Balancing Act: The Intersection of Clinical and Billing Issues in Your Therapy Practice

A competent administrative team or billing specialist in your private practice provides the necessary infrastructure and know-how to help your practice run smoothly and efficiently. From being the first line of client care, to submitting insurance claims, and resolving any billing issues quickly, a trusted and skilled team is vital to both you and your clients.

But do you know how your engagement on billing-related matters can influence the clinical health of your practice?

The financial partnership between therapists and their clientele extends far beyond mundane billing matters, signifying a faith-filled relationship between both parties. Balancing client needs regarding insurance, billing, and payment plans, and clinical issues can be difficult to navigate. While employing a billing specialist may seem straightforward, it is essential to remember that the reality is much more nuanced.

As a VP of Operations for Manhattan-based private practice, I have experience navigating billing, insurance, and operational matters for both private practice therapists and non-profit organizations. Over the years, I've encountered a variety of situations that illustrate how seemingly minor billing issues can have an immense effect on the relationships between therapists and their clients. 

In this article, you’ll learn about billing pitfalls that can interfere with developing the therapist-client partnerships you desire, and how to create more effective connections with your clients and your team.

5 Billing Situations That Can Have a Surprising Impact on Your Client Relationships:

#1 Therapy practice billing and uncertainty or confusion about insurance coverage

It’s important to recognize that most clients aren’t experts (and don’t care to be) when it comes to the ins and outs of their insurance coverage and benefits. They may receive conflicting information from their insurance company, or employer, and things can change year to year even with the same plan. If you send your client to your admin or billing team when they’re trying to navigate the complexities of the process, this can signal to the client that their therapist is disinterested or unavailable to help (when they may in fact require a space to process fears or need extra support). 

By delegating to your billing team, you may also remain out of the loop on any issues or frustrations your client is experiencing as potential barriers to treatment. In my experience, this can backfire in several ways by putting undue pressure on the billing team and leading the client to feel disconnected from the therapist who has insulated themselves from the process. 

Your client will sense that this is something they shouldn’t burden you with, and may develop unrealistic expectations for what your billing is even capable of. After all, if their therapist isn’t able to offer support with this common challenge, where should the client turn for compassion and comfort? 

It's critical for the billing specialist or team and therapist to be aligned, informed, and willing to help the client navigate their insurance benefits or coverage changes with confidence. This sets the stage for a positive therapy experience the moment they walk in the door and in the years to come.

#2 Denial or rejection of insurance claims causing clinical billing issues

These disputes typically require extra attention by the billing team to ensure a satisfactory answer or ensure necessary supporting documentation is fulfilled. On the clinical side, clients may be surprised or upset to learn that their claims were denied or rejected. That’s where the client-therapist relationship comes into play. Addressing these issues candidly with your clients during the session is paramount to maintaining the therapeutic alliance. 

Therapists and billing teams should work together to review the specific reason for the denial or rejection. It could be due to incorrect coding, missing information, or other administrative errors. Understanding the reason will guide you in the next steps. By collaborating closely and communicating effectively, therapists and billing teams can navigate the denial or rejection of insurance claims in a way that minimizes stress for all parties involved and ensures the best possible outcome for the client.

#3 Therapy billing and unpaid sessions

Life happens, and throughout your career you may encounter clients who aren’t able to pay for any variety of reasons. Despite what it looks like on the surface, an unpaid invoice is often a clinical issue that could have a far-reaching impact.

For example, if a client is struggling financially to pay an invoice but is in need of therapy services, the therapist may be put in a position to provide counseling pro bono, or with a sliding pay scale, in order to maintain the therapeutic relationship—something that isn’t always possible. In this case, the therapist may feel compelled to overextend themselves, in an effort to allow the client to continue treatment. 

This conflict can also affect the progress of treatment, as the client may feel anxiety or guilt about the outstanding balance that needs to be paid, leading them to avoid sessions or struggle to focus during conversations. 

At the end of the day, when an invoice remains unpaid, the clinical therapist-client relationship and work inside the therapy room is inevitably affected. As such, it’s important that office managers in private practice clinical settings view unpaid invoices as more than just financial issues, but as important conversations with clinical considerations.

#4 Insurance policy or benefit changes

While we may provide information to a client regarding their insurance company, we're not responsible for, nor can we guarantee, that all of their benefits, coverage, and claims will be covered or reimbursed. This is especially true if you're an out-of-network provider. 

Setting reasonable expectations and boundaries regarding our responsibility to a client helps to foster good, trusting relationships with clients and our group. It also helps to protect the interest of the therapist, as well as the client, both financially and legally, from taking on responsibilities outside of the scope of our practice. 

It’s essential to recognize the difficulties that the healthcare and insurance industry can bring for our clients. People struggling with an unpredictable health system may feel frustrated and become angry with whomever is the closest relief valve at that moment. This means that billing and administrative staff can often end up on the receiving end of the client’s distress. It is essential that we be cognizant of this dynamic to protect our valued staff members in these circumstances. Reasonable expectations and boundaries help to keep clients informed of the services we can offer, as well as our limitations.

#5 No-show appointments or late cancellations

When repeated issues of attendance arise, these are typically symptoms of a larger problem that should be discussed and worked through between the therapist and client. Therefore, a no-show appointment or late cancellation is another item that may appear to simply be another billing concern, but its roots go deeper. 

Imagine that a client who may already be financially stretched thin misses an appointment due to an emergency. If your practice automatically charges a late cancellation fee, it’s easy to see how treating no-shows as just billing issues could unintentionally lead to ruptures in the therapeutic alliance.

Strengthening Client Relationships Through Improved Therapy Billing Engagement

So, what steps can you take to enhance my engagement with the billing process and strengthen your connections with clients? Below are a few best practices I’ve implemented over the years with great results:

1. Schedule regular check-ins with your therapy practice billing team- Having regular meetings ensures that any client-related billing concerns or issues that come up are discussed in a timely manner. This doesn’t need to be tedious, a 15-minute check in once a week to go over emergent concerns. It can be unnecessarily stressful for you, your team, and your clients when an urgent issue arises seemingly out of nowhere. Stay informed ahead of time and give yourself the opportunity to troubleshoot and explore all possible solutions in a calm state.
    
2. Get curious and be proactive when it counts - Having a clearly defined billing and client policy is essential to setting expectations and properly informing clients. While this establishes the foundation, it's vital to remain flexible when issues arise. When seemingly minor billing issues come up (i.e. declined credit card, claim submission denied, late cancellation, insurance benefits update, etc), it's important to stay curious and take proactive steps to ensure that all parties are in the loop about what’s going on and who’s responsible for the next action step in the process.
    
3. Go behind the scenes to avoid clinical billing issues -  Having a firm grasp on your practice’s billing information, such as payment histories, credit card charges, and insurance claims, is essential for taking control of your practice's financial health. While you may have a competent billing team or specialist you trust, knowing where this information is kept and having easy access to it will ensure you have the full clinical picture of each of your clients at a moment’s notice.

Communication Between your Therapy Clinical and Billing Team is Vital to the Success of your Practice

Therapists have the weight of many decisions to make in running a successful practice. No matter how complex the billing processes and clinical issues associated with running a successful practice are, there’s no single blueprint that guarantees success. Above all, a successful practice relies on strong collaboration and communication between clinical and billing services. 

I hope that this article has given you a glimpse into the nuance between financial and clinical services in your own therapy practice. Now that you have this newfound insight, you’ll be more aware of moments that can help or hinder client relationships and progress. By fostering a meaningful climate of communication, cooperation, and trust between yourself and your billing team, your private practice has the potential to blossom and thrive.