Everything You Need to Know About Taking Insurance in Private Practice with Rebecca Ingram Rowe

Mar 27

Insurance billing has a reputation. Ask around in any private practice Facebook group and you'll find a mix of people who swear by it and people who burned out trying to make it work. What I've noticed is the difference usually isn't the insurance itself. It's whether or not the practice owner had a system.

I sat down with Rebecca Ingram Rowe, a speech therapist who has been running a profitable, multi-location speech therapy practice in North Carolina for 10 years, to talk about what taking insurance actually looks like when you do it well. She and her business partner now run Activated Practice Solutions, a full-service billing company, specifically because they've seen how much confusion there is in this space and they want to help.

This is not a post about whether you should take insurance. That's your call and your business. This is about what to know if you decide to.

Start with your back end before anything else

Rebecca opened her doors on day one with Medicaid and private pay, and one of the first things she did was get an EMR and a part-time biller. That's not a small thing. It's actually the whole foundation.

When you're taking insurance without those systems in place, the billing doesn't disappear. It just gets pushed to the end of the day when you're exhausted, and that's when mistakes happen and claims get missed. Rebecca's advice is to carve out at least a half day per week for admin if you're managing billing yourself. Not as an afterthought. As a protected, blocked time on your calendar.

And even if you outsource it, that admin time doesn't go to zero. You still need to be looking at the numbers. She talked about a time she trusted someone to handle credentialing, and work wasn't being done. She only found out by calling the insurance company herself. That kind of oversight matters, even when you're paying someone else to manage the work.

Credentialing is not as hard as it sounds

Most people get overwhelmed by credentialing because it feels like a lot of information going in a lot of different directions. Rebecca breaks it down simply: get your business structure right first, have a group NPI if you plan to hire, fill out your CAQH profile, and then follow up with each insurance company every 10 to 14 days. That last part is the one most people skip.

Credentialing takes time, but it's not complicated. It's follow-up. You have to call and ask where things stand. When you're outsourcing this, you need confirmation emails passed to you and some kind of call log or shared dashboard so you can see what's actually happening with your application.

When it comes to staff, each clinician needs to be credentialed individually. Rebecca is clear that billing under someone else's NPI isn't the right move. If they're providing the service, their NPI needs to be on the claim. That means you may need to hold claims or adjust who sees which clients while credentialing is in process. It's a cash flow consideration, and building up enough reserve to handle that gap is part of planning ahead.

Your initial rates are a starting point, not a final answer

This was one of the most valuable parts of the conversation. A lot of practice owners accept the rates they're offered because they don't know they can push back. Rebecca was offered $41 for a 92507 early in her career. She didn't take it. She asked for a meeting, explained the rate didn't work for her practice, and asked for what she needed. They gave it to her.

The rule she follows: never sign anything until you've seen the rates for every code you plan to bill. Some insurances are upfront about this. Others make you dig. But it's non-negotiable. You have to know what you're agreeing to before you agree to it.

If you're already credentialed and your rates have been cut or are being threatened, Rebecca's practice has even enlisted families as advocates. She's transparent that this isn't a common move, but when an insurance company is trying to reduce what practices get paid, the families served by those practices have real influence. They're the customers, and they can make calls and send emails on behalf of the practices they value.

Protecting your revenue through the day-to-day

Claims fall through the cracks when no one's watching them. I've talked with practice owners who had tens of thousands of dollars in unfiled claims, some past the window for filing at all. It happens when you're overwhelmed and billing feels like one thing too many. The answer isn't to push through. The answer is systems.

Rebecca's practice uses an EMR that lets them submit and receive claims electronically, track denial reasons, and catch errors before they compound. A lot of denials come down to something simple: a wrong date of birth, a missing piece of insurance information at intake. The back end starts at the front desk.

Her team also verifies benefits before every client's first session, and walks families through their worst and best case financial scenarios up front. No surprises around money. That's not just good billing practice. It's good client care.

The bigger practice management lesson in all of this is the same one that shows up everywhere in business: set aside the time to work on the business, not just in it. Insurance doesn't run itself. But it also doesn't have to take over your life if you build the right foundation.