Click here to read part one of this series.

In my previous article, I introduced the concept of the cloud-based practice management system and began to detail how it can help counselors achieve a paperless office. I covered tracking of client data, scheduling, clinical notes and the Health Insurance Portability and Accountability Act (HIPAA). This month, I will discuss the remaining important features and list some current products on the market.


In our endeavors to make our work profitable as counselors, having an effective billing system is important. First, counselors need to understand the difference between billing solutions and accounting solutions. A billing solution is focused on the creation of invoices and collection of payment. A typical billing system won’t fulfill all accounting needs such as bookkeeping and tax-related items. At this writing, I am not aware of any cloud-based practice management solution that includes a full accounting package. For now, a practice may still need a program such as QuickBooks and/or an accountant. I don’t foresee that changing anytime in the near future because programming a full-featured accounting solution is a significant undertaking.

With that in mind, the billing solution should allow creation of an invoice for an individual session or for any outstanding balance. It should allow entry of payments received from clients or insurance companies as well as production of receipts. It should allow creation of a statement for a client (covering a range of dates) that includes charges, payments and amounts due. All of this information should be easily accessible in a way that allows tracking of what has been paid and what is owed (accounts receivable).

The true power and point of comparison for a billing module lies in how well integrated and easy to use it is. The more quickly a counselor can access and understand the information, the more time and money the business is likely to save.

Billing features to consider include:

  • Other charges or credits: These “non-session” charges might include fees for paperwork or consulting. Credits can occur when a copayment turns out to be less than originally reported by the insurance company. 
  • Integration: Being able to pull up a client’s record and immediately see an account balance is a significant time saver and a great tool in helping practitioners collect what is due to them. Being able to enter payments while viewing an appointment or note is very efficient. 
  • Fee schedules: A fee schedule allows entry of rates for various services that are automatically charged to a client when services are performed. Robust systems will allow creation of more than one fee schedule.
  • Insurance tracking: Being able to enter contracted insurance rates allows a practice to see at a glance what payments it should expect to receive in the coming weeks. This feature is integral to producing accurate reports.
  • Client aging reports: This report displays every client that owes money, how much the client owes and how long the client has been carrying the balance. 
  • Insurance aging reports: This report shows all insurance payments that have yet to be received and how long it has been since a claim was filed. 
  • Superbills: This feature allows a practice to provide a value-added service by offering clients a document that includes all the information needed to file a claim.
  • CMS-1500: The CMS-1500 is the standard filing form for insurance claims. Although the vast majority of insurance companies now require electronic claims, some still accept this paper form. 
  • Revenue reports: Although a billing system isn’t an accounting system, the ability to produce revenue reports may provide information a practice needs to enter into its accounting system. 
  • Batch statements: This is especially useful to larger practices that bill for services. Being able to produce statements for all clients who are carrying a balance with a couple of clicks is a huge time saver.
  • API: An API (application programming interface) allows one piece of software to communicate with another. Although this can be useful in all modules of a system, it is particularly beneficial in the billing module for pulling information into an accounting package. 

Electronic claim filing

When effectively integrated into the rest of a system, insurance claims can be filed in mere clicks. This means that within seconds of finishing a session note, a claim could already be on its way to the insurance company electronically. Did I mention that claims submitted electronically tend to get paid faster?

Practice management software, through electronic data interchange (EDI) standards, can allow users to electronically file their claims without having a direct relationship with a clearinghouse. A good system will act as an initial “scrubbing” machine, alerting you to the omission of required information and other error warnings that likely would elicit a rejection from the clearinghouse or insurance company. Feature-rich systems will also track claims from submission to payment, importing the ERA (electronic remittance advice) and applying the payments to the correct clients/sessions.

Claim filing features to consider include:

  • Insurance providers: It is important to verify that credentialed insurance companies are supported by the solution and its clearinghouse.
  • Integration: Being able to submit claims as part of work flow is efficient. This flow is usually best achieved by having a claims submission button attached to an appointment on the schedule or the session note itself. 
  • Contracted rates: Entering contracted rates with each paneled insurance company can decrease the time spent on data entry because the system will automatically pick up what payment to expect.
  • Batch submission: Some systems allow review and submission of all claims as a batch at the end of a workday. 
  • Tracking: A system should give status information on filed claims, indicating when they have been sent to the insurance company. It should also give notification of a rejection, including the reason for the rejection.
  • Clearinghouse integration: The more clearinghouse information accessed directly within the software, the better. This access may include the ability to check claim status, verify benefits and have ERAs automatically imported and applied to the correct clients/sessions.

