Insurers have rules about how long a session they’ll pay for, how many they’ll pay for per day or week, and often a maximum number of treatments that they will pay for. The mental health needs of the patient may exceed the services the insurer is willing to pay for, making balancing an effective treatment plan with adequate reimbursement tough for mental health professionals. Mental health billing’s distinctions arise from the nuanced characteristics of behavioral health services. Acknowledging these differences is essential for accurate reimbursement, effective treatment, and continued progress in destigmatizing mental health care. Explore the core elements of mental health billing and master best practices for precise coding and documentation, empowering practitioners and stakeholders alike. Traverse the dynamic interplay between insurance coverage and mental health billing on this pathway.
Out of thousands of possible CPT codes, mental health services only span 24 in total. So use our behavioral health cpt code cheat sheet to pick the ones relevant to your situation. For mental health providers, the billing process can be challenging but not impossible. If you dig mental health billing for dummies into the points mentioned in this article, you will get where you want to be – having your practice receive the deserving reimbursements on time. To input the data and create the forms, you can try using a pure software solution, such as an EHR (electronic health record).
Understand the difference between ICD-10 and CPT codes.
If you have a client who comes in for an appointment for an ailment or service that isn’t covered by their insurance provider, you’re going to receive a denial on their claim that you submit. Whether you’re looking for that software solution or the full support of an RCM team, Gentem has you covered. We provide physician-designed technology that increases reimbursements and reduces administrative costs for behavioral health practices.
Innovative and trusted advisor, with experience driving profitability through astute management of medical group businesses, revenue cycle operations, transitions, and process improvements. Lead revenue cycle management, customer service and support, ensuring an outstanding customer experience. A group of patients is chosen to get interactive treatment in an effort to alter behavioral patterns. Some involve coverage issues, others are easy fixes, like outdated or missing information.
Who can provide mental health services?
However you end up doing them, you need to transcribe this information onto a CMS1500 form and send it electronically or physically to the insurance company. You now have all the necessary information to file claims, you know what to charge the patient in person, and you know where to file the claims. 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). To help illustrate that point, I’ll give you another example of what this industry is like within the state of Ohio. Your clearinghouse should be able to help with the denial recovery process by explaining what happened, pointing out errors, and generating appeals letters or resubmitting corrections to payers.