Mental healthcare providers can also become frustrated with medical billing because of the lack of resources. Many private practices are small and have limited administrative support to help with the task of medical billing — which can lead to unintentional errors and overworked physicians and therapists. The list of codes that mental and behavioral healthcare providers must know is essential for billing purposes and services. For instance, if a psychiatrist or therapist makes an error and documents the wrong code, a patient may not receive proper treatment. In addition, it would be a time-consuming hassle to fix the mistake and ensure that the patient is receiving an accurate, automatic diagnosis code for insurance billing and mental health services. Essentially, an incomplete or inaccurate medical record would reflect that medical and mental health services are unnecessary for the patient.
- The length of a session, the location of services, the therapeutic approach, the age of the patient and their willingness to participate can all affect coding and billing.
- This procedure can prolong insurance billing and prevent a patient from receiving the treatment they need.
- If your organization uses the “more ideal” claim submission process that I detailed above, these payers throw a wrench into things.
- By familiarizing themselves with these terms, practitioners can improve their coding accuracy, streamline their billing processes, and effectively communicate with insurance companies and patients.
- After all, there are differences between the types of claims that hospitals submit compared to those coming from mental health facilities.
An EOB is a document sent by an insurance company to the patient and/or provider after processing a claim. It explains how the claim was processed, the amounts paid by the insurance company, and any remaining patient responsibility. The NPI is a unique identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS).
Mental Health Billing for Dummies: A Summary
This error often results in insurance companies not paying for the service, making it difficult for behavioral health providers to do their job and patients to get the treatment they need. Proper note-writing and documentation also play a huge role as a communication tool used between mental health providers and professionals. ‘PrimeCare Medical Billing Services’ is a trusted partner for mental health providers, offering comprehensive assistance in medical billing.
If you don’t want to use one centralized EHR system, you can file claims to each insurance company’s website via the submission guidelines in Chapter 2. Filing claims involves submitting each date of service with all this information one by one. Each insurance company has their own online portal to submit claims, some terrible, some fairly okay. CPT is an acronym for Current Procedural Terminology and a CPT code is a 5-digit number code signifying the types of services you’re providing as a health service provider. Our behavioral health CPT code cheat sheet gives you a short list of the most used codes.
Chapter 4: EOB & Claims Processing
Once the client’s eligibility and benefits are confirmed, proceed with the scheduled mental health session. During the session, ensure accurate documentation of the services provided, including the date, duration, and nature of the session. You should also check their insurance coverage for mental health services right away. Affirming coverage ahead of time is one easy method to save hassles down the road. 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.
The Center of Medicaid and Medicare Services (CMS) 1500 form is the standard paper form that mental health practices must use to submit claims. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. We recommend using one EHR software, ideally custom built only for mental health providers, to manage all your clients in one place, and to submit all your appointments through one website. An online “filter” that ensures the claims you are submitting are formatted correctly. Many insurance companies require providers to use an online clearinghouse. Another important aspect of mental health billing is making sure that everything is properly documented in the medical record.
Tips in Billing for Mental Health Services
Our fully templated EHR offers many different features that can benefit you and your patients, such as patient portals, charting and automatic coding. Whether you work in an inpatient or outpatient setting, ICANotes can simplify your daily processes with our mental health billing solutions. Start your free trial today or request a live demo to see how we can help you get billing right. You may even think to yourself, « Why do I need to write mental health notes? » Consider all valuable and relevant information insurance companies may need to confirm your reimbursement. In addition, note writing will help you stay more organized with your patient notes if you see a large number of clients regularly.
- Review the EOB to ensure accurate payment and check for any denials or adjustments.
- It is very important to ensure that attention is paid to differentiation within the CPT codes and the apt usage of codes to avoid any repercussions.
- Efficient mental and behavioral health claims processing is vital for balancing quality care and financial sustainability.
- Otherwise, you may face claim denials or reimbursement problems for the mental health care you provide.
- This error often results in insurance companies not paying for the service, making it difficult for behavioral health providers to do their job and patients to get the treatment they need.
A lot of time, mental healthcare professionals find it difficult to juggle between rendering patient care and filing claims. Mental healing requires a lot of collaboration between the medical professional and the patient. Partial or incomplete coordination of care will have adverse impacts and will only bring in several inconveniences and discrepancies for both practice and patients. The more specific your providers and billers can be about services rendered and diagnoses made at clinical encounters, the more you’ll get paid. This requires intimate knowledge of behavioral health coding, as well as access to comprehensive resources on the subject.
It’s always best to check benefits before the first session and re-validate at the start of the year when coverage renews or if your client’s insurance changes. Throughout this article, you will learn the right mental health billing tips and guidelines. As a mental health provider, your goal is to provide the best care to your clients. It also plays a vital role in maintaining people’s well-being and healing their emotional wounds. We’ll help you ensure you utilize the CPT Code modifiers that best describe the services you render and if you still need help, consider reaching out to our billing service. Valant software simplifies your revenue cycle and helps you recover overdue payments sooner.
- If the claim has not been received, no corrected claim needs to be submitted, the original claim needs to be submitted.
- It may make you rethink the number of patients you can reasonably see in a week.
- Every client and practice is unique, and medical billing standards are ever-evolving.
- Well, each of those payers has a different web portal for claim submission.
- The unique payers that still cling on to paper stand no chance against the most ideal alternative for claims processing.
Every insurance payer has a series of requirements required to receive reimbursement for claims. Luckily, we’re going to learn together by breaking down the essentials mental health billing for dummies of mental health billing in this definitive step-by-step guide. Since the COVID-19 pandemic, more clinicians are providing mental health care via telehealth.