Mental Health Billing for Dummies: A Comprehensive Guide Boost Your Practice Revenue

Mental health services are all similar, due to the fact that they are almost all performed as a type of counselling service. Because of this, there is not a very large amount of codes that you can bill for mental health services. As such, most insurance companies cover mental health services, as long as they are considered medically necessary. 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.

For example, some insurance will only cover mental health services by specific providers, such as physicians, psychiatrists, clinical psychologists and clinical social workers. Additionally, some independent mental healthcare providers can only diagnose the patient with a mental disorder because insurance will not cover the actual treatment. The provider of the mental health services plays a crucial role in the mental health billing process. The services will be charged based on the type or qualification of mental health provider rendering them. Depending on that, the insurance covers a part or in some cases the whole of the coverage. As mentioned above, the verification of benefits (VOB) is important to confirm a patient’s insurance coverage and the service they intend to receive.

Re-File Insurance Claim As Corrected on CMS1500 Form

Although it seems straightforward, it’s worth mentioning that you bill for the first appointment first and then refer to the other codes based on session length. Gathering the information from your clients is only the first step, it’s also your responsibility to ensure that it’s accurate, up-to-date and eligible. Your NPI is a 10-digit number that’s used to identify you to other healthcare partners and payers. Once scrubbed, your claim is ready for submission to a payer for reimbursement.

• The psychiatric diagnostic evaluation, also known as a psych evaluation, is typically performed to evaluate patient’s medical and mental health.
• Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient.
• In fact, it is important to endorse double-checking in the billing process.
• Ideally, your patient portal will be able to store patients’ credit card information for easy, one-click payments.
• The process by which you fill out a CMS1500 form with your client’s demographic and insurance information, your provider information, and the appointment information.
• It gets complicated so it’s important to have a biller who makes sure that the claims are filed correctly to avoid payment delays.
• 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.

We do your eligibility and benefit verification phone calls to figure out if you can see the new client that you want to see. As already mentioned in this article, Verification of Benefits is a crucial aspect to ensure the patient’s insurance coverage details and the kind of services that they have intended to encounter. The first tip is to know your patient’s insurance plans and benefits before each visit. However, mental health billing for dummies making sure you understand the coverage available for each patient before receiving any services will lead to a larger return. Collect all necessary demographic information from the client, including their full name, address, contact details, and date of birth. Additionally, gather their insurance card information, including the insurance company name, policy number, group number, and any necessary authorizations.

Ask About Eligibility

You can work hard to submit your claims, and go above and beyond for it as well. Mental health insurances are very stringent when it comes to reimbursing the mental health services. On top of that, medical insurance for mental health will only have coverage up to a certain extent which makes it very hard for the medical professional. If you want to focus on providing healthcare rather than processing claims, you can hire a billing company to handle your claims. Aside from billing and claims submission services, some outsourcing billing companies also take care of prior authorization, VOB, claim denials, and follow-ups.

If, however, this same patient has decompensated since the last visit and changes are needed in the treatment regimen, a higher level of E/M is warranted. These rates are for Medicare and do not represent a guarantee of payment from any company, rather this is public data published by CMS.gov annotating a national rate schedule for mental health CPT codes. We translate the gibberish that is medical billing into English for you.

CPT Codes and Modifiers for Mental Health Claims

This step ensures that both the client and the provider are aware of their financial responsibilities. Medical necessity refers to the justification of a healthcare service or procedure as reasonable and necessary for the diagnosis or treatment of a patient’s condition. Insurance companies require documentation of medical necessity to approve reimbursement for mental health services. Mastering mental health billing is pivotal for seamless access to quality care while maintaining financial equilibrium.

Denials and rejections at this stage should be thoroughly investigated to determine the root cause and potential solutions. Speak with an insurance representative directly for ideas on how to fix and resubmit denied requests. The representative may be able to assist you with the solution that will result in a payment. Sometimes the patient’s plan simply doesn’t cover a particular treatment and there’s little you can do. The tools in an integrated processing system for medical billing positively impact many different aspects of the revenue cycle, including facilitating faster payments and making bill distribution easier. A comprehensive mental health EHR system empowers you to mix and match resources to meet the communication, billing and administrative needs of your practice.