Client portal

How much time and money might a practice save if it didn’t have to manage appointment reminders? If it no longer had to print intake forms and assessments? If clients could pay their bills or reschedule appointments online? These are some of the potential components in a client portal, one of the least common but most sought after features in a cloud-based practice management system.

A client portal consists of a website where clients have unique accounts that allow them access to their information (and to their information only). This information comes directly from the practice management system. After logging in, clients may be able to see all of their currently scheduled appointments, send the counselor a secure message, pay their bills and more.

Client portal features to consider include:

  • Website integration: This refers to whether the client portal is integrated into an existing site.
  • View appointments: This feature allows clients to see currently scheduled appointments. 
  • Schedule appointments: Some systems allow clients to schedule their own appointments. They can see available appointment times and then choose one that is open. 
  • Complete paperwork: This feature, currently one of the most rare in practice management systems, allows clients to complete forms (intake, informed consent/HIPAA, assessments) via a web browser. Upon submission, the forms are immediately part of the client’s system record. 
  • Customizable forms: Some systems allow customization of online forms and even creation of completely new ones. With this feature, any form you have clients fill out could be completed online.
  • Secure messaging: This feature allows the client and provider to send secure messages to each other through the system, eliminating the need for email (which is not a secure delivery system).
  • BillPay: This feature allows clients to view invoices and statements and to pay outstanding balances via the portal. Some systems even allow clients to pay their session fees in advance.
  • Journal: Although this can be created in any system that allows for customizable forms, some provide a separate journaling option with distinctive features. This allows the client to keep an online journal as part of the therapeutic process.


Following are some important items to consider that don’t fit conveniently into any of the previous categories.

Clinician groups 

In many cases, private practices involve a group of clinicians who may want to use the application. In such cases, evaluating whether and how the product can handle groups is important.

Data portability

Consider how difficult it would be to move data should migration to a different practice management system become necessary. Consider how a solution provides for exportation of data and importation from another program.

Graphic user interface/user experience

Graphic user interface (GUI) refers to the actual look of the application — the colors, the buttons, the arrangement of fields and so on. User experience (UX) refers to the overall feel and flow of the application. For example, are buttons/functions where they are expected? Is there a natural flow to data entry?

Tablet friendly

Related to the GUI/UX, and important to a growing number of counselors, is the question of whether the application is easy to use on a tablet computer (iPad, Android or Windows).


Apart from testimonials, it can be difficult to evaluate technical support for a product until a practice is using that product and a problem arises. Fortunately, many applications offer either a free trial or a 30-day refund policy. It is a good idea to ask some questions during this time because it offers the best chance to gauge how responsive the technical support will be.


Product reliability is also difficult to measure without personal experience using the product or hearing a lot of feedback about the product. Knowing an application will be available when needed and that data is secure and backed up provides peace of mind.

Data storage

Most of these applications provide the opportunity to upload documents. One question to ask about any service is whether there is a limit to the amount of data storage available.


Consider whether the system allows for integration with other software through an API. For example, will it allow billing information to be exported into an accounting program? Will it allow scheduling information to be imported into another calendar application (typically through iCal)?

Current options

Following is a list of cloud-based practice management systems targeted to mental health providers in private practice.

Choosing a cloud-based practice management system is not something to rush into. Care and attention need to be paid to myriad factors, including privacy and security mandated by HIPAA, requirements of licensing boards and insurance companies, current and future business practices, and features and costs. It is likely that a practice will continue with the same system for a long period of time, so there are significant benefits to finding the right fit the first time.

This article and the article in the previous issue were distilled from a 12-part series that the author originally published at

HIPAA and mental health professionals

Most counselors are well-acquainted with the Health Insurance Portability and Accountability Act (HIPAA) regulations regarding privacy. Many professionals, however, have only a basic knowledge of the security facets of HIPAA. With the recent release of the HIPAA Final Rule, it has become even more important that counselors are aware of their responsibilities when it comes to security electronic PHI (protected health information). In an upcoming article for his new Counseling Today column, Rob Reinhardt will be exploring where counselors are now, where they need to be and how they can get there. Please help him tackle the first part of his article by completing a brief survey about mental health professionals and HIPAA at



Rob Reinhardt, a licensed professional counselor and ACA member, is a private practice and business consultant. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at

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