Mental Health Billing: What Every Therapist Needs to Know

Usually an EMR, electronic medical record, has pertinent patient data in one provider’s office. An EHR, electronic health record, is more comprehensive and can be used for a patient across multiple health practices. The next challenge that we saw was the challenge of expansion, as mentioned earlier.

• You can use software to allocate the payments in a batch correctly and resubmit claims if the total amount from the payments in a batch is low.
• 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 in taking a look with many of our coding experts, these are the ones that came to top of mind.

Affirming coverage ahead of time is one easy method to save hassles down the road. If you’re new to Mental health billing, you may feel overwhelmed, uncertain, or anxious about the process. Most mental health experts aren’t trained to navigate the medical billing landscape. After all, billing is closer to business administration and finance than it is to healthcare disciplines. We provide accurate, up-to-date information on mental health billing and coding so you can feel confident in your organizational decisions. We also offer expert support so you can get the most out of your reimbursement process.

And while they’re there on the right hand side as well, in between we start getting a number of codes that are in what’s called our medicine section of CPT. And that’s important because in this case, codes that are in the evaluation and management section of CPT are available to be reported by physicians and those who we indicate are qualified health care professionals. The article noted two archetypes for behavioral health integration that you see here. Billing clients directly can help providers avoid using these mechanisms and reduce their billing costs. Some behavioral health professionals don’t join insurance networks or accept payments from insurers.

Cities and other local governments often fund nonprofit organizations and treatment centers to help improve the behavioral health of residents within their communities. The number of organizations and providers, their specialties, and the requirements to receive funding differ depending on the local government’s decisions. Cities and towns also collaborate with state and federal governments to help optimize behavioral health outcomes. Like states, larger cities may have organizations or departments that focus on mental health for residents.

Having a system to handle the variance is essential, particularly if billing in multiple locations and states. Even outside these locations, Medicaid rules can differ slightly from state to state. For example, Nebraska approved expanded Medicaid coverage in 2018 but didn’t offer full coverage to those who qualified until 2021. Maine implemented its Medicare expansion in 2019 and provided retroactive coverage until July 2018. If you are experiencing any technical issues related to the search, selecting the ‘OK’ button to reset the search data should resolve your issues.

trends in resident physician burnout that demand action

Aside from accurate demographic information, make sure you have specifics on diagnosis, medications and treatments. It’s also helpful to document all steps in the prior authorization process if it’s needed. Verifying benefits is the most important part of the revenue cycle management (RCM) process. If you don’t understand the patient’s coverage before their appointment, you could lose the claim from the get-go. Since the COVID-19 pandemic, more clinicians are providing mental health care via telehealth.

So we focused on removing the human element from the charge capture process. We did this by automating the time accumulation process, and then also by removing any action that the PCP needs to do to drop a charge. Many of these are reported over extended periods, so many of our previous codes will be reported for a particular visit or an episode of service. These, you can tell you have a true ongoing relationship and a broader care management with the patient. In the case of cognitive assessment and care plan services, that’s reported once every 180 days.

• With the level of patient frustration that may rise along with the inaccuracies, practices also might encounter significant deterioration in their efficiency.
• It’s also good to know that a separate diagnosis is not required if you’re using that model reporting E&M and psychotherapy on the same date of service.
• There are often repeated services, with more consistent and repetitive medical billing.
• Fee-for-service behavioral health billing rewards the quantity of services over the quality.
• The representative may be able to assist you with the solution that will result in a payment.
• If you have had issues with incorrect information in the past leading to claims issues, it’s always best to implement double-checking in your practice.

If the mental health practices could familiarize themselves with this, they can be more confident about their claims and get away from feeling intimidated once the claims get submitted. Psychiatric Billing’s exclusive focus on mental health-related billing ensures that its billing professionals have expert knowledge of the latest insurance rules, government regulations, and coding requirements. The company is tech-focused and allows clients round-the-clock access to information such as claim status, client balances, authorization status, and more. To avoid these situations, it’s a good idea to evaluate clients’ insurance coverage before each visit, if possible.

Make and store copies of insurance cards.

