Therapy Credentialing and Billing 101

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!

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.

• Intro

• Discussion

  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

• Closing

• 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

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.

OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic.

Speaker interests: Kara Welke is the founder of Next Level Occupational Therapy and Home Therapy Solutions, which provide compliance, billing, and business support services to therapy practices — the category of services discussed in this course.