Principals for success as a Clinical Mental Health Counselor
Donald E. Deering, Ph.D., L.P.C., N.C.C.
During this presentation I wanted to provide some practical information in an effort to assist Professional Counselors (PCs) in preparation for successful practice at all levels, particularly clinical mental health counseling. As such, the topics I chose to discuss included:
- Mental Health Parity and Addiction Equity Act (MHPAEA) and its impact on PCs
- National Provider Identifier (NPI), what is it and how do you apply for it
- Council for Affordable and Quality Healthcare (CAQH), what is it and how to apply for it
- Insurance panels accepting PCs and how to apply
- Billing practices and “Incident to” billing, what is it and how can PCs benefit
- Sound business practices for PCs
- Setting up or restructuring your practice
- Mergers & acquisitions with other clinical providers
- Marketing yourself as a PC
Mental Health Parity and Addiction Equity Act (MHPAEA):
The MHPAEA has nearly leveled the playing field for allowing clients access to mental health care benefits. The former economic barriers (high deductibles and copays, session caps, etc.) suffered by mental health insurance subscribers have been made equal to whatever the clients medical health insurance benefits are (same deductibles and copays, etc.). However, limited exceptions remain that can be reviewed by doing a basic internet search of MHPAEA. This act has resulted in an increased need for mental health professionals, which has coincided with PCs becoming increasingly paneled by health insurance carriers.
A PCs preparation for being paneled with health insurance carriers depends on PCs obtaining two important registrations/identifiers:
National Provider Identifier (NPI):
First, the NPI allows clinicians to become nationally and publicly registered, much like Social Security numbers identify US Citizens. The NPI replaces all other insurance identifiers (BCBS, UPIN, Medicare, License numbers, etc.) The NPI became mandatory for all clinicians billing insurance companies as of May 23, 2007 (https://www.emedny.org/hipaa/npi/NPI_Script.pdf) Licensure (LLPC/LPC) is minimally required to register for a NPI and it only takes minutes to complete the applications process (https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart)
Counsel for Affordable Quality Healthcare (CAQH):
Second, the CAQH allows insurance carriers to quickly identify clinicians, verify credentials, expedite insurance carrier panel applications, update files, etc. A NPI is required to register for a CAQH number and this process will require a couple hours to complete the application (can be reviewed/revised as necessary). Additionally, you must contact a PC participating insurance carrier to obtain a CAQH number prior to completing the CAQH website application process. The insurance carrier you contact will require your NPI which will then be requested by the CAQH online application(https://upd.caqh.org/oas/)
Once you have secured your NPI and CAQH identifiers, you will be eligible to apply for all PC participating insurance carriers(http://www.michigancounselingassociation.com/licensure.html)
It is imperative to the recognition and evolution of PCs that we secure these identifiers as well as become registered with as many health insurance carriers as possible (PCs are never under obligation to accept client referrals). Although PCs will only likely be paneled if they obtain a LPC (and the accompanying National Board for Certified Counselors: Nationally Certified Counselor designation), some carriers will panel LLPCs as well. Additionally, all PCs should obtain a NPI and CAQH number so that we are minimally acknowledged at the state and national level as relevant.
Billing Practices and “Incident to” Billing:
Incident to billing practices allows PCs who are not eligible at present to be paneled with a particular insurance carrier (Medicare, BCBS, etc.) to provide services “incident to” another provider who is paneled with that insurance carrier (Physicians, Nurse Practitioners, Psychologists, Social Workers, etc.). Remember, this is not a licensure supervisory role, as only PCs can supervise PCs, but rather a billing supervisory role. This “incident to” provision became allowable for PCs in late 2010 by BCBS and has been allowable by Medicare since 2008. This provision has resulted in significant opportunity for PCs to work in many different settings that were otherwise not very probable. Details of this process are outlined on page 15 of the document within the link provided above this article, click on “Incident To Service Guidelines”.
Sound Business Practices / Setting Up or Restructuring Your Practice:
A PC is much like any other fee for service professional. That is, PCs are experts in mental health and as such, we charge for services rendered. There are many calculations that factor into how much money a PC charges for services rendered. However, the more PCs that become paneled with insurance carriers, the more those fees become somewhat fixed and/or commensurate with our mental health counterparts. Be that as it may, PCs should seek legal and accounting professionals council to ensure the structure of services provided is done so properly. This initial investment is minimal relative to the significant investment of resources made in your becoming a PC. Furthermore, the more knowledgeable we as PCs become about business practices in the context of professional mental health services, the higher the probability of our success will be.
Mergers & Acquisitions with Other Providers:
The process of “merging” and/or “acquiring” is nothing more than a mutual agreement by two entities to work together and/or be acquired by one or the other. Although this concept may seem foreign to the world of PCs, this may be one of the most powerful ways PCs can become a more recognizable force. We all have different skill sets and one of the most significant challenges of private practice is that the owner must be proficient in many areas of business, i.e. legal, accounting, billing, marketing, etc. Partnering up with other PCs who may offer a skill set necessary to successfully operate a practice is an excellent way to maximize success and moreover profitability. Alternatively, some mental health providers (Psychiatrists, Nurse Practitioners, Psychologists, Social Workers, Professional Counselors, etc.) have built a solid practice through the years and no longer wish to wear all the hats required of a sole owner. These individuals are often eager to join forces with other group practices in an effort to simplify their own life, while maximizing profits and continuing their work as clinicians.
Marketing Yourself as a PC:
In this day and age of relentless self-promotion and social media, one must ask the question… how much is too much? The answer to that is simple. Until you have your own Dr. Phil show, it’s not too much! Marketing yourself is more than seeking out potential clients and passing out business cards and brochures. It is about building long-term relationships. It is seeking out like minded professionals who share your passion for helping people become the best they can be. It is seeking out other clinicians who offer services different and/or beyond what you offer. It is seeking out opportunities (much like this one is for me) to participate and offer a value added service to someone who may someday seek out your services and/or recommend you to someone else in need of your services. Additionally, consider what your strengths and weaknesses and be honest with yourself. You don’t have to be good at everything… you just need to know people who are good at what you are not. Then, learn from them. Lastly, help other PCs become successful in some way, shape or form. Remember, high tide, raises all ships!