The Claim Game

EPISODE SUMMARY

Jeremy sits down with Brian Valasek, President of the Ohio Association for Counselors and Private Practice and owner of Beyond Your Valley, to discuss what it takes to build a sustainable private practice.

Brian shares his therapist-first approach, the importance of specialization, and how practice owners can evaluate payer relationships. They also explore reimbursement challenges, client experience, insurance vs. private pay, and what the future could hold for insurance-based therapy.

KEYWORDS

private practice, group practice, mental health, therapist burnout, insurance reimbursement, private pay therapy, insurance billing, payer contracts, practice management, therapist specialization, client experience

TAKEAWAYS

Take care of your therapists. A therapist-first culture can help clinicians thrive long term while creating a better experience for clients.

Specialization creates clarity. Helping therapists find their niche can strengthen their clinical work and make it easier for clients to find the right provider.

Know what a session actually costs. Reimbursement alone doesn’t tell the whole story. Practice owners need to understand payroll, taxes, overhead, administrative work, and other costs when evaluating payer contracts.

Client experience matters. Fast responses, clear expectations, and thoughtful therapist matching can make a meaningful difference throughout the client journey.

Insurance participation is a business decision. Practice owners have to weigh reimbursement, administrative complexity, access, and sustainability when deciding which payer relationships make sense.

The insurance vs. private pay conversation is evolving. Rising healthcare costs, administrative burden, and reimbursement challenges are raising bigger questions about the future of insurance-based therapy.

CHAPTERS

00:00 Introduction to Brian Valasek and His Roles

05:18 Building a Therapist-First Private Practice

13:48 What It Takes to Build a Sustainable Private Practice

29:50 Insurance vs. Private Pay: The Future of Therapy

38:28 Connect with Brian Valasek

RESOURCES

Today Sponsors: practicesol.com

Visit beyondyourvalley.com

Visit OACPP.com

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog

Are you spending more time answering billing questions than actually growing your practice? In this episode of The Claim Game, Jeremy Zug breaks down the hidden cost of being your team's go-to help desk and how it could be costing you an entire workday every week.

Jeremy explores the risks of relying on one employee for billing knowledge, why documented workflows are essential for protecting your revenue cycle, and how a structured 30-day training program can turn existing administrative staff into confident, capable billers. Plus, discover how reimbursement rate comparisons can uncover missed revenue opportunities and help practices negotiate smarter payer contracts.

Learn how to build a stronger billing team, reduce costly interruptions, and reclaim your time to focus on growing your practice.

Revenue Cycle Management, Medical Billing Training, Biller Training, Practice Management, Billing Workflows, Insurance Claim Denials, Administrative Efficiency, Healthcare Billing, Practice Growth, Reimbursement Rates, Payer Contract Negotiation, Billing KPIs, Accounts Receivable, Practice Solutions

Being your team's help desk is costing you. Frequent billing interruptions can add up to 30 hours a month that could be spent growing your practice.

Don't let billing knowledge walk out the door. Relying on one employee without documented processes creates a major risk to your revenue cycle.

Standardized workflows protect your cash flow. Checklists, training resources, and clear procedures keep billing operations running smoothly through employee turnover.

You can train your existing team. A structured 30-day training program can equip administrative staff with the skills to manage billing confidently.

Training doesn't end after 30 days. Ongoing coaching and support help your billing team handle complex denials, payer questions, and unexpected challenges.

Know what your market is paying. Comparing reimbursement rates with similar practices can reveal missed revenue and strengthen payer negotiations.

00:00 The Hidden Cost of Being Your Team’s Help Desk

07:34 From Admin to Expert Biller in 30 Days

09:44 Know What Your Market Is Really Paying

Today Sponsors: practicesol.com

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance

Every denied claim costs your practice more than delayed revenue. According to the 2026 Availity Abrasion Index, reworking a denied claim costs an average of $52.74—and those expenses add up quickly.

In this episode, Jeremy Zug explains why many practices have a billing sequencing problem, not a billing problem. He breaks down the hidden costs of claim denials, common workflow mistakes, and how the six-stage Billing Blueprint can help reduce denials and improve revenue cycle management.

