Mental Health Billing for Dummies 2023 Guide

So once again, I would like to thank everybody for spending part of their evening with us. So let’s say if you see the patient typically in your office, I believe it’s place of service 11, if I remember my place of service codes correctly. So you would report it with a place of service of 11, but add a modifier 95 to the code to indicate that it was delivered using a telemedicine functionality.

For mental and behavioral health services, this is not always the case. There is a wide range of factors that contribute to the differences in these services. The length of a session, the location of services, therapeutic approach, age of the patient and their willingness to participate can all affect coding and billing. You may even think to yourself, “Why do I need to write mental health notes?” Consider all valuable and relevant information insurance companies may need to confirm your reimbursement. In addition, note writing will help you stay more organized with your patient notes if you see a large number of clients regularly. By having KASA Solutions take care of your mental health billing and claims, you can rest assured that your claims and documentation always matches up.

It’s time to protect your bottom line.

Also perform a new eligibility and benefits check for that client from Chapter 2 of this mental health billing for dummies guide. Make sure you’re filing claims to the right place, with the right information. 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.

A telltale sign that who you’re evaluating isn’t a leading mental health clearinghouse is if they don’t have experience integrating with the EHR your organization’s using. You see, MCOs are usually still large insurance payers, making it hard to get through to them regarding a specific claim from one of your clients. So, your clearinghouse should have direct contacts to reach out to on your behalf regarding any issues with your claims. The last step in the mental health billing process is to rework your denials and submit them for an appeal. The process of submitting your client claims to your clearinghouse and/or insurance payer. Hopefully this guide was a helpful introduction to mental health billing claims.

What is Mental Health Billing Services?

For instance, you could provide a dedicated email address or online form to update insurance information. In cases where multiple sessions are needed daily, the documentation should clearly explain https://www.bookstime.com/ why these sessions are necessary for the client’s treatment and well-being. Indicate the specific CPT code corresponding to the service (e.g., psychotherapy, evaluation, medication management).

• For instance, after you provide a service, you should expect to receive a reimbursement from a claim.
• Documentation helps support the medical necessity of each session.
• 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.
• So I wanted to call that one out, and again, there are options.
• But don’t let these problems disrupt your thought process or weigh you down.
• This blog post aims to answer some commonly asked questions about mental health billing.

So that’s the distinction that I know of in terms of how to report telemedicine services during the PHE. We adapted assessment tools to build the form that we have our clinicians enter clinical information into. So it’s all within the EHR and it’s all doable, but it’s going to require a really strong partnership with an EHR architect to build solutions that work specifically for collaborative care. 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. Now, one more thing that really makes this very different than what you’re used to is that the majority of this is done over the phone, and that was even before COVID.

We handle your insurance billing

This type of form replaced UB-92 forms in 2007 and it’s also sometimes referred to as CMS 1450. It involves checking for and correcting spelling and formatting errors. ANSI 837I is the accepted electronic format for facilities that have to use UB-04 claim submission forms. You want to know you can call your billing admin, a real person you’ve already spoken with, and get immediate answers about your claims.

• If you’re enrolled with your payer to receive the status of the claims you submit through your clearinghouse or by other computerized means, you’re receiving electronic admittance advice (ERA).
• The following are a few questions and answers commonly asked regarding mental health billing.
• And for those of you who are not very familiar with behavioral health insurance issues, a lot of patients’ behavioral health coverage is actually carved out.
• They’re a 5-digit code that the Department of Health and Human Services (HHS) created to instill uniformity.
• Once you complete your session note, a claim is automatically generated and billed to insurance.

To give you an example, there are public payers for every county in the state of Ohio that handle alcohol, drug addiction and mental health services (ADAMHS). The Center of Medicaid and Medicare Services (CMS) 1500 form is the standard paper form that mental health practices must use to submit claims. So it went from no coverage for those codes to getting paid for codes. They also permitted it to be used for new or established patients.

Here are some quick questions and answers that will save you time and money. Things can definitely get tricky when specifically coding for complex situations, out of business hours, in crisis, for extended sessions, for phone sessions or sessions in a variety of locations, and so forth. Happy to do this whole process for you as every other billing service should. Refile claims that have been mental health billing received and rejected, you normally have a longer time to refile claims as corrected. We help our providers by managing their data in an easy to use free EHR software, and communicating via calls, texts, and email. Gather if they have a copayment to make per session, or a deductible and coinsurance that you will need to