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What Is It Like To Be a Medicare Therapist? An interview with Gabrielle Juliano-Villani, LCSW

Curt and Katie interview Gabrielle Juliano-Villani, LCSW, about what it looks like to take Medicare. We talk about common myths and what the actual experience is like. We also explore the business case for taking Medicare and why (and how) therapists can grow their practice by opting in as a Medicare provider.


Click here to scroll to the podcast transcript.

An Interview with Gabrielle Juliano-Villani, LCSW

Photo ID: Gabrielle Juliano-VillaniGabrielle Juliano-Villani is a licensed clinical social worker, consultant, coach, entrepreneur and educator based in Sarasota, Fl. She has been in the mental health field for over a decade specializing in stress, chronic health conditions, and trauma. After scaling her group practice to 7 figures and realizing her own burnout in 2021, she sold her thriving group practice and made it her mission to educate others on the impact stress has on our everyday lives. Gabrielle pulls from her experience as an EMDR and Polyvagal Informed therapist to utilize mind/body approaches to help others implement everyday strategies to manage stress and live their best lives. Gabrielle helps therapists, billers, and other mental health professionals like you understand how to integrate Medicare billing into your practice without pulling all your hair out. Gabrielle is an international speaker, former coach for the Small Business Administration, retreat leader, and has been featured in Authority Magazine, The Daily Om, Bustle, and the Everyday Woman TV Network. When she’s not working, Gabrielle is teaching Zumba, surfing, or reading a psychological thriller at the beach

In this podcast episode, we talk about taking Medicare as a therapist

Curt and Katie asked Gabrielle Juliano-Villani, LCSW to come in to talk about what it is like to take Medicare as a therapist.

 What is involved in being a Medicare provider?

“I didn’t find [working with Medicare] any more difficult than, you know, credentialing with regular insurance. I actually find Medicare to be much more straightforward and easier to work with.” – Gabrielle Juliano-Villani, LCSW

  • Clientele on Medicare include elderly and disabled
  • There is a huge need to clinicians to take Medicare
  • You will get a lot of referrals – Gabrielle filled up her caseload and made 6 figures in her first year in private practice

What types of clinical expertise is necessary for therapists who take Medicare?

  • Loss of independence and aging issues
  • Grief and loss
  • Chronic health conditions and illnesses
  • Loss of mobility
  • Dementia and cognitive issues
  • Family dynamics and estrangement
  • Understanding later in life logistics
  • Caregiver concerns

What are the business or day-to-day elements of taking Medicare?

“I can tell you that I was billing 250 or more Medicare sessions a week for years and never got audited by them.” – Gabrielle Juliano-Villani, LCSW

  • Referral sources are medical doctors, care managers, and other therapists
  • Website content designed with caregiver or family member in mind (who would be searching for the services)
  • Sorting through Medicare and Medicare Advantage (i.e., commercial insurance Medicare replacement) plans – clients don’t know the difference between Medicare and Medicare Advantage
  • Ask to see all of their insurance cards to identify what coverage they have:
    • Bill Medicare directly for patients with Medicare – you are a Part B provider (outpatient) – you will get 80% from Medicare and the other 20% from the patient, a supplemental plan, or Medicaid
    • Bill the commercial insurance plan for Medicare Advantage patients (like regular insurance billing)
  • Audits are not common and are navigable with good notes and ability to make corrections
  • Audits are more likely if you’re doing unusual billing practices
  • The application process is probably the most challenging part of taking Medicare

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Relevant Episodes of MTSG Podcast:

What Do Therapists Need To Do About Medicare? Opting in or out for 2024: An interview with Joy Alafia, CAE

Busting Insurance Myths: An Interview with Barbara Griswold, MFT

Should Private Practice Therapists Take Insurance?

