed, okay, they've got their student loan payment, they've got a million bills, they've got to earn a living, and now all of a sudden the Medicaid and reimbursement rate, especially when you're working for a group and the group is taking a split, it's not that great.
00:30:41.960 --> 00:30:42.920
So what happens?
00:30:43.079 --> 00:30:47.799
Your wonderful, eager new clinician is like, I'm sorry, I can't afford to see you anymore.
00:30:48.200 --> 00:30:48.839
Right.
00:30:49.240 --> 00:30:49.559
Yeah.
00:30:49.799 --> 00:30:51.160
Or I've got to go out on my own.
00:30:51.240 --> 00:30:53.240
I can't, you know, I can't work for this practice anymore.
00:30:53.319 --> 00:30:53.480
Right.
00:30:53.559 --> 00:30:55.960
I've got to take you with me, or get credentialed separately.
00:30:56.120 --> 00:30:56.200
Right.
00:30:56.359 --> 00:30:57.799
It's like a whole thing, right?
00:30:58.039 --> 00:30:58.920
Oh my goodness.
00:30:59.079 --> 00:30:59.400
Yeah.
00:30:59.640 --> 00:30:59.880
Okay.
00:31:00.039 --> 00:31:02.440
So let's let's talk about the platforms for a minute.
00:31:02.519 --> 00:31:06.920
Maybe you could just, I know that's a whole nother, like I said, we need 17 episodes.
00:31:07.240 --> 00:31:08.599
That's a whole other podcast.
00:31:09.319 --> 00:31:19.079
Could you touch on well so when we say platforms, Trema, Headway, Alma, Gross, Undermine, all of these like venture capitalist platforms that will credential you, they'll bill for you.
00:31:19.319 --> 00:31:22.519
You just kind of show up, see your clients, and they do the rest for you.
00:31:22.839 --> 00:31:28.920
What like what do you mean when you say like, like, of course, clinicians are doing this?
00:31:29.079 --> 00:31:34.680
They it's like what you need to do because otherwise you're screwed, kind of like what you didn't say that, but that's my paraphrasing.
00:31:35.000 --> 00:31:35.319
I'll know.
00:31:35.480 --> 00:31:37.720
I I'm trying to keep my language clean.
00:31:38.039 --> 00:31:38.359
Okay.
00:31:39.480 --> 00:31:47.079
In some areas, to be perfectly honest, let's say you are supervisory billing.
00:31:47.240 --> 00:31:53.400
I get I you're you're billing for me, I get my license, and then I want to join that same network.
00:31:53.559 --> 00:31:58.759
In some areas, clinicians are now being told, nope, the only way you can join is through headway.
00:31:59.079 --> 00:32:01.079
You can't join independently anymore.
00:32:01.400 --> 00:32:01.559
Right.
00:32:02.839 --> 00:32:03.640
So now what?
00:32:03.880 --> 00:32:06.680
What are my options if I want to keep seeing these clients?
00:32:07.799 --> 00:32:08.759
Bill through Headway.
00:32:08.839 --> 00:32:09.000
Yeah.
00:32:09.319 --> 00:32:15.160
I mean, unless they can afford to self-pay, which that's a shrinking population right now.
00:32:15.480 --> 00:32:15.799
Yeah.
00:32:16.039 --> 00:32:18.839
And why would you if if your insurance covers therapy?
00:32:19.079 --> 00:32:20.519
I mean, that's a whole other thing.
00:32:20.839 --> 00:32:23.000
You're paying so much for your insurance.
00:32:23.319 --> 00:32:23.880
It's true.
00:32:24.039 --> 00:32:36.120
And you know, I saw a graph the other day, I can't remember where I saw it, but the insurance companies that are associated with each of the the platforms, like they're they they're part owners now.
00:32:36.279 --> 00:32:41.000
And I can't remember who goes with who, but I document it in some of my blogs.
00:32:41.160 --> 00:32:42.599
I try to keep current on it.
00:32:42.759 --> 00:32:45.720
It's yeah, it's it's a moving target.