To input the data and create the forms, you can try using a pure software solution, such as an EHR (electronic health record). EHRs come with calendaring, appointment reminders, simplified documentation, internal messaging, a patient portal, and credit card processing. Look for an EHR explicitly tailored to the behavioral health providers.

Then we’ll take a look at some of the practical steps you can take that will improve your approval rate and have a direct impact on your practice’s bottom line. The first tip is to know your patient’s insurance plans and benefits before each visit. However, making sure you understand the coverage available for each patient before receiving any services will lead to a larger return. While mental health billing isn’t easy, it can certainly be achieved with the right strategy and skill set. And to be able to report that work of the physicians and the QHPs, and our non-physicians as well, in many cases.

Things to Consider When Opening Your Own Private Practice

Organizations submit reimbursements for each service, like counseling, individual therapy, or group therapy. For accurate fee-for-service billing, behavioral health providers have to keep track of fee information for each individual’s insurance company. They must also maintain good records of the services each person receives. Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient. Diagnosis coding is documented to make it easier to categorize different mental disorders or diagnostic evaluations during therapy. These codes are essential for the billing process concerning insurance.

This medical record will help support the diagnosis and procedure code that is billed to insurance. The mental health billing process is based on the data on your patient’s insurance card. This information will tell you how to seek and receive payment for your services, so if you get it wrong, you’ll face delays receiving revenue.

The reason they’re not on the telehealth list, because they’re designed to be virtual. So you have Interprofessional Telephone, Internet, EHR Referral Services that may be an area of use. There’s a code for the referral and sort of the referee, if you think of it that way, and then some additional codes that I wanted to highlight, particularly for telephone and virtual visits. Most of these are designed for use with established patients in most situations.

To check whether the claim is hung up at the clearinghouse or with the payer, check your clearinghouse software for a claim rejection. If the claim has passed the clearinghouse checkpoint, you will need to call the payer to determine why there is a delay in payment. Time spent on therapy is a key factor as billing for treatment is based on the number of units. Correct medical codes based on the time spent can avoid errors involving the number of units billed.

Correctly Use Mental Health CT Code Modifiers

Someone had a question about the vaping, whether or seven could be used for vaping. So I’ll admit I don’t have much experience working with managed care. We have a great managed care team that handles all that, but I would encourage anybody just to start by calling the insurance providers the same way that they would have set up any other credentialing. It’s also good to know that a separate diagnosis is not required if you’re using that model reporting E&M and psychotherapy on the same date of service. And so that could be a very useful avenue for areas where it may be applicable for a given patient. It may not be something where you’re implementing it in a broad practice, but it is an option for those patients who may benefit from that.

Psyquel Solutions is your best bet when it comes to billing software for mental health professionals. With over 20 years of experience in the mental health sector, we’re delighted to have played a role in the growth of thousands of mental health clinics and psychologist services in every area of the country. Working as a mental health professional, there are many different entities that may be responsible for settling your client’s account, and often it’s not the client themselves. The sessions could be funded by their employer (due to a work-related incident), by the government, covered by health insurance or by private payment (by the client or a family member). For reimbursement on a claim, you have to file the correct claim code with the right insurer and submit the claim along with the correct billing format. If the insurance company has a preferred filing method, make sure you comply with it and the time frame set forth by the insurer.

This is important because the claims address on the card isn’t always the correct address and if you submit to the wrong address your claims will be rejected. It gets complicated so it’s important to have a biller who makes sure that the claims are filed correctly to avoid payment delays. This is yet one more reason why mental health providers choose billing services like TheraThink to help. This is a headache you don’t deserve nor are your trained to handle. In mental health, an EMR is an electronic version of a paper chart and progress notes used by mental health providers in a practice setting. Not to be confused with EHR (Electronic Health Record) which is a more comprehensive digital record of a patient’s complete medical history that can be used to treat a patient holistically.

Frequently Asked Questions

Ideally, only clean claims are submitted, but denied claims are inevitable. Anytime a practice takes on a new patient, before treatment begins it’s important to understand everything about the patient’s coverage and payment options. Determining what is covered, what isn’t, and what limitations exist for the patient’s payment plan is absolutely necessary. The standardization of medical health practices leads to the possibility of superbills in medical health billing. With these standardized procedures, services can simply be combined into superbills.