The Sky is Falling: How Therapists Can Protect Our Industry, Patient-Centered Care, and Our Businesses, An Interview with Dr. Ajita Robinson


Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at:

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at:

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann

Music by Crystal Grooms Mangano

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about the things that we do in our practices, the things that are going on in the mental health field. And we are returning to follow up on an episode that we ended last year with: a little bit about signing up for Medicare for our LPCCs, LMFTs out there. And that was about kind of the signup process, the decision making process of whether or not you should sign up. And now we’re joined today by Gabrielle Juliano-Villani, LCSW. And she’s gonna help share us like what it’s actually like to be a Medicare provider. She’s had a practice in the past. She’s wonderful resource on all of this kind of stuff. So thank you very much for joining us and sharing your wisdom with us.

Gabrielle Juliano-Villani 1:06
Thank you so much for having me. I’m actually really excited to get this out there, talk to people about Medicare, give them all of the info that they need to know. And I hope that it helps your audience and your listeners.

Katie Vernoy 1:18
We are so excited to have you on this episode. We already mentioned your stuff in that last episode that Curt was talking about. I’m just excited to actually be able to pick your brain and get information for folks who are actually considering being Medicare providers. Because so many people were talking about, like, how do you opt out? How do you opt out? And so anyway, we’ll get into that. But the first question that we ask all of our guests is, who are you? And what are you putting out into the world.

Gabrielle Juliano-Villani 1:43
So, I am, I mean, I am a social worker. I’m also a Zumba instructor. Besides all of those things I’m also a consultant and a coach and a sound healer. And I help therapists with Medicare. I also help therapists scale and sell their practices like I did and add additional income streams. And I also run retreats and do trainings on burnout prevention through polyvagal theory. So I do a lot of very different things, which is good for me.

Katie Vernoy 2:16
That’s awesome. I love it.

Curt Widhalm 2:17
One of the things that we start a lot of our episodes with is coming from a place of learning, a place of if other people have made mistakes. And we asked, what do people get wrong about this? But I think for this episode, I think it’s what are some of the wrong perceptions about being a Medicare provider?

Gabrielle Juliano-Villani 2:36
That’s a great question. Because yes, that comes up a lot, obviously. And I think what I hear a lot, or what I see a lot is like a lot of fear, and a lot of like, it’s hard, it’s scary because it’s the government. So, there’s like a lot of red tape. And there’s a lot of audits and there’s a lot of clawbacks, and there’s tons of paperwork. And most of those things are actually not true. But that’s what I hear most of the time.

Katie Vernoy 3:04
So, as an LCSW, you’ve been able to take Medicare for quite some time. But not most people do. Like there’s a lot of social workers that may or may not have opted out with this whole opt out thing seems to be new to folks.

Gabrielle Juliano-Villani 3:17

Katie Vernoy 3:19
But, but what motivated you to actually get a practice that was focused on serving Medicare patients?

Gabrielle Juliano-Villani 3:26
So, before I started my private practice, I actually worked for Humana and I was an in-home care manager for them. And I worked specifically with their Medicare Advantage people. And I loved that job. I loved the clients. They were great. And of course, you know, it’s Humana. So, there were layoffs coming. And I was like, What am I going to do next? And so one of my friends and colleagues, and who became a mentor to me, actually, she was like, I’m going to start a private practice. And I’m going to take Medicare and I’m going to do the same thing. And I was like, Okay, I’ve always wanted to work for myself. That sounds cool. That’s I’m very impulsive sometimes. That’s literally how I started my business. And I was, but you know, I didn’t know anything about it. And I actually felt more comfortable with Medicare because I had I knew about it from Humana. I knew about it, actually, because my mom used to work in the Medicare world. And so it felt very easy to me. And I liked the clients. And I also knew that there were not a lot of people who were Medicare providers in our community. And I knew that we needed that. Just from the work that I had done I knew that there was always a need for mental health professionals who accepted Medicare and who enjoyed and understood working with that population. So, that is kind of what started it. And I actually found the process not that difficult. And I’m not saying that to like shame anybody who’s been like, oh my god, this is such a pain in the ass because it is a pain in the ass. But I didn’t find it any more difficult than, you know, credentialing with like regular insurance. I actually find Medicare to be much more straightforward and easier to work with.