00:32:45.880 --> 00:32:57.480
There is, I think, one of my recent newsletters has a link out to somebody that's following it even more closely than I do, and it all shows the interrelationships.
00:32:57.559 --> 00:32:58.359
It's very sick.
00:32:58.519 --> 00:33:20.039
And then there's a whole generation of up-and-coming platforms that you've never heard about that just feature like one specific like there's eating disorder, there's a couple for kids, there's substance use, then there's something called inner well, which I haven't seen that one that I I just I was like, how can that even be safe?
00:33:20.200 --> 00:33:28.519
Because what it is is it's ketamine assisted through telehealth, and at a distance I'm going, how is it even safe?
00:33:29.240 --> 00:33:29.720
Wow.
00:33:29.880 --> 00:33:30.200
Yeah.
00:33:30.359 --> 00:33:30.519
Yeah.
00:33:30.599 --> 00:33:31.240
And it's a platform.
00:33:33.079 --> 00:33:33.880
Interesting.
00:33:34.039 --> 00:33:34.599
Yeah.
00:33:35.160 --> 00:33:36.759
And no one even heard of that.
00:33:37.079 --> 00:33:46.519
What's also making me just crazy is you know how they talk about all the time like they want medical behavioral integration and how that's a great thing.
00:33:47.160 --> 00:33:48.440
I think it's a wonderful thing.
00:33:48.839 --> 00:33:50.039
You know why it doesn't work?
00:33:50.200 --> 00:33:51.000
Contracting.
00:33:51.240 --> 00:33:55.640
Because credentialing and contracting, because behavioral health is still segregated.
00:33:55.799 --> 00:33:59.720
I'm sorry, what was that about mental health parity and not discriminating or segregating?
00:33:59.960 --> 00:34:02.359
It doesn't seem to apply to credentialing and contracting.
00:34:02.519 --> 00:34:09.319
That needs to be addressed legislatively on the state level until we can get a federal government that's going to pay attention to this.
00:34:09.639 --> 00:34:16.359
The other thing, though, is that the model that I like is called COCM.
00:34:17.000 --> 00:34:19.159
I'm forgetting the acronym all of a sudden.
00:34:19.239 --> 00:34:23.400
But anyway, there are platforms now devoted just to COCM.
00:34:23.559 --> 00:34:30.599
And it's so hard to get contracted for that because of this divide between medical and behavioral.
00:34:31.000 --> 00:34:32.839
I know you don't know the acronym, but what is COCM?
00:34:33.239 --> 00:34:36.039
COCM is a really good model.
00:34:36.599 --> 00:34:36.839
Clini.
00:34:37.239 --> 00:34:38.919
And I'm going to talk clinically again.
00:34:39.159 --> 00:34:39.479
Okay.
00:34:39.639 --> 00:34:46.119
And I think clinicians would love it because it takes all this administrative nightmare off of their plates.
00:34:46.519 --> 00:34:57.639
If you can get together with a primary care physician, not a psychiatrist, a primary care physician, and work with them to set up this.
00:34:57.879 --> 00:34:59.239
It's like a triangle.
00:34:59.479 --> 00:35:01.079
You've got the primary care.
00:35:01.159 --> 00:35:16.039
And and the whole the whole rationale here is that primary psychiatric medications are much more prescribed in primary care settings than in psychiatry because psychiatry nurse practitioners are so few and don't take insurance.
00:35:16.439 --> 00:35:18.599
So it's a it's a it's a triangular model.
00:35:18.679 --> 00:35:25.399
You have the primary care who is who owns, I guess, the patient.
00:35:25.559 --> 00:35:35.879
Then you have a psychiatric consultant who is a psychiatrist or a nurse practitioner, and then the therapist, psychologist or master's level, or even provisionally licensed.
00:35:36.199 --> 00:35:38.839
I was gonna say, did you bill incident to this?
00:35:39.239 --> 00:35:40.199
That's incident too.
00:35:40.439 --> 00:35:41.239
That's incident two.
00:35:41.959 --> 00:35:42.359
Yeah.
00:35:42.679 --> 00:35:47.319
You can you are the case manager, but you can also do therapy with this person.