Claim denials, medical billing, revenue cycle management, clean claims, denial prevention, billing workflow, billing mistakes, claim submission, billing systems, group practice management

Every denied claim comes at a cost. Reworking a denied claim costs an average of $52.74, meaning just 10 denials per week can cost a practice over $27,000 annually.

Your billing problem might actually be a sequencing problem. Inefficient workflows and inconsistent processes can create unnecessary denials and lost revenue.

Preventable denials are system failures. Incorrect patient information, expired eligibility, and missing authorizations can often be caught before claims are submitted.

Claim submission should come last. Following the six-stage revenue cycle management process helps ensure claims are clean and ready before submission.

Consistency beats speed. A structured claim submission schedule and regular payment posting can help prevent costly billing errors.

Better systems create room for growth. An organized billing process allows practice owners to spend less time fixing claims and more time growing their practices.

00:00 The True Cost of Claim Denials in Your Practice

02:25 The Billing Sequence Mistake Costing Practices Thousands

06:18 How Denied Claims Cost Your Practice Thousands

07:44 Why Claim Submission Should Be the Last Step in Billing

09:18 Fix Your Billing Systems: Join the Free Webinar

Today Sponsors: practicesol.com 

Register for October 29th’s Webinar here

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

As your practice grows, the way you handle billing may need to grow with it. What once felt manageable can quickly turn into weekends spent chasing claims, increasing AR, and less time focused on leading your business.

In this episode of The Claim Game, Jeremy Zug breaks down the signs that your practice may have outgrown DIY billing and when outsourcing can make sense. He explains why being capable of handling billing doesn’t necessarily mean you should—and how getting it off your plate can give you more time to focus on your clinicians, referral relationships, strategy, and growth.

Jeremy also discusses in-house vs. outsourced billing, why there isn’t one right solution for every practice, and how your billing needs can change as your business grows.

medical billing, outsourced medical billing, mental health billing, private practice billing, practice growth, practice management, billing services, medical billing company

Your billing process should grow with your practice. What worked when you were smaller may become overwhelming as claims, clinicians, and AR increase.

Billing shouldn’t keep you from leading. If billing is taking time away from recruiting, training, referrals, and strategy, it may no longer be the best use of your time.

Know when it’s time to outsource. If billing follows you home, takes over weekends, or becomes something you dread, getting it off your plate may be the right next step.

In-house billing can still be a great option. The key is building the department properly with the right people, processes, training, and systems.

Your billing solution can change as you grow. Outsourcing now doesn’t mean outsourcing forever—the right approach can evolve alongside your practice.

00:00 When Billing Becomes a Growth Problem

03:33 When It’s Time to Outsource Your Billing

06:44 Your Job Is to Grow the Practice

Today Sponsors: practicesol.com

Book a Free Consultation

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

A full schedule doesn’t always mean a financially healthy practice. Sometimes the real problem isn’t patient volume—it’s revenue that’s getting stuck in the billing process.

In this episode of The Claim Game, Jeremy Zug explains how rejected claims, unresolved denials, aging AR, and inefficient billing workflows can quietly drain revenue even while a practice continues to grow. He shares why “busy” isn’t a useful measure of billing performance, what practice owners should actually be looking at, and why fixing revenue leaks should come before investing in more growth.

Jeremy also explains how a Practice Health Check can help owners step out of the day-to-day, identify where money is getting stuck, and determine whether their billing infrastructure is ready to support growth.

accounts receivable, AR management, medical billing, revenue cycle management, private practice billing, billing performance, claim denials, rejected claims, cash flow, practice growth, billing efficiency, Practice Health Check, Practice Solutions

A busy practice isn’t always a healthy practice. A full schedule can hide revenue leaks caused by billing issues.

Pay attention to aging AR. Claims sitting unpaid for 60, 90, or 120+ days deserve a closer look.

Busy doesn’t equal effective. Measure how quickly rejected claims and denials are worked—not simply how much activity your billing team produces.

Growth can mask billing problems. Adding clinicians and patients may increase collections while underlying revenue cycle issues continue to grow.

Collect before you create more. Before spending more on marketing or growth, make sure you’re collecting the revenue your practice has already earned.