Katie Vernoy 5:16
So before we move on, I just want to comment to folks: listen closely, if you’ve already opted out, we’re still we’re putting this out in the first 90 days, most likely for most of us who opted out. So, you have a decision to make, you can opt back in before 90 days is up. So so listen closely, because it seems like what you what you’re describing is, you found a you found a population you love to work with, you found a need in the marketplace. And you found doing this pretty straightforward. I mean, that sounds like a business. That is a great match for a lot of folks.

Gabrielle Juliano-Villani 5:49
Yep, exactly. And that’s why I love that I’m here talking about this, and that we’re getting it out there because there is there is a lot of fear. I mean, I, before we started recording, I was talking about how I was on a consult with somebody. And with those people, they were in Washington State. So just want to say that rates are different everywhere. But that’s what they said. They said, I heard it’s really difficult and that the rates suck. And I said, Well, let’s check together. So we did check together. And they were like, wow, that’s actually more than some of the insurance payments that I get. And I’m like, well, that’s why I want you to look because some places it is low and some places it’s not. And so that’s important to know, also, is that there seems to be this blanket statement of like it’s hard to work with, and it sucks. And that’s just not true.

Curt Widhalm 6:40
So you started your practice with Medicare, or at least got on to it very, very early. I’m wondering kind of how that impacted the the clients that you saw, or maybe in comparison to some of the other practices around you who weren’t taking Medicare; like what were some of the things that you noticed, when you were running your business as far as clients coming in, client referrals, maybe income kind of comparisons versus people taking insurance, private pay, that kind of stuff.

Gabrielle Juliano-Villani 7:11
So, what I noticed is that they’re the type of clients are definitely different. And I do think that’s important to talk about, because people on Medicare are not just elderly, but there’s people who are disabled who are on Medicare as well. So there is a large range of age groups that you can see. But the issues were a little bit different. And I will say that once, I found one other person in the community who knew that I was a Medicare provider, she filled up my practice. She still emails me, I sold my practice in 2021. And she still emails me and says I need a Medicare provider in Denver. Can you give me one. So that is you know, the importance of relationships and connection. And that’s just that’s how I built my business. And so the referrals were like non stop coming in. I cleared six figures in my first year by myself. And I saw about like 20 ish clients per week. And I will also say when I first started, I also did something different and unique. And I did in home just like I did with Humana because I really liked that. So I did all of my sessions in client’s homes or at independent or assisted living facilities. And then post COVID. We switched totally to telehealth, and we did a little bit of maybe like 5 to 10% of in home sessions still. But we switched to telehealth, and that was fine. And that’s I think is another issue is that people also have this idea that, Oh, you work with old people. They can’t use computers, telehealth is a no go. And that has not been an issue for us. There’s been some clients, but we also do or we used to do a lot of phone sessions, which Medicare does cover as well. And those were just as effective and worked just as good. So.

Katie Vernoy 9:09
What is the clinical work look like, you said that it’s a different population. What is the clinical work look like with Medicare patients? Obviously, there’s a broad array. So I’m talking about, you know, what are the different types of clinical expertise somebody might need to have?

Gabrielle Juliano-Villani 9:22
The things that you will likely see most often are loss of independence and aging issues. So people you know, moving into this next phase in their life, whether it’s retirement or getting towards the end of their life and trying to make sense of things that have happened. Of course, lots of grief and loss that comes as we get older, unfortunately, and chronic health conditions and chronic illness and so that you’ll see across a big span because if somebody is on disability, then they have some sort of chronic health issue. And then as we age we get more of those also. So if you work with chronic pain or chronic illness, taking Medicare could be really good for your practice, if that’s a specialty that you work with. Family dynamics and family estrangement, and so we definitely need LMFTs who understand that. Because there’s a lot of family stuff that comes up as we get older and things change, and people are moving into facilities. And we’re trying to figure out power of attorney and wills and all of that stuff. So those are really common issues as well. I said loss of independence, like loss of mobility. And then again, going with chronic health stuff like dementia, cognitive issues, and lots of caregiver issues, also, that definitely plays a part in all of it.

