In short, you’ll receive more money and avoid unpleasant surprises by getting the copay out of the way up front. Even beyond that, though, there are essential “connections” that your clearinghouse needs to have with MCOs. However, as we know from the first definition I gave you, denials aren’t a dead end. The claims that come back to you with a denied status are particularly important.
Gather Right Patient Information
We discussed solutions to meet the challenges providers face in this practice. Billing services for psychiatry are more complex than other medical specialties. Medical billing services start right after the patient makes the first appointment with your clinic, and you begin to enter the patient’s information.
- This isn’t one of those industries where you dive right into it and learn as you go.
- Otherwise, there is a chance that you won’t get paid for your provided services.
- Happy to do this whole process for you as every other billing service should.
- If your practice has an online providers portal, you can also check there to discover and verify a patient’s benefits and eligibility for your services.
- Moreover, these errors can also put you in difficult situations like penalties.
- The list of codes that mental and behavioral healthcare providers must know is essential for billing purposes and services.
- Mental health revenue cycle management (RCM) is essential for maintaining a profitable mental health practice.
Step 1: Information Collection
To break it down, let’s compare it to routine checkups at a doctor for your physical health. The doctor will usually perform the same exams and tests for many patients, such as checking blood pressure, height, weight, listening to your heart or getting blood samples. We’re going to help you figure out the outline of mental health insurance billing. There will be many links to other resources, scripts, and templates to help do mental health billing for dummies. We at Practolytics process medical billing for Mental and Behavioral Healthcare including Ketamine and Esketamine (Spravato®).
Create and Submit Your Claim
You can discover how to appropriately bill insurance for treatments rendered by verifying this crucial element. We’ll teach you what behavioral health modifier to use for your insurance claims based on your license or degree, including the CPT codes allowed for those services. Now you must think medical billing is all about sending invoices to patients or payers (insurance companies).
It also usually has a series of pre-established connections to insurance organizations to streamline submission. What I’m trying to convey is that you’re not the only healthcare professional who’s faced with the challenge of getting paid by client insurance providers. If your claims require appeal, speak to a customer support representative about obtaining the necessary forms to file https://www.bookstime.com/articles/capital-budgeting your appeal. Use your reference ID from your eligibility and benefits verification phone call to fight your case. You can ensure your claim is not denied at the clearinghouse by calling the insurance company and asking if they have the claim on file. Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated.
- Learn how to offload your mental health insurance billing to professionals, so you can do what you do best.
- 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.
- Since you and your staff work within your PM/EHR daily, the most ideal process to submit mental health claims to all of your client’s payers is through it.
- You use this tool every day, so why not make it a habit to check the “claim status” section that’s included with and provided by your clearinghouse?
- For example, some insurance will only cover mental health services by specific providers, such as physicians, psychiatrists, clinical psychologists and clinical social workers.
- This is a key step in the process, verifying eligibility early helps stop this type of denials months before you would receive them.
- It is equally important to determine and document the medical necessity based on which the ICD codes are assigned.
Somewhat Ideal: Logging Back Into Payer Portals
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.
Always Double-Check Each Patient’s Insurance
- These payers are in the minority but you don’t want to take any chances.
- Once the client’s eligibility and benefits are confirmed, proceed with the scheduled mental health session.
- The psychiatric diagnostic evaluation, also known as a psych evaluation, is typically performed to evaluate patient’s medical and mental health.
- The length of a session, the location of services, the therapeutic approach, the age of the patient and their willingness to participate can all affect coding and billing.
- 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.
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 Center of Medicaid and Medicare Services (CMS) 1500 form is the standard paper form that mental health practices must use to submit claims. Luckily, we’re going to learn together by breaking down the essentials of mental health billing in this definitive step-by-step guide. If you are struggling to find out the place of service code or modifier to use for your insurance claims, this is something we provide as part of our billing service free of charge. The majority of group practices and almost all successful individual private practices utilize outside billing services in one capacity or another. 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.