00:00 The Hidden Revenue Problem Behind a Busy Practice

05:48 Stop Measuring Busy, Start Measuring Results

11:05 Find the Cash Hiding in Your AR

Today Sponsors: Visit practicesol.com

Book a Practice Health Check

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

Your reimbursement rate isn’t necessarily the market rate. In this episode of The Claim Game, Jeremy Zug explains why practice owners should look beyond their own contracts to understand what comparable practices are actually being paid.

Jeremy explores how reimbursement benchmarking and market data can uncover hidden revenue opportunities, strengthen payer negotiations, and help practices make smarter decisions about their payer strategy. The bottom line: you can’t negotiate a rate you don’t know exists.

insurance reimbursement rates, reimbursement benchmarking, payer negotiations, insurance contracts, fee schedules, behavioral health billing, mental health billing, private practice, payer strategy, reimbursement data, rate negotiation, revenue cycle management, practice management

Your rate isn’t necessarily the market rate. Your contract shows what your practice is being paid, not what comparable practices are receiving.

Small differences can have a major impact. A seemingly modest reimbursement gap can translate into significant lost revenue at scale.

Market data creates leverage. Knowing what similar practices are paid can help you approach payer negotiations with better questions and stronger information.

Small practices have advantages, too. Solo and small group practices may lack volume, but they often have more flexibility to adjust payer mix, services, and strategy.

Reimbursement isn’t set in stone. Payers, services, markets, and rates can change—and practice owners can explore opportunities beyond their existing contracts.

You can’t negotiate what you don’t know exists. Regularly benchmarking reimbursement can help you make more informed decisions about the future of your practice.

00:00 Your Reimbursement Rate Isn’t the Market Rate

03:33 Using Market Data to Negotiate Smarter

07:11 Getting Creative With Payers and Reimbursement

10:22 See What Practices Like Yours Are Getting Paid

Today Sponsors: Visit practicesol.com

Check Out Rate Vantage

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

In this episode of The Claim Game, Jeremy Zug sits down with Gabrielle Juliano-Villani, LCSW, to discuss scaling a seven-figure group practice, navigating burnout, and stepping into the CEO role. Gabrielle shares lessons on leadership, delegation, and taking risks, plus why Medicare and Medicaid can offer valuable growth opportunities for behavioral health practices.

Group Practice, Private Practice, Medicare for Therapists, Medicaid, Practice Burnout, Group Practice Growth, Practice Management, Healthcare Billing, Medicare Billing, Practice Leadership, Revenue Cycle Management

Growth Can Come at a Cost: Scaling to seven figures taught Gabrielle that growth isn't worth sacrificing your well-being or alignment.

Boundaries Make Better Leaders: Clear expectations and systems protect your time while helping your team work more independently.

Step Into the CEO Role: Delegating routine tasks gives practice owners more time to focus on leadership and growth.

Do It Afraid: You don't have to eliminate fear before taking action. Progress often requires risk and a willingness to fail.

Don't Fear Medicare: Medicare and Medicaid can provide meaningful opportunities for behavioral health practices to grow and get paid for valuable work.

Compliance Matters: Strong documentation and appropriate billing can help reduce the fear surrounding audits and clawbacks.

00:00 Gabrielle's Journey to Private Practice

17:24 Stepping Into the CEO Role & Doing It Afraid

29:54 Why Practices Shouldn’t Fear Medicare

37:25 Connect with Gabrielle

Today Sponsors: Visit practicesol.com

Visit gabriellejulianovillani.com

Visit medicareconsultingfortherapists.com

Connect with Gabrielle on Instagram

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

In this episode of The Claim Game, Jeremy Zug sits down with clinical psychologist and practice owner Dr. Michelle Perry to discuss innovation, problem-solving, and leadership in private practice.

Michelle shares how the limitations of insurance led her to explore new models of care, including wellness services, therapy intensives, and ketamine-assisted therapy. She also explains how she uses data to solve business problems, recognize when it’s time to pivot, and lead with both compassion and accountability.

Private Practice Leadership, Group Practice Growth, Practice Management, Ketamine-Assisted Therapy, Therapist Leadership, Lean Six Sigma, Mental Health Practice, Practice Growth, Employee Accountability, Practice Owner

Innovation May Require a New Approach: When traditional insurance models limit care, practice owners can explore creative, compliant alternatives.

Solve the Right Problem: Identify the root cause and use data before jumping to a solution.