… 10:46
(Advertisement Break)

Curt Widhalm 10:47
How does the day to day of business work with this? How do you get referrals from Medicare? Is it like other insurances where somebody puts into a big database, I’m looking for a Medicare provider? Like, I, you know, if I’m looking for a Medicare medical provider, if I go for a doctor, or you know, I go to my insurance plan, is it the same kind of client experience as far as how they find you? Like, what are the and then I’m also curious about, like, the nuts and bolts of like, billing and payment times and all this kind of stuff? Like, is this basically just an insurance company, but it’s run by the government?

Gabrielle Juliano-Villani 11:22
It is a little bit different. That’s a really good question. And so to answer the first part about like, where to clients come from? I, you know, did the same thing that everybody does, right? Were, who’s your ideal client, and where are they and all those things, and Medicare clients tend to go the doctor a lot. Again, chronic health stuff. So I built my practice by googling Medicare providers near me, Medicare doctor’s offices, and I called them, I went in there, I built relationships with either the nurse care managers, or if they had a social worker there, whoever made referrals, I wanted them to know who I was. And that is what really built my practice hugely, because they do have clients coming in every day who have Medicare, who are depressed, anxious, have life transition stuff going on, and they needed somebody to refer them to. So that’s where the bulk of our referrals came from. And then with our website, you know, we definitely did get outreach from the client themselves. But typically, it is a caregiver, or like their daughter or their son or a family member who’s reaching out for services also. So the content on my website was kind of written more, you know, from an SEO and a marketing perspective, was written more to who would be searching for that? Probably their kid who’s like, my mom is depressed, and we need help, or my mom just got diagnosed with dementia, and we need help. So that’s my website content was written more towards that. But other health professionals and other therapists were the ones who really, truly filled up my practice. I had a Psychology Today, and I didn’t even have a website until like, mid 2020, when my practice had been open for a couple of years. And I had already hired multiple clinicians at that point. And we just community referrals is how we built all of that. So Medicare, I think does have actually I know, they do have a provider directory, but I don’t think anybody really looks at it. So you won’t be getting phone calls from Medicare people, usually. But you will be getting calls from people in the community, other social workers, other nurses and hospitals, hospice, palliative care, doctors offices, who are looking for places to refer clients.

Katie Vernoy 13:47
So there’s Medicare and Medicare Advantage. And so my assumption is even the billing might be different for those two. Can you talk through a little bit of the nuts and bolts for folks on what it looks like to take each of those plans?

Gabrielle Juliano-Villani 14:02
Yes. So, this is extremely important. So if you’ve been listening, and you’re like doing something else, put your phone down and listen. Because this is what causes the most problems, and the most like people will schedule consults with me. And it’s this always. So there are those are two separate things. So it’s important to know that people who are on Medicare, whether they’re disabled, or if they’re over 65, they have a choice. And that choice is to stay with regular Medicare from the government or to get a Medicare Advantage plan which sometimes is called a Medicare replacement plan. And just ignore the fact that Medicare Advantage plan even has Medicare in the name because it has nothing to do with Medicare and it has everything to do with the commercial insurer. The commercial insurer sets different rates. It has different deductibles, it has different co-insurance, it’s all different. And unless that advantage plan has out of network benefits, you also need to be credentialed with them, too. So if somebody came to you, and they said, I’ve United Health Care AARP dual complete, you would have to be a network with UnitedHealthcare. With Medicare. And you also United Healthcare has to know that you’re in network with Medicare, because they have to opt you into the Medicare Advantage plans. So, it is definitely more complex and complicated. And that’s why a lot of people don’t take them. We didn’t take any of them until, like, the year that I sold my practice, and we only took one because it is just more work and more administrative stuff to deal with. And it’s not as straightforward because all of those plans are different. And clients don’t know the difference either. So, I say this in my training, like you need to ask your client 100 different ways, 100 different times, because they don’t know. They’re gonna be like, I have Medicare and I have United, and you’ll be like, Oh, great. So you have Medicare, and then you have a United supplemental, which is different. But it’s not that. So there are like these little nuances that you do need to know about the billing. And if you want, I can go deeper into that.

