Behavioral Health vs Medical Billing: How Mental Health Differs
In total, there are three different insurance codes in the mental healthcare industry. These are CPT (Current Procedural Terminology) https://www.instagram.com/bookstime_inc codes, ICD-10 (International Classification of Diseases and Related Health Problems) codes, and DSM-5 codes. Each taxonomy was designed to create a common way to communicate treatments, diseases, procedures, and evaluations for mental and healthcare providers. A lot of time, mental healthcare professionals find it difficult to juggle between rendering patient care and filing claims.
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The CMS1500 form is the standard health insurance claim form used for submitting mental healthcare claims to bill Medicare service providers. The CMS-1500 form is used for single practitioner claims and to submit charges through Medicare Part-B. For mental health providers, the billing process can be challenging but not impossible. If you dig into the points mentioned in this article, you will get where you want to be – having your practice receive the deserving reimbursements on time. You don’t have to when using a reputable mental health insurance billing service.
- To sweeten the deal, the form that you sent came with a return envelope and form for the payer to fill out and resend to you about the claim’s status.
- When retroactive authorization can be awarded, do so and when not, fill out the necessary paperwork to request authorization.
- Understanding and adhering to HIPAA regulations is paramount for maintaining patient confidentiality and avoiding legal issues.
- Learning more about the behavioral health billing process can make it easier for you to spend more time and energy on your patients and less on inconvenient discrepancies.
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- 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.
Billing Errors
If your claim isn’t quite right, the clearinghouse will send it back to you, highlighting the errors. If your claim looks right, the clearinghouse sends the claim directly to the insurance company you have selected. He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. 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.
- Ensure you refile claims in a prompt manner to make the timely filing window for claims submission.
- However, if you file an incorrect code or accidentally file it to the wrong insurer, you can be denied or run into other billing issues.
- You should also understand the type of information required in each section of the form because various payers may require different information.
- If you don’t know which CPT codes to use for billing, refer to our popular and easy to read guide here.
Services
If you can bill patients for their portion of expenses online, you’re more likely to collect payment. You need a patient portal that notifies patients when an outstanding balance accrues and allows them to pay online. Ideally, your patient portal will be able to store patients’ credit card information for easy, one-click payments. Some involve mental health billing for dummies coverage issues, others are easy fixes, like outdated or missing information.
Not Required Patient Demographic Information
Clearinghouses screen for incorrect content and discrepancies before a claim ever reaches the insurance company, so your claim may be rejected by the clearinghouse first. 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.
- So, although you’re technically submitting your claims electronically in this sense, it’s STILL a very manual process.
- If your questions are not resolved with the above techniques, you can pull the required insurance data from EHR (Electronic Health Record).
- For that treatment, the required cost gets reimbursement from the insurance service.
- Mental health practices can leverage the technology to carry out the VOB process.
- Benefits are the amount of money or services provided and covered under an insurance policy.
- Nevertheless, behavioral health practices across the nation manage to learn best billing practices and keep the revenue cycle churning, and you can, too.
We call and ask for specific people to submit claims to, reps that can receive faxes on a call, or setup systems to ensure claims are successfully submitted and processed https://www.bookstime.com/bookkeeping-for-independent-contractors by each insurance company. We recommend using one EHR software, ideally custom built only for mental health providers, to manage all your clients in one place, and to submit all your appointments through one website. An online “filter” that ensures the claims you are submitting are formatted correctly. Many insurance companies require providers to use an online clearinghouse. Following these best practices for your mental health billing will make the tedious process more bearable. Reimbursement rates are the predetermined fees that insurance companies are willing to pay for specific procedures or services.