00:35:47.399 --> 00:36:00.919
And it is all managed by the primary care office and billed by the primary care office, which means it's incident two and you're getting reimbursed more because it's going through a medical rate, higher rates.
00:36:01.159 --> 00:36:10.599
So trying to set that up from our end is almost impossible because of the segregation of credentialing and contracting.
00:36:10.759 --> 00:36:12.519
So guess who's coming into this?
00:36:12.759 --> 00:36:13.959
The platforms.
00:36:14.199 --> 00:36:19.399
And now I've found platforms that you want to do COCM, oh, sign up with us.
00:36:20.199 --> 00:36:22.039
Ah, I have not even seen that.
00:36:22.119 --> 00:36:22.679
That's interesting.
00:36:23.000 --> 00:36:24.119
I'll have to get you the names.
00:36:24.199 --> 00:36:27.079
It's it's it's in my kind of ever research.
00:36:27.319 --> 00:36:32.679
I've got this research file of emerging platforms and who invests in who.
00:36:32.759 --> 00:36:38.279
And and yeah, I mean, Cygna even owns outright a platform.
00:36:38.359 --> 00:36:39.479
It's called Octave.
00:36:40.039 --> 00:36:41.559
Um, right, right, right.
00:36:43.639 --> 00:36:45.639
I think Headway and maybe Alma.
00:36:45.799 --> 00:36:47.959
I I don't remember the specifics, but I think so.
00:36:48.119 --> 00:36:48.279
Yeah.
00:36:48.439 --> 00:36:50.839
I mean, it's like that that has to be illegal.
00:36:52.119 --> 00:36:58.679
Unfortunately, I you would just think that I don't know what you would call that, but like antitrust laws, or you know, I don't know what that is, but if too much.
00:36:58.919 --> 00:37:01.000
Don't even get me started if it makes sense.
00:37:01.319 --> 00:37:01.559
Okay.
00:37:01.799 --> 00:37:08.039
It's like we're told that you and I can't converse about rates because we're somehow colluding.
00:37:08.199 --> 00:37:15.959
And like that, like that's gonna make a difference if if people on your Facebook page talk about rates, like that's somehow illegal.
00:37:16.279 --> 00:37:23.799
But this whole platform thing, and and this gets into another big area of mind, which is price transparency.
00:37:24.199 --> 00:37:24.679
Yeah.
00:37:24.919 --> 00:37:39.000
Um, there are tools where I can find out when anybody is reimbursed by insurance down to the tax ID and NPI level, and I have the tax IDs and NPIs of Alma, Edway, Brula, blah, blah, blah.
00:37:39.399 --> 00:37:41.799
Whoa! And I know what they're getting paid.
00:37:42.039 --> 00:37:43.319
And here's the a lot.
00:37:43.479 --> 00:37:44.759
And here's the thing.
00:37:45.000 --> 00:37:48.759
What they're getting paid is a heck of a lot more than what you're getting paid.
00:37:49.000 --> 00:37:49.159
Right.
00:37:49.399 --> 00:37:55.879
They may like$10 more than what you would be paying if you contracted independently.
00:37:56.119 --> 00:37:58.759
But I've seen them making a lot more.
00:37:58.919 --> 00:38:05.639
And here's the thing: if your client has a deductible, your client is paying what they're making, not what you're making.
00:38:05.879 --> 00:38:06.199
Right.
00:38:06.439 --> 00:38:19.639
And honestly, it's legal money laundering because they're taking the money from Blue Cross's pocket on the right hand and they're putting it in Blue Cross's pocket on the left hand, and then they're making a little DU for your trouble.
00:38:20.199 --> 00:38:22.599
And it should be illegal, but it's not.
00:38:22.759 --> 00:38:23.719
Not yet anyway.
00:38:23.959 --> 00:38:24.519
It's so crazy.
00:38:24.599 --> 00:38:24.759
Yeah.
00:38:24.919 --> 00:38:26.119
When you really start thinking about it.
00:38:26.279 --> 00:38:26.759
Oh my gosh.
00:38:27.000 --> 00:38:27.559
It's disgusting.
00:38:27.799 --> 00:38:28.039
Okay.