Katie Vernoy 16:24
I think I wanted to make sure I’m understanding. I have been an insurance provider in the past. And I actually took Medicaid for a while. And it sounds like it’s similar the Medicaid plans that I took, it was like I was in network with a virtual plan. And then I signed up for Medicaid, and then opted in with my insurance plan. So I was able to see some Medicaid clients through it was MHN. So if anybody cares, but like it was something where it was still like MHN. You know, I in the back of my mind, I was I was a Medicaid provider when I was a pre licensed individual. And so I knew how to, you know, all the billing and the background, all that kind of stuff, but it was just like I was billing through MHN it…

Gabrielle Juliano-Villani 17:06

Katie Vernoy 17:06
In Medicare Advantage plans, is it similar? It’s just like, it’s like your billing the the commercial insurance plan? Are there other requirements related, you know, besides you know, making sure that you’re enrolled and opted in and all that kind of stuff? Is there anything different between a Medicare Advantage plan and a commercial insurance plan?

Gabrielle Juliano-Villani 17:22
Nope. You just Bill however, you normally would bill, Blue Cross, Blue Shield, or United, or whoever. So you and you bill them directly. Don’t bill Medicare. The commercial insurer manages the billing, they’re the ones that pay you that fee schedule comes from if you have a problem, you contact them. So yes, it’s just like normal.

Katie Vernoy 17:42
And it’s probably similar to whatever your fee schedule is on the commercial insurance plan. But it’s not the same, right? Like the Medicare Advantage plans might have different rates than the commercial insurance. That’s my guess. You don’t have to know.

Gabrielle Juliano-Villani 17:57
They do. And in most cases, they’re lower. Not always, but usually they’re lower. And that’s, again, why people don’t like to deal with them. But it does depend. And it depends on your state. And it could even depend on your county. So it does vary greatly.

Katie Vernoy 18:13
Yeah. And I mean, it was like, for me, I think it was like within $1 or two per session. It wasn’t like a huge like, it wasn’t like $20 difference. It was like within $1 or something.

Gabrielle Juliano-Villani 18:22
I think for a lot of them. Yes, I know, for a fact that United in most states, again, this does vary a little bit in different states. But United tends the United Medicare Advantage plans tend to be much much lower, like $30 $40 $50 lower.

Katie Vernoy 18:39
Wow, okay. Okay. So, that’s good to know. So yeah, so Medicare Advantage, there may be an advantage to taking these plans, but they’re there. It’s basically just taking insurance. So if you’re not already taking insurance, you’ve got a few more extra steps. You got to get enrolled with the insurance, and then you will also have to opt in to Medicare for that plan. Okay. For straight ahead Medicare, what does that look like?

Gabrielle Juliano-Villani 19:03
That is so much easier because it’s the same everywhere as far as what your co-insurance and things are going to look like. And so everybody, all anyone who is listening to this is a part B provider, because that’s outpatient, so we only deal with Medicare Part B, you build Medicare Part B in your state. And you can do that through your EHR, I think is always the easiest. But you can do it through Office Ally, and then each region has like their own portal that you can use as well. So, and that’s free, it is a little bit more setup, and I think, possibly a little bit more difficult, but it’s free, and you can do it that way. And so you just directly bill them and you get paid 80% from Medicare directly and you’ll get that in two weeks, and the other 20% either a supplemental plan will pay for or potentially Medicaid or it’ll be the client’s responsibility. So it’s always the same. Like, you know, you’re gonna get 80% from Medicare in two weeks. And then the other is either the client, a supplement, or Medicaid.

