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mental health billing

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. The nice thing is that at least it’s gone from no coverage to some coverage and some level of the payment parity. So there are differences, but you also want to make sure that you report that place of service and the modifier 95 appropriately when you’re using the other codes.

  • So we, of course, had to negotiate contracts for these services with each of our payers.
  • We were fortunate in that we had peers and other organizations that had tried to do this previously with what were then called G-codes, which are temporary Medicare codes.
  • So we focused on removing the human element from the charge capture process.
  • It’s one of, if not the only specialty that is often carved out of insurance plans.

When these payers present themselves, it’s not the end of the world but it does present a process change. If your organization uses the “more ideal” claim submission process that I detailed above, these payers throw a wrench into things. This is why it’s so important to choose a clearinghouse that has strong connections with payers and/or MCOs that are common in the mental health space. 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. The process your clearinghouse runs your submitted claim through before sending it to the payer.

Other Coding Information

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. By contacting insurers and making sure that clients’ coverage is still in effect and has not changed, mental health professionals can stay informed and avoid wasting time on rejected claims. This can be labor intensive, but the time it will save makes it worthwhile. Changes in the mental health billing landscape happen on what seems like a daily basis. You can’t expect to stay “in the know” regarding everything that happens…you have clients to care for.

  • Now it’s time to verify their insurance coverage and your network status in their plan, then their benefits based on all of that, via a phone call.
  • The behavioral care manager works closely with the patient and the primary care provider to coordinate that patient’s care, to follow up on treatment adherence, and to really own the care plan.
  • Note that the patient provided informed consent for the treatment and that confidentiality was discussed.
  • Readers are urged to seek professional help if they are struggling with a mental health condition or another health concern.
  • We do your eligibility and benefit verification phone calls to figure out if you can see the new client that you want to see.

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. 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.

It’s time to protect your bottom line.

While each state is different, many have expanded coverage for telebehavioral and telemental health during the COVID-19 public health emergency. Many states currently match Medicare’s telebehavioral and telemental health coverage. The federal government, state Medicaid programs, and private insurers have expanded coverage for telebehavioral and telemental health during the COVID-19 public health emergency.

mental health billing

Accepting the lower reimbursement may be worth it to secure regular clients. 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. So, although you’re technically submitting your claims electronically in this sense, it’s STILL a very manual process. If ALL of your patients had Health First Colorado as their payer, this wouldn’t be that bad of a manual process…but that’s not the case. 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.

About the BHI Collaborative

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. Another tip for submitting mental health billing claims properly is to familiarize yourself with common claims forms that many insurance companies use, such as the UB-04 form. This form is usually reserved for mental health clinics and specialized health centers for medical billing.

mental health billing

To make this submission method even less appetizing, Medicare requires that mental health providers use electronic billing. And then secondly, there is an impact on the patient in regards to enrolling in this program. Medicare or CMS requires that we obtain advanced consent from the patient, because this is a billed service for non-face-to-face time, which is a key difference from what patients are used in an outpatient setting.

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