Beginners Guide to Mental Health Billing for Therapists

We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC). It is necessary to bill accurately and submit clean claims for the services provided to run a profitable practice/billing operation. Outsourcing your billing process takes the load off your back and allows you to use your staff for better purposes.

EFT (electronic funds transfer) services help you keep abreast of your claims by delivering payment quickly upon approval, so you can check unpaid items off your list faster. CMS recommends specific documentation, including timesheets, encounter notes, time and place of service, and evidence. It is crucial to establish the medical requirements of the procedures/treatment, and detailed documentation can assist you reduced denials.

The Department of Veterans Affairs and the Children’s Health Insurance Program (CHIP) contribute to Medicaid. The federal government also provides mental health block grants (MHBGs) that help states build their community mental health infrastructures. Value-based reimbursements reward professionals who provide quality care while helping reduce the resources needed to help each person.

• However, regardless of the services you provide, it’s always a good idea to check that your patient is covered for the mental health services they need.
• That’s not quite the case, but you can see that there are some avenues in terms of being able to interact with patients if you’re in a telemedicine environment in a situation that you can still connect with those patients.
• These codes are also known as ICD codes, or the International Classification of Diseases, which are the required code set for billing purposes.
• Sometimes, a large group can make scrolling thru a document unwieldy.
• We adapted assessment tools to build the form that we have our clinicians enter clinical information into.

The doctor will usually perform the same exams and tests for many patients, such as checking blood pressure, height, weight, listening to your heart or getting blood samples. To ensure the financial health of your mental health practice, fast, efficient, and effective mental health billing services are essential. Psychiatrists, psychologists and therapists can improve their collection rate by hiring trained staff who understand billing for mental health services and the ins and outs of the insurance industry. The extra cost of hiring someone will be offset by the increase in revenue from seeing more patients and building your practice.

Anesthesia Billing & Coding: Success Tips

The high variance in coding and breadth of therapeutic treatments available requires a high level of expertise. Overall, this leads to less standardization in mental health billing than with medical billing. Behavioral health billing has many areas in common with psychotherapy billing, but has more of a focus on social services. Behavioral health billing can include community social workers, behavioral specialists, or other experts which add another layer to take into consideration when coding.

Medicaid and Medicare get their funding from the federal government and states. Individual psychotherapy CPT codes should be used only when the focus of treatment involves individual Mental health billing psychotherapy. Psychiatric service CPT codes should not be used when other CPT codes such as an evaluation and management (E/M) service or pharmacological codes is more appropriate.

Plutus Health Tips

And then the psychiatrist is also available to the primary care providers for ad hoc consultation for an hour or two throughout the week. I’m definitely mixing up the names and what is true at Northwestern, but that’s an example that might happen with a patient. It’s one of, if not the only specialty that is often carved out of insurance plans. And it’s important for these types of items that some of them are for use before a patient has a specified illness. So even before a patient has a set diagnosis, you have a chance to connect and work and intervene with that patient. Certainly in individual settings, the codes are defined by how much time is spent, increasing time increments, as well as in group settings.

The length of a session, the location of services, therapeutic approach, age of the patient and their willingness to participate can all affect coding and billing. There are many different mental health treatments and services with varying restraints that can make medical billing difficult. To break it down, let’s compare it to routine checkups at a doctor for your physical health.

When you start working for a new client, always check if preauthorization is required before providing any non-standard session. So we are at the end of our time, just about, and so I want to thank you both for joining us this evening, spending part of your evening with us and our participants. And so our upcoming webinar is scheduled for Thursday, October 22nd. And our physician experts will be talking about strategies for virtual health or excuse me, virtual behavioral health integration. We can put that in the chat box, and we can also make sure that that’s included our follow-up email as well.

Support & Peace of Mind for Mental Health Professionals

2) Try using the MCD Search and enter your information in the “Enter keyword, code, or document ID” box. Your information could include a keyword or topic you’re interested in; a Local Coverage Determination (LCD) policy or Article ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. Try entering any of this type of information provided in your denial letter. Other Information CPT codes 90885, 90887, are considered incidental services and are not separately payable. Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure. Add-on codes may only be reported in conjunction with other codes, never alone.

Even when it’s optional, pre-authorization can help speed up billing and payment processes and help organizations get payments faster. With most insurers, pre-authorization takes between five and 30 days. Typically, mental health patients and insurers receive bills for treatments such as therapy, psychological testing, and medical management.

And these are services that are really designed to help engage patients early in the care continuum and they’re also a little bit easier, I would think, to incorporate in a smaller setting. You don’t necessarily need a broad range of providers and physicians and a broad team to affect them. And some of them can actually be conducted even before the patient has a particular issue or condition, particularly when it comes to preventative medicine, which I think is going to be extremely important right about now.

What Is Batch Billing?

And these codes are important because they’re specifically for psychotherapy when they’re performed with another evaluation and management service. So they’re designed to add on to another service that you may be performing. Now, there are requirements that those services have to be separately identifiable, they have to be reported, obviously, using specific codes. And there are lots of guidelines in terms of what’s determined to be separately identifiable, and what have you.

Setting the record straight on proper use of modifier 25

You can ensure your claim is not denied at the clearinghouse by calling the insurance company and asking if they have the claim on file. We cannot and will not advice you to use a single diagnosis code, even though it is a very common practice for therapists to use one code for all of their patients (e.g. anxiety or depression). Insurance claims can be filed quickly and successfully with Psyquel’s insurance claim management system. Bridging the gap between providing your clients with the best level of care and making sure that you get paid for your work can be a challenge if you are a healthcare professional.

By contacting insurers and making sure that clients’ coverage is still in effect and has not changed, mental health professionals can stay informed and avoid wasting time on rejected claims. This can be labor intensive, but the time it will save makes it worthwhile. In the mental health billing process, there’s no such thing as gathering too much information. Request as many facts as possible, including the patients’ full legal names and current addresses. Our mental health insurance billing staff is on call Monday – Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy.

Practices that render mental health services must incorporate several treatments and a huge variety of components in order to ensure smooth processing of both patient care and billing. If there are any errors in the billing process, it can critically hinder the treatment process, thereby largely affecting patient care. The billing process can be frustrating and generally a big sigh compared to treating patients; however, the sooner you start, the sooner you get paid. And if you’re worried you can’t complete the process solo, the billing features of medical practice management systems (PMS) or third-party medical billing services can provide invaluable help. In mental health, CPT codes tell insurance companies the length and type of a patient’s treatment session, or any diagnostic interviews or procedures performed. The correct terminology and adherence to guidelines result in the correct amount for the insurance to pay the provider and avoids rejected claims.

For instance, after you provide a service, you should expect to receive a reimbursement from a claim. However, if you file an incorrect code or accidentally file it to the wrong insurer, you can be denied or run into other billing issues. If your practice has an online providers portal, you can also check there to discover and verify a patient’s benefits and eligibility for your services. Behavioral health providers should be aware that many commercial insurance companies and state Medicaid programs outsource their mental health claims to an outside third party.