Curt Widhalm 20:09
Okay. And so let’s just pretend for a second that one of our listeners or one of our people on this podcast has no idea how insurance works whatsoever.

Gabrielle Juliano-Villani 20:27
But that’s good, because there are more Curts out there. So that’s why we need you.

Curt Widhalm 20:33
I’m sitting here, and I’m listening to you to have lots of insurance experience. So, if I am somebody who I’ve never been in network with anybody before. So, I have opted into Medicare, I don’t, I’m not aware of Medicare Advantage things that has never been a concern for me. I have a client come in at the end of the session, I shake them down for 20%. And then I wait two weeks for the other 80%. Is this like, I’m needing maybe a little bit more of a basics on this.

Gabrielle Juliano-Villani 21:11
Okay, no, that’s totally fair. So potentially, so you would like you know, right, that they have traditional Medicare, regular Medicare from the government. So you know, like Joe’s coming in, and you meet with Joe, and then after Joe is gone, or at the end, you’re going to bill Medicare for Joe’s session. And you know, that Medicare is going to give you 80%. But you also need to ask Joe, do you have a supplemental plan or Medicaid. We’re like, show me all of your insurance cards is usually what I would ask those clients. I’m like, let me see everything, and then I’ll know. So Joe will probably pull out and most cases, not always, but a lot of people on regular Medicare want the supplement, because then they don’t have any medical bills to pay. And those premiums for them are higher, but then they don’t have monthly bills. So, Joe, likely will pull out a supplemental card, and it’s gonna say like, United Healthcare, Plan G supplement, and you’re gonna know, oh, because you took my training, you’re gonna know that supplement pays his copay. And so you’re like, bye, Joe. I’ll see you next week, and Medicare and your plan G supplement pay for everything. And you don’t have to do anything, you just bill Medicare, Medicare sends you the 80%. Medicare also sends that claim to Joe’s United Health Care Plan G supplement, and then the Plan G supplement pays you that 20% a couple of weeks later.

Katie Vernoy 22:44
So, you only need to build once.

Gabrielle Juliano-Villani 22:47

Katie Vernoy 22:48
Okay, that’s great.

Gabrielle Juliano-Villani 22:49
In most cases, yes. Of course, there’s like these like little weird one offs. But I don’t really think that we need to delve too deep into that. Generally that’s what makes it so nice as you bill once and then you get paid for Medicare, and then you get a nice little check in the mail a couple weeks later. And that’s exciting to you.

Katie Vernoy 23:09
Got it. Does that make sense, Curt?

Curt Widhalm 23:12
It does. Thank you. It does. And I, and I’m assuming all of the other people who have considered how this might work are very appreciative as well.

Katie Vernoy 23:25
So the complexity here seems like it’s it’s determining that they have straight ahead Medicare, and that they have whether or not they have a supplemental plan. When you ask them for all their insurance cards, does it become clear pretty quickly which they have? Okay.

Gabrielle Juliano-Villani 23:41
It does. Because a lot of times what will happen, like I was saying earlier, if somebody, a client has a Medicare Advantage plan, but they don’t know that, and they say, Oh, I just have Medicare in United. When they give me their card or I look at their card, I’ll see it’s going to say Medicare Advantage United Healthcare. And so I will know okay, that’s actually not a supplement, that is a Medicare Advantage plan. That means I need to bill United. So once you see them, it makes much more sense that helps a lot.

Katie Vernoy 24:11
So but if you’re just straight ahead Medicare and not a Medicare Advantage provider or not in network with United, is there anything you can do?

