Therapy Credentialing and Billing 101

Earn 1 hour of continuing education by joining OT Potential after taking this course.

Course Description

In talking to therapy start-ups this year, I’ve heard a common stumbling block: Credentialing.

And, honestly, I was shocked when I dug into the space. It feels like the seemingly boring task of getting credentialed with insurance has turned into what honestly feels like a world of sharks. It seems like there are 3 trends at play:

• This is truly a bureaucratic headache: You do need to buckle up for some super confusing portals to get credentialed.
• Credentialing services are all too happy to take your money: They take your personal information because of this barrier—but because the process itself is murky, they often over-promise and under-deliver, without clarity into what is happening.
• Big companies like Grow Therapy want to present this task as too difficult for an average therapist, so you join their platform (where they do the credentialing for you, but own your contract).

In today’s episode, we want you to feel empowered to understand credentialing and billing with insurance. We’ll help you understand this complex system and how you can navigate it.

Honestly, every therapist who works in insurance reimbursement should understand this process (because if you don’t do it yourself, that means someone is probably doing it on your behalf). Our goal is for you to leave with a checklist of what to do—and the confidence to do it!

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OT Potential courses are presented as live webinars, then released on-demand video and audio via the OT Potential Podcast. Attendance in the live webinar will be indicated on your certificate. Learn more about how our courses help meet live webinar requirements, and OT CEU requirements overall.

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Learning Objectives

1. You will be able to recognize the key administrative steps involved in the insurance credentialing and contracting process for OTs, PTs, SLPs, and mental health therapists. 
2. You will be able to identify barriers to therapy access created by the complexities of the current credentialing process.

Agenda

Intro (5 minutes)

Discussion (40 minutes)

1. Tell me about your own entrepreneurship story and how you got interested in helping fellow business owners. 
2. What have you seen among entrepreneurs in terms of credentialing feeling like a barrier to getting started.  
3. Give us credentialing 101 – what is insurance credentialing? What specifically do business owners need to know? 
4. How do we get started with credentialing- what information would you gather and where would start? (Touch on Medicare, Medicaid, and private insurance) 
5. What happens next in terms of contracting with a payer? (Touch on Medicare, Medicaid, and private insurance)
6. What do we need to know about billing? 
7. What do we need to do to maintain our credentialing with payers?
8. Honestly, it feels like this administrative burden is unnecessarily limiting access to therapy. If you could reform the system what changes would you make? 
9. What advice do you have for aspiring private practice therapists? 

Live Q&A (10 min)

Closing (5 min)

Supporting Research and Journal Articles

• How Phantom Networks And Other Barriers Impede Progress On Mental Health Insurance Reform
• Electronic documentation burden among outpatient rehabilitation therapists: a qualitative descriptive study and quality improvement initiative
• A Systematic Review on Professional Regulation and Credentialing of Public Health Workforce

Target Audience/Educational Level

Our target audience is occupational therapy practitioners who are looking to learn more about therapy credentialing and billing. The educational level is introductory.

Financial and Non-financial Disclosures

It is the policy of OT Potential to disclose any financial and non-financial interest the provider or instructor may have in a product or service mentioned during an activity. This is to ensure that the audience is made aware of any bias of the speaker.

We here at OT Potential have no financial stake in this topic. 

Speakers

Kara Welke, OTD, OTR/L, CLT

Kara Welke, OTR/L, is the founder of Next Level Occupational Therapy and Home Therapy Solutions. Since 2019, she has supported occupational therapy professionals in starting and growing private practices, with a focus on compliance, billing, and business systems. She leads a team that partners with clinicians to build sustainable, high-quality practices that support both patient outcomes and long-term success. Kara is also a leader in geriatric care and founded Home Therapy Solutions in 2018, which became the first mobile therapy practice recognized as an Age-Friendly Therapy Practice, advancing community-based models that support aging in the RIGHT place and align with the 4Ms framework.

Sarah Lyon, OTR/L

Sarah’s passion is helping fellow OT practitioners translate evidence into daily practice. Sarah earned her BA in religion from St. Olaf College, then earned her master’s degree in occupational therapy from New York University in 2011.

Since then, she’s worked in numerous facilities, including a critical access hospital, an acute trauma hospital, and a state inpatient psychiatric hospital. Sarah is the founder/owner of OT Potential. Read more about OT Potential here.

This course was designed to meet your continuing education requirements

We designed the courses in the Club to meet the requirements for “online” and “independent/self-study” courses. To verify the requirements from your specific state (within the US), check out our post, OT Continuing Education Requirements. If you are outside of the United States and have questions, please contact us.

We are proud to be an AOTA Approved Provider and to meet the requirements for your NBCOT renewal.

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