Pivoting Isn’t Failure: When something isn’t working, use what you’ve learned to find a better opportunity.

Hold Space AND Hold Standards: Great leadership requires protecting your vision and setting clear expectations.

Compassion and Accountability Can Coexist: You can support your team while still holding people accountable to their commitments.

Protect Your Culture: Addressing underperformance and establishing clear standards helps protect the entire team.

00:00 Breaking the Mold of Traditional Therapy

20:16 Stop Forcing It: Knowing When to Pivot

34:08 Protecting Your Vision as a Practice Owner

47:45 Connect with Michelle

Today Sponsors: Visit practicesol.com

Connect with Michelle on LinkedIn

Email Michelle: [email protected]

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.

In this episode of The Claim Game, Jeremy Zug sits down with retired psychologist and business coach Nicole McCance to discuss how she grew from a burned-out solo practitioner to building a 55-therapist, multi-seven-figure group practice.

Nicole shares the systems and strategies behind that growth, including hiring the right team, creating SOPs, using AI and automation, attracting and retaining clients, and focusing on your zone of genius. She also breaks down her five-step approach to scaling and the mindset that helped her make the leap from clinician to CEO: “do it scared.”

Group Practice Growth, Private Practice, Scaling a Therapy Practice, Practice Management, Systems and Automation, Hiring Therapists, Digital Marketing, Client Retention, AI for Private Practice, Practice Growth

Systemize Before You Hire: Document your processes and build clear SOPs so your practice can operate without everything depending on you.

Hire for the Right Fit: Nicole shares why your first hire should reflect your personality, energy, clinical approach, and brand.

Growth Is More Than Marketing: A scalable practice needs systems to attract, convert, and retain clients—not just generate leads.

Delegate, Automate, Eliminate: Create more time for your zone of genius by removing tasks that don’t require your expertise.

Do It Scared: Growth can feel uncomfortable. Nicole explains why moving forward despite fear was key to becoming a CEO and building a practice that could run without her.

00:00 Scaling from Solo to 55 Therapists

13:28 SOPs, Training, and Smarter Systems

22:30 The Five Steps to Practice Growth

34:23 Systems, ROI & Doing It Scared

Today Sponsors: Visit practicesol.com

The Business Savvy Therapist Podcast: https://mccancemethod.com/podcast/

Sign up for Nicole’s FREE Masterclass: How to Build a 7-Figure Group Practice + earn 1 CE Hour:
https://mccancemethod.com/webinar-free-masterclass-from-solo-to-superteam/

Facebook Group:
https://www.facebook.com/groups/947689352498639

Instagram:
https://www.instagram.com/nicole.mccancemethod/

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

In this episode of The Claim Game, Jeremy Zug sits down with Tara Wells, sports social worker and founder of Finish Line Mindset, to discuss building a private practice around therapy, coaching, and prevention.

Tara shares her approach to separating coaching from clinical work, transitioning from insurance to private pay, and using networking to grow her practice. They also discuss setting boundaries, finding the right niche, and building the confidence to create a practice that works for you.

Private Practice, Sports Social Work, Sports Mental Health, Private Pay Practice, Mental Health Practice, Practice Growth, Alma, Headway, Private Practice Marketing

Know the Line Between Coaching and Therapy: Clearly defining the scope and boundaries of each service is essential when offering both.

Your Niche Can Be an Advantage: Specific messaging helps the right clients and referral partners understand who you serve.

Insurance Isn't the Only Path: Tara shares how she moved from insurance platforms to a private-pay model that better fits her practice.

Relationships Build Practices: Networking and word-of-mouth referrals have become key drivers of Tara's growth.

Set Boundaries Around Your Business: Creating intentional time away from clients and work helps protect your life outside the practice.

Start Before You Feel Ready: Experiment with marketing, networking, and new opportunities while you still have a safety net.

00:00 Building a Practice Around Therapy and Coaching

13:41 The Journey from Insurance to Private Pay

28:43 Setting Boundaries as a Practice Owner

37:50 From Self-Doubt to Taking the Leap

Today Sponsors: Visit practicesol.com

Learn More About Finish Line Mindset and The Unpacked Mastermind

Connect with Tara on Instagram and TikTok

Learn More About The Claim Game: Visit practicesol.com/podcast

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.