00:38:28.599 --> 00:38:31.319
So, do you want to tell us that tool is or is that top secret?
00:38:31.399 --> 00:38:32.839
Is that secret?
00:38:32.919 --> 00:38:35.000
The problem is it's extremely pricey.
00:38:35.399 --> 00:38:40.519
I subscribe to it, and and every month I go over with my accountant because it's about$2,000.
00:38:43.559 --> 00:38:46.439
Why would I charge for price transparency data dips?
00:38:46.679 --> 00:38:47.639
Because I love that.
00:38:47.959 --> 00:38:54.839
I have to, I, and I call it PTSD, price transparency strategy data dive.
00:38:55.079 --> 00:38:59.399
And so I sit there and I meet with you, and you tell me your goals.
00:38:59.559 --> 00:39:01.239
Who do you want to get a better rate from?
00:39:01.319 --> 00:39:19.079
And we do a deep dive into your market, and I advise you on the feasibility, and then we craft like a customized rate increase letter, which does a heck of a lot better than a template, dear insurance.
00:39:19.319 --> 00:39:21.959
I deserve more money because blah blah blah.
00:39:22.119 --> 00:39:25.719
I make this much, and the going rate is this much, and yeah, I know.
00:39:26.119 --> 00:39:27.079
I have all this trading.
00:39:27.319 --> 00:39:28.039
I know it works.
00:39:28.279 --> 00:39:34.199
I have the statistics and the research, and I make it very research-based, and that's what they eat up.
00:39:34.439 --> 00:39:38.519
And so I've been able to do better than average.
00:39:39.239 --> 00:39:43.719
But then there's times when I look at the data and I'm just like, mm-mm, it's not happening for you.
00:39:43.879 --> 00:39:44.679
It's just not mad.
00:39:44.919 --> 00:39:45.159
Yeah.
00:39:45.479 --> 00:39:46.519
But it's not a thing.
00:39:46.839 --> 00:39:48.199
At least you know.
00:39:48.599 --> 00:39:48.919
Yeah.
00:39:49.079 --> 00:39:53.799
And don't beat your head against the wall, and you can look at other options for your practice.
00:39:54.039 --> 00:39:55.639
You know, amazing.
00:39:55.719 --> 00:39:55.799
Yeah.
00:39:55.959 --> 00:39:58.919
Or like deep panel, like this is what I'm never gonna get a raise from.
00:39:59.000 --> 00:40:00.199
Maybe I need to get off this panel.
00:40:00.279 --> 00:40:01.079
Maybe that makes more sense.
00:40:01.479 --> 00:40:01.879
Exactly.
00:40:02.039 --> 00:40:02.439
Yeah.
00:40:02.679 --> 00:40:04.199
Wow, that is so cool.
00:40:04.519 --> 00:40:06.039
What a what an awesome service.
00:40:06.279 --> 00:40:06.839
Yeah, yeah.
00:40:07.000 --> 00:40:09.719
That is that is one that's becoming ever more popular.
00:40:09.879 --> 00:40:26.919
And and so, but to get back onto the policy level, it's like your question about how is this legal is like so in an in a in an era where price transparency is a thing, yeah, like how is it that we can't share rates?
00:40:27.079 --> 00:40:32.839
And I've pretty much figured out that the sharing rates is not illegal.
00:40:32.919 --> 00:40:37.079
It's the all right, let's get together and boycott Cigna until they pay better rates.
00:40:37.239 --> 00:40:38.279
That's the illegal part.
00:40:38.519 --> 00:40:42.519
But then again, they're still you know colluding.
00:40:42.839 --> 00:40:44.679
I mean, they collude through CAQH.
00:40:45.000 --> 00:40:47.639
CAQH is all owned by the payers.
00:40:48.039 --> 00:40:53.159
Oh, the board of directors reads this insurance company, that insurance company, the other insurance company.
00:40:53.639 --> 00:40:54.279
Oh my god.
00:40:54.519 --> 00:40:57.559
And CAQH has other tools that people don't know about.
00:40:57.799 --> 00:41:03.399
For instance, you know how you get these clawbacks two years later.