Gabrielle Juliano-Villani 24:20
You could go through the hoops of seeing if they have out of network benefits. And if you want to give them a super bill, you can do that. Or you can courtesy bill for them as well. I would just be really careful if you’re going to courtesy bill. And that means that you’re not in network, but you’re submitting the claim anyway, and you’re going to accept whatever United pays you, if they pay you. I just find that when you do that, it just gets way to more complicated. If there’s a problem, you’re not a provider, and so United’s going to totally ignore you or whoever the insurance is. And so it just adds to more problems. So…

Katie Vernoy 24:59
So, you recommend Super billing.

Gabrielle Juliano-Villani 25:00
You can super bill. And or you could try and refer them out to somebody who takes that plan also, because, yeah, it can just get very complicated.

Katie Vernoy 25:13
So, it seems like there’s probably education you want to have on your website, if you’re just a straight ahead Medicare provider, so that you’re not getting a ton of folks coming in with Medicare Advantage that you really can’t bill for.

Gabrielle Juliano-Villani 25:26
Yes, we made it very clear. But, you know, again, clients don’t know. So. And so you just want to be upfront about that. I know. I was just talking about this the other day with somebody. And they’re like, you know, we did the whole consult call that was 20 minutes of my time, and we get to the end, and they have like this Humana Medicare Advantage that they don’t take. And so not to be rude. But I would always start the conversation with like, I only, you know, accept regular Medicare. And I don’t want to waste your time and have you tell me your whole story, if I don’t take your insurance. So, why don’t we just start there before we get to the next part?

Katie Vernoy 26:03
Sure. That’s a good idea.

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Katie Vernoy 26:07
Audits are something else that people really worry about. What can you tell us about that?

Gabrielle Juliano-Villani 26:12
I can tell you that I was billing 250 or more Medicare sessions a week for years and never got audited by them.

Curt Widhalm 26:24
So, this is within your group? Because I’m imagining…

Gabrielle Juliano-Villani 26:28
Yes. I’d be dead.

Katie Vernoy 26:36
And also a time traveler or in alternate reality?

Gabrielle Juliano-Villani 26:40
Yes, exactly. Yes, it was with my group. And also, I have a Medicare Facebook group with 3300 people or something like that in it. And the majority of people in there say the same thing. I’ve been billing Medicare forever, I’ve never gotten audited. But audits do happen. That’s part of being a provider for any insurance. And it’s really just about having good notes and preparing yourself in advance. And I have lots of resources for that. But it’s not too much different than commercial insurance. And they also, I know this is gonna sound shocking, also, they’re also very nice and flexible without it. So they, they don’t come in and recoup a ton of money from you. They’re going to say we want to see these notes, and you show them and if they’re like these notes are not good, or they’re not meeting what they want, they’re going to tell you what they want. And they’re going to say we’re going to come back in 45 days, and we’re going to look again. So they it isn’t as scary as it sounds, and they will audit more if you are doing like unusual billing practices is really the biggest thing. So, if you’re seeing somebody 90837, which is like 60 minutes, 53 minutes or more, if you’re billing that for one client five times a week, then yeah, they’re probably going to audit you. Because they’re gonna be like, what the hell’s going on with this client where they need to see you, every single day, and you’re just a normal outpatient mental health provider, this is not IOP, or anything like that. Like what’s going on here? So, those types of things can definitely, you know, send off alarm bells for them. But I just am all about documenting medical necessity. You are the expert and your client. So just document that in your notes, and they will look at it, and you’ll probably be fine.

Katie Vernoy 28:37
Some insurance companies will audit because you’re billing 90837 once a week, it sounds like saying that is an issue with Medicaid, Medicare.

Gabrielle Juliano-Villani 28:47
I don’t think so I think in some states, they might audit more because of that, where there’s a lot of fraud. So that’s the other thing to remember is even though none of us are probably committing fraud, a lot of other people do. And there’s a ton of Medicare fraud, and so they audit more in Florida, of course. I’ve also noticed they seem to audit a little bit more in Illinois sometimes as well. But I’ve done lots of consults with people about Medicare audits and the only ones that didn’t pass were kind of those situations that I was explaining before.

