How to Bill Insurance for Therapy Sessions: The Basics

We recommend seeking professional help online research, a colleague, course, or through delegation. We’re going to help you figure out the outline of mental health insurance billing. There will be many links to other resources, scripts, and templates to help do mental health billing for dummies. CPT codes communicate services and tasks performed by mental health professionals during sessions. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best.

So that includes the time that behavioral care manager spends with the primary care provider, spends with the consulting psychiatrist, and also spends with the patient. Basically, anything that that can be described as the provision of behavioral health care is technically allowable as a billable service. In addition, the billing for collaborative care is accumulated and billed monthly for participation in the program at the end of the month, rather than billing for encounters as we complete them.

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And not every code is available in a telemedicine setting, but there are some, and I did highlight of the ones we went over here. Those that are in red are listed in one of the appendices in the CPT book, and that’s that appendix is designed to specifically talk about codes that have been approved by the panel for use in a telemedicine setting. It requires real-time audio-visual, among other things, and there is a modifier 95 that can be reported with those codes. Now, right now during the public health emergency, we all know that there are a number of waivers that CMS has enacted for additional services to be provided during the PHE in a telemedicine environment.

In the meantime, the client is responsible for the bill, and the economic burden may cause a client to attend therapy less frequently. So joining a provider panel may be a better option for both the therapist and client. Tufts insurance almost always requires authorization for a claim. Also, in the case of psychological testing, you always need to obtain an authorization. Some insurance companies like Blue Cross of Massachusetts allow up to 12 visits without authorization, and then providers are required to get an authorization for the next 12.

Mental Health Billing for Dummies Index

Longer-term treatment plans, especially those involving multiple sessions over an extended period, might be more likely to require pre-authorization. Determine if prior authorizations are required for specific https://www.bookstime.com/ treatments or sessions. However, coding errors can delay reimbursement, so it’s important to keep track of each bill you send out. If you don’t receive payment within 30 days, follow up with the insurer.

• Ensuring that all components of mental health billing are accurate and on time can be challenging.
• So joining a provider panel may be a better option for both the therapist and client.
• 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.
• For example, if you work with a private insurer who offers only a 90-day filing period, consider filing all claims within 90 days.
• And in taking a look with many of our coding experts, these are the ones that came to top of mind.
• And these codes are important because they’re specifically for psychotherapy when they’re performed with another evaluation and management service.

Finally, you can completely give up and join an agency and close your private practice. Submit the claim as corrected claims so they act to reprocess the original claim. Make sure to submit the claim id number with all of the changes you need to make on your claims. Go back to your EHR, online portal, or paper claims and refile these claims. Determine the client’s demographic and insurance information.

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In this case, the cognitive assessment and care plan services is actually one of those codes. So I wanted to highlight that certainly, and I understand, based on yesterday, that I think the PHE has been extended another 90 days. With that, I’ll probably go to the next slide and we’ll start talking about really the continuum and kind of do a little level setting for everyone in the audience. And certainly COVID has heightened everyone’s awareness and quite likely the need for behavioral health services to be available in addition to addressing medical concerns.

• If the client’s insurance denies coverage due to the lack of pre-authorization, check if there’s an appeal process.
• If your organization is in Ohio and your clearinghouse doesn’t have electronic connections or personal contacts for each of the 175 ADAMHS payers in each of the state’s counties, you’re in trouble.
• Add-on codes may only be reported in conjunction with other codes, never alone.
• Go claim by claim, date of service by date of service, and refile the claims as correct with insurance.
• That way, you can easily tell the status of that piece of mail and whether or not the paper claim got to the payer’s address.

So there are a couple of limitations or actually exemptions that are in place during the PHE, and specifically provisions … Certainly, they’re not the only payer in town, but they’re a major payer in town. And one thing to remember is we only went over a few codes here that were eligible for telemedicine. It’s important to note when we did a webinar back in May, I think we had about 70 codes that were in the CPT, CPT codes that were designated as telemedicine eligible specifically. I know we did have some items, particularly around smoking cessation, and we actually have a service where individuals can actually send queries, particular coding queries to us. So I want to go back and research that just before responding.

This can lead to differences in how billing is structured, with mental health billing often accommodating multiple sessions over time. Perhaps because of this, sadly, many practices collect less than 85% of the money they are owed from insurance companies. If you’d prefer to offload all of this nightmare, you can hire a billing service as well (and we only work with mental health providers).

• You call that company to inquire if they have active coverage, if you can see them based on your relationship with that insurance company, and if so, what their copay, deductible, or insurance looks like.
• So, when I mention this, some examples of what we saw were that some of our peers were recording patient activity and paper registries or third-party tools.
• For mental and behavioral health services, this is not always the case.
• And so our upcoming webinar is scheduled for Thursday, October 22nd.
• You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%.

So this could mean potentially eight or more five-minute or two-minute encounters over the course of the month being accumulated and billed as one charge. And then in addition, this is technically a medical service for all billing purposes. And now, before I dive in any further, I want to emphasize that NM chose this model because it best met our patients’ and organization’s needs.

Treatment Plans

Mental health services often include various types of therapy, such as psychotherapy or counseling. These services are typically billed differently from medical procedures or interventions. The Current Procedural Terminology codes used for therapy services in mental health are specific to the type of therapy provided. This mental health insurance billing for dummies guide is just simply not the place to explain the vast number of ways that billing plays out.

Call up the phone number on the back of their insurance card and begin the process of verifying eligibility and benefits. This form enables you to do advanced changes to your claims and billing. Many clearinghouse solution providers will ask you what EHR your organization utilizes during mental health billing initial deliberations. If the average denial rate for submitted claims is more than 11%, you should expect to lose that much revenue. To sweeten the deal, the form that you sent came with a return envelope and form for the payer to fill out and resend to you about the claim’s status.