00:41:04.039 --> 00:41:11.000
Oh, I'm sorry, this person really had Aetna primary, and so United is clawing back the money and now go bill Aetna.
00:41:11.559 --> 00:41:12.039
Yeah.
00:41:12.279 --> 00:41:20.199
The tool that they use to identify that was invented by CAQH, and it's a subscription tool that the insurance companies have.
00:41:20.359 --> 00:41:30.039
They all share their data of who's insured, and then they go query it via like an API after a certain length of time, and then that's how they know to call back from you.
00:41:30.279 --> 00:41:32.039
Oh my god, that makes me want to puke.
00:41:32.439 --> 00:41:33.079
Yeah.
00:41:33.639 --> 00:41:35.559
Because then you're out of the timely filing window.
00:41:35.959 --> 00:41:37.079
Oh, it can be it can be disputed.
00:41:37.559 --> 00:41:38.039
Can you still?
00:41:38.119 --> 00:41:38.679
It can be disputed.
00:41:38.919 --> 00:41:43.879
Oh, it's it's absolutely disputable and winnable, but the problem is they're counting on you not because it's a lot of work.
00:41:44.199 --> 00:41:44.439
Right.
00:41:44.679 --> 00:41:44.919
Right.
00:41:45.000 --> 00:41:45.799
And that's where you come in.
00:41:45.959 --> 00:41:46.519
That's where it comes in.
00:41:46.919 --> 00:41:47.079
Yeah.
00:41:47.479 --> 00:41:47.959
I love it.
00:41:48.119 --> 00:41:48.679
Oh my gosh.
00:41:48.839 --> 00:41:49.719
Thank you for being here.
00:41:49.959 --> 00:41:54.679
And tell people where to find you, how do they work with you, winter training, and all that good stuff?
00:41:54.919 --> 00:41:57.479
So psychbuildingcoach.com is the main website.
00:41:57.639 --> 00:41:59.639
There's a lot there, a lot free.
00:41:59.879 --> 00:42:01.479
I have a newsletter.
00:42:01.559 --> 00:42:05.639
I try to keep people up to date on what affects you.
00:42:06.439 --> 00:42:11.239
I try to, if where possible, report good news as well as bad news.
00:42:11.479 --> 00:42:24.759
You know, like, you know, congratulations to let's say Illinois, because in Illinois, you it's a new state law, January 1, 2027, 141% of Medicare guaranteed for Illinois clinicians.
00:42:25.000 --> 00:42:26.039
That's a huge jump.
00:42:26.519 --> 00:42:31.079
And the insurance companies are already circling the wagons trying to find a way around that.
00:42:31.159 --> 00:42:33.319
And I'm probably going to be reporting on that here shortly.
00:42:33.479 --> 00:42:39.000
So psychbillingcoach.com, there's a free newsletter, free blog, free.
00:42:39.319 --> 00:42:42.359
I have like a news blog as well as like a blog blog.
00:42:42.439 --> 00:42:48.119
And the difference is kind of one's more my opinion and more in-depth, and one is more just all right, you know, Dr.
00:42:48.359 --> 00:42:51.719
Oz said that you know Medicaid is going to be revalidating.
00:42:51.879 --> 00:42:54.919
So here's what you need to know, and much more factual.
00:42:55.239 --> 00:43:03.399
And then hit on schedule, and you can schedule a consultation or the price transparency session, or my my tool that you mentioned.
00:43:03.479 --> 00:43:09.159
It's it's not like your tool, your tool is more like billing 101, like getting people into it.
00:43:09.479 --> 00:43:15.239
My tool is a little harder, and it's still not done after how many two and a half years?
00:43:15.559 --> 00:43:18.599
Because I'm literally being a it's never done.
00:43:18.759 --> 00:43:20.919
Well, it's never done, but it's not done.
00:43:21.079 --> 00:43:31.639
But I'm literally building a resource of everything you need so that if you want to know, hey, does Blue Cross of Texas allow supervisory billing?
00:43:31.879 --> 00:43:33.079
You can come find it.
00:43:33.159 --> 00:43:36.519
Or hey, can I charge a no-show for Tricare?
