You can collapse such groups by clicking on the group header to make navigation easier. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. Do not report the CPT add-on code for Interactive Complexity code in conjunction with Psychotherapy for crisis codes or in conjunction with E/M services when no psychotherapy service is also reported.
- The AMA does not directly or indirectly practice medicine or dispense medical services.
- Insurers sometimes need prior authorization (pre-authorization) before approving a patient for mental health care.
- This is mostly because every payer has a different web portal to submit claims and they usually don’t provide the best user experience.
- The AMA assumes no liability for data contained or not contained herein.
- However, please note that once a group is collapsed, the browser Find function will not find codes in that group.
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. Common Procedural Technology (CPT) codes are also necessary for billing for therapists and other mental health providers.
Least Ideal: Calling Payers
When learning how to bill for therapy services, there is always room for improvement and efficiency. Some elements can speed up insurance billing and ensure a reduction in errors — benefitting mental health providers and patients alike. Consider these mental health billing tips that can help make the process smoother.
Many health insurance plans also require pre-authorization, which means that patients must get permission before receiving coverage for some mental health services. This procedure can prolong insurance billing and prevent a patient from receiving the treatment they need. Mental healthcare providers can also become frustrated with medical billing because of the lack of resources.
Here are some essential tips that will help you maximize reimbursements and improve your revenue cycle. To ensure the financial health of your mental health practice, fast, efficient, and effective mental health billing services are essential. He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. Our Beginner’s Guide to Mental Health Billing is for the brand new and having-no-clue outpatient therapist looking to learn how to bill insurance companies.
Medical billing includes straightforward services, such as diagnostic testing (laboratory tests or radiologic exams). Mental and behavioral health services range from psychotherapy to medical management, and psychological testing services to inpatient or outpatient rehabilitation. The biggest hurdle with coding for mental and behavioral health services is understanding the differences in coding and the restrictions within a patient’s insurance plan. This is a reason why mental health billing becomes complicated for providers, as it’s challenging to offer standardized treatment for all patients — making billing just as complex. It’s important to know the types of covered mental health services for your patients who may have varying insurance or medical coverage.
- (Or, for DME MACs only, look for an LCD.) Review the article, in particular the Coding Information section.
- These payers are in the minority but you don’t want to take any chances.
- Remember way back in step 2 when I mentioned the phone call to the number on the back of your client’s insurance card?
Forgetting a diagnosis code — It’s easy to forget to include all relevant ICD-10 codes in a claim. If you are providing services that address two different conditions, you’ll need to include both codes in the claim. Upcoding — Upcoding is another red flag that can trigger an investigation of abuse or fraud. Upcoding describes the practice of using a code with a higher reimbursement rate when you shouldn’t.
An initial office visit may not need pre-authorization but psychological testing may require it. An insurer may also need prior authorization for additional care after a certain number of visits. Billing for a 45-minute therapy session may not be as straightforward as billing for a yearly wellness check or lab test.
How Is Mental Health Billing Different From Medical Billing?
Partial or incomplete coordination of care will have adverse impacts and will only bring in several inconveniences and discrepancies for both practice and patients. 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. 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.
The type of form you’re required to submit to the payers you work with depends on what type of behavioral health organization you work for. The process of submitting your client claims to your clearinghouse and/or insurance payer. A clearinghouse is usually a service offered by a third-party organization that acts as a central repository and middle-man to your claim submission process.
All ICD-10 codes start with a single letter, followed by three or more numbers. ICD-10 codes follow a common convention, making it easier to determine which code is the most accurate one for a particular case. Knowing how the codes are composed will help you navigate them more easily.
You can discover how to appropriately bill insurance for treatments rendered by verifying this crucial element. 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. Detailed patient documentation will help you with both prior authorizations and claim appeals. 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.
Sometimes when eligibility responses come back it will explain what’s “in-network” and “out of network”. Apart from the confusing ICD Codes with CPT code assignment errors, the other kind of mistakes that could occur include undercoding or upcoding. When considering whether to join a network or accept payment from insurers, it’s important to evaluate their pre-approval rules and their limits for payment.
The DSM-5 is a vital tool to assist therapists in identifying, diagnosing, and describing mental disorders. It also serves to provide clinicians with a common language for communication and research. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA.
How to Determine Mental Health Insurance Reimbursement Rates
Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims. Insurance regulations to support telemedicine have been regularly evolving with this increased popularity. With more and more services being available via telehealth, insurer rules and regulations change to best accommodate both patients and providers needs with their policies.
We ensure prior authorization of the patient’s eligibility & benefits with mental health insurance to avoid denials in the long run. Our team of medical billers & coders instantly know the ICD codes for behavior & mental health, which allow us to submit clean claims. Submitting claims can even differ from one payer to another, so it’s important to focus on the regulations and codes that apply to the services rendered, and the guidelines of the patient’s plan. Essentially, an incomplete or inaccurate medical record would reflect that medical and mental health services are unnecessary for the patient. 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.
While you may feel a bit stung for having to accept $80 for a $150 service, remember that insured clients tend to be more reliable repeat customers than those that pay with cash. Accepting the lower reimbursement may be worth it to secure regular clients. 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.
Explanation of Benefits (EOB)
It is equally important to determine and document the medical necessity based on which the ICD codes are assigned. 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. 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. You have all the necessary patient and session information to file claims. Now it’s time to check eligibility and benefits to ensure they have coverage that will reimburse you.
The U.S. then developed a clinical modification (ICD-10-CM) for medical diagnoses based on the WHO’s ICD-10 set. These codes describe diseases, signs and symptoms, abnormal findings, complaints, and external causes of injury or diseases. An ICD-10 code essentially tells payers why you provided a patient with the services you did.