Curt Widhalm 29:25
Anything else that people need to know because even as I’m learning more about this process, I’m not even sure that I know what all needs to be asked on this.

Gabrielle Juliano-Villani 29:37
Um, that’s a good question, too. I think we hit a lot of the big pain points for people. And I know that it does seem scary and overwhelming and it’s the government and all of those things, but that’s really why I do what I do and why I’m such a big proponent for Medicare is because it really did help me build my practice, and got us great clients. And it wasn’t difficult, we didn’t get audited, we got paid easily and on time. And so those are things, you know, I can’t, I don’t want to force anybody. And that’s not my job. But I just want everybody to have all of the information to make an informed decision that works best for you and your business and how you work clinically. And so I hope maybe if you were on the fence, or you didn’t know anything about Medicare, that this can maybe shed some light on some of the more positive things, because there are a lot of them, instead of a lot of the fear mongering that I keep hearing and seeing, and people DMing me that, you know, they’re afraid. Someone told them that if they opt out, they’ll never be able to find a job ever again, and that they’re going to get recouped all of this money. And it’s like, let’s all take a breath, and just look at the information.

Katie Vernoy 30:57
If someone is inspired right now, they’re like, Okay, I opted out, or I didn’t make a decision yet. And I’ve got a little bit of time to make a decision here. And I’m thinking I want to take Medicare, what advice would you give them?

Gabrielle Juliano-Villani 31:10
So I would tell them, you know, the application is probably the hardest part out of all of this. And the system Medicare uses looks like it’s from 1980, because it probably is. So it is very antiquated. And it’s kind of a pain in the ass. And so I always tell people, like I have a little guide on one of the blogs on my website, like these are all the documents you need, have them and just set aside some time and just work through it each question one by one, try not to get overwhelmed. Or if you do feel overwhelmed, do it in chunks, because it will save your application. And also there’s a paper application. And so if there are errors, that’s going to take more time, but a lot of people in my Facebook group have been doing the paper application because it’s a lot easier to work through than the Medicare Pecos system.

Katie Vernoy 32:05
Oh, really? Because everybody has been recommending, like, do the electronic version. And I looked at the paper version, and I got super overwhelmed. And I’m sure the the electronic version must walk you through and only give you limited answers versus like, here’s every question ever needed, right?

Gabrielle Juliano-Villani 32:22
I find the electronic version to be better, because it also pulls information from NPPES, which is where you get your NPI. And so it just pulls that from there. So that makes it easier, I think. And you can also, you know, automatically if there’s a problem. You can easily check the status and upload things. If you send in a paper application, and there’s a problem, it’s gonna take probably a couple of weeks for them to get that back to you. And so I just find that electronic is easier for me. But a lot of people in my group are preferring the paper version. So.

Katie Vernoy 32:57
But like working like like, like homework, they’re like, Okay.

Gabrielle Juliano-Villani 33:01
Exactly. Exactly.

Curt Widhalm 33:07
You’ve made reference to your blog a few times, where can people find it and all of the wonderful things that you do to help guide people about in this process?

Gabrielle Juliano-Villani 33:17
So, I have lots of free resources, blogs, videos on my website, And it’s the same group on Facebook, Medicare Consulting for Therapists, tons of q&a, and videos and like, feature posts about everything you need to know in there. And then if you are more interested in the other things that I do, like retreats, and business coaching and all that stuff, I’m at And that’s the same across what Tiktok, LinkedIn, Facebook, Instagram is @gjvconsulting.

Curt Widhalm 33:56
And we will include links to all of that in our show notes over at And follow us on our social media, join our Facebook group, the Modern Therapists Group to continue on with these discussions. And until next time, I’m Curt Widhalm with Katie Vernoy, and Gabrielle Juliano-Villani.

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