00:43:36.839 --> 00:43:39.159
You know, or how do I credential with this or that?
00:43:39.239 --> 00:43:42.599
Or what what's the deal with this like champ VA?
00:43:43.159 --> 00:43:51.639
You know, just all those rules, manuals, like one place where you can dig into it, but I am not AI.
00:43:52.039 --> 00:44:02.599
I'm only using AI to find the citations, and then everything else is you know, infographic done by me, video done by me, text written by me.
00:44:02.839 --> 00:44:06.839
And I have no venture capital funding either, so I have to earn a living.
00:44:07.639 --> 00:44:09.879
So that's why it's going really slowly.
00:44:10.039 --> 00:44:15.559
And but I'm about, I guess 65, 75, 65-ish percent done, I think.
00:44:15.639 --> 00:44:18.599
And so I do have beta subscribers, and that's what it is.
00:44:18.679 --> 00:44:23.399
And there's a lot of like form templates and things like that that that I offer as well in there, too.
00:44:23.479 --> 00:44:27.959
So and subscribers get 15% off of everything else that I that I offer.
00:44:28.039 --> 00:44:30.759
So that's kind of my services in a nutshell.
00:44:31.079 --> 00:44:31.639
I love it.
00:44:31.719 --> 00:44:33.639
Yeah, thank you so much for being a guest today.
00:44:33.799 --> 00:44:36.359
And of course, we're gonna have to have you back for some of these other topics.
00:44:36.439 --> 00:44:38.919
I'm sure people are gonna be like, but you didn't talk about this enough.
00:44:39.639 --> 00:44:41.559
We touched on so many things.
00:44:41.799 --> 00:44:48.679
And oh, I forgot to mention I also give webinars once a month, they're generally on Fridays, Friday mornings about once a month.
00:44:48.839 --> 00:44:51.879
The one in July is gonna be on supervisory billing.
00:44:52.199 --> 00:44:52.599
Love it.
00:44:52.679 --> 00:44:53.079
Yeah, yeah.
00:44:53.159 --> 00:44:56.759
And we're gonna have links to all of that that you guys can check out the show notes.
00:44:57.000 --> 00:44:57.799
And thank you.
00:44:58.039 --> 00:44:58.679
Thank you for being here.
00:44:58.919 --> 00:45:00.039
This is so helpful.
00:45:00.199 --> 00:45:06.199
You're gonna save a lot of people from a lot of pain, you know, by just suggesting that we research the stuff ahead of time.
00:45:06.439 --> 00:45:07.000
That's the goal.
00:45:07.159 --> 00:45:08.599
I like I I know I'm weird.
00:45:08.679 --> 00:45:13.639
I like the research, and you don't have time, you don't have time to research.
00:45:13.879 --> 00:45:16.279
Yeah, and you, I mean, we need people like you.
00:45:16.439 --> 00:45:17.639
Your blog is amazing.
00:45:17.719 --> 00:45:21.639
I've looked at it many times for different because the SEO is so good.
00:45:21.799 --> 00:45:25.079
Anytime I put I type in a search, like your blog pops up.
00:45:25.159 --> 00:45:25.719
It's really great.
00:45:25.799 --> 00:45:29.959
So you want to tell my website person that because super realmers for real.
00:45:30.519 --> 00:45:31.799
That's happened multiple times.
00:45:31.879 --> 00:45:37.159
I mean, I think that's the first time I ever heard of you, you know, was just like randomly finding one of your blog posts about something.
00:45:37.239 --> 00:45:39.479
I don't remember what it was, it was something with Medicare, probably.
00:45:39.719 --> 00:45:40.839
Thank you for everything that you do.
00:45:41.079 --> 00:45:41.879
Oh, you're very welcome.
00:45:41.959 --> 00:45:43.879
And thanks, thanks again for having me.
00:45:48.359 --> 00:45:53.799
Between sessions is brought to you by Barries because clinicians deserve support too.
00:45:54.039 --> 00:46:01.399
To learn how berries can help you streamline your notes, reduce stress, and make space for what matters most, visit hayberries.com.
