Newcomers to mental health billing may experience confusion, doubt, and helplessness. This is very normal, so relax. Most people working in mental health need more training to handle complicated medical billing. Billing, after all, has more in common with business and finance disciplines than it does with medical specialties.
Nevertheless, behavioral health offices throughout the globe can pick up effective billing techniques and maintain a healthy revenue cycle, which you can practice as well. Following are some things that every therapist needs to be aware of before entering the billing field.
Mental health billing and the revenue cycle
What does “revenue cycle” mean? It refers to the entire money-making process, from finding a new paying customer to receiving the check in your bank account. Even though there is a lot more to learn about this cycle, this is a quick summary of the main steps.
1. Admission Details
Good billing practices commence with the creation of a new patient record.
Why? Since the majority of billing errors—such as incorrect names, errors in patient ID numbers, missing fields, etc.—lead to insurance companies rejecting claims. You’ll require exacting precision on details like these to produce what the billing industry refers to as a “clean” or error-free claim:
- The complete legal name of the patient
- Birth Date
- Current residency
- Member ID for insurance
When misleading information or typing mistakes make their way into the initial patient records, errors appear on every bill until you notice the problem. Since mental health professionals often see patients more than once, a single billing mistake could result in a chain of further, more time-consuming corrections and resubmissions.
Therefore, verify and re-verify the data you enter for a new patient. Also, you should find out as soon as possible if their insurance covers mental health services. A straightforward way to avoid such headaches is to ensure coverage in advance.
2. Patient Copayment
Whenever feasible, take the patient’s copayment at the time of the appointment. Once your patient has left the facility, your chances of collecting that money decrease. Also, billing the patient later for many copays could lead to an unexpectedly high bill that the patient will have to pay all at once.
If you pay the copay beforehand, you’ll get more money and prevent hassles.
3. Prepare and File Your Claim
The industry-standard claim submission form is the CMS-1500. The form will also request information about your treatments and your practice, including the date and location of the service, any applicable diagnostic or service codes, your tax ID, etc., in addition to the patient’s identifying information and insurance information. A flawless claim uses standard formats, includes no typos or false information, and is otherwise error-free.
You will either fill out this form electronically or by hand or hire a third-party biller to do the whole thing.
- Depending on how effectively the system is integrated, utilizing internal billing software automatically takes the pertinent patient information from your records and generates claims in the proper format. You can submit claims for EHR billing either through a claim’s portal offered by the payer or clearinghouse or directly through your software.
- Increasing numbers of insurance providers are moving away from paper claims in favour of electronic ones. Before mailing a paper claim, verify the company’s or clearinghouse’s procedures.
- If you plan to use third-party billing, you’ll require a safe method for billers to access your claims data. Giving billers login access to the secure, HIPAA-compliant software your office already uses is one approach. No matter what process you use, it would help if you kept all patient documents safe.
4. Track the Status of Claims
Verify the system’s progression of claims once they have been sent. You can follow electronically submitted claims on a user dashboard provided by payers and clearinghouses. The billing software you use also has tools for tracking claims. Regular status updates should be given to you by third-party billing services.
EFT services, which stand for “electronic funds transfer,” let you stay on top of your claims by sending payment quickly after approval. This enables you to cross unpaid items off your list more quickly.
Pay close attention to claims that are getting older and need to be processed promptly. A clearinghouse or payer may need to be asked to explain why anything has been stopped and how quickly it may be addressed.
5. Address Denials and Appeals
There are numerous reasons why insurance companies deny claims—some concern coverage problems, while others are simple changes like obsolete or incomplete data.
Clearinghouses check claims for errors before sending them to insurance providers, so your claim may be rejected. Most of the time, you can fix it and try again. You need to consult your clearinghouse’s software to determine if the claim is stuck at the clearinghouse or with the payer. Call the payer to find out why there is a delay in payment if the claim has successfully gone through the clearinghouse stage.
After the clearinghouse, the payer must approve your coverage request. It’s vital at this point to dig deep into the reasons for any rejections or denials and find ways to fix the underlying problem. Talk to an insurance agent directly to find out how to improve and resubmit requests turned down. You might get help from the representative in finding a solution that will earn you money. There are situations when the patient’s plan does not cover a specific treatment, and there is nothing you can do about it.
6. Obtain Payment
This is the part that everyone enjoys the most. To clarify the payment amount, you will receive a check or EFT and an explanation of benefits. You’ll have to charge your patient the difference if the insurance company declines to pay the total cost of the treatments. This is why it’s important to check if each service qualifies for benefits right from the start. If you don’t, you can create a surprise bill for your patient. These are the three most common mental health CPT codes:
These are the three most common mental health CPT codes:
- 90791 – Intake session—must be invoiced just for the initial appointment with the patient.
- 90834 – Individual Therapy Session, 45 to 55 Minutes
- 90837 – Individual Therapy Session of 56 Minutes or More
It looks easy to bill the intake code for their first session and either a 45-minute or 60-minute session for the rest, depending on how long their sessions are.
Additional prevalent CPT codes for mental health
- 90846: Psychotherapy for families or couples without the patient present.
- 90847: Psychotherapy for families or couples with the current patient.
- 90853: Psychotherapy in the group without family.
- 90839: Crisis psychotherapy for 60 minutes (30 – 74 minutes)
If you are having trouble translating specific components of your services to ICD10 diagnosis codes and CPT codes, consider reaching out to us because we are professionals at helping precisely and solely with our mental health billing and coding service.
The billing process can be intimidating. But the correct tools will enable you to manage it effectively and receive the compensation you deserve.
Doctor Papers streamlines your revenue cycle and speeds up the recovery of past-due debts. With auto-generation for claims and monitoring of aging bills, our fully integrated solution eliminates different stages of the procedure.
- Schatzberg, A. (2022, March 25). Mental Health Billing: What Every Therapist Needs to Know | Valant. https://www.valant.io/resources/blog/mental-health-billing-101-what-every-therapist-needs-to-know/
- D. (2016, October 13). Beginners Guide to Mental Health Billing for Therapists. TheraThink https://therathink.com/beginners-guide-to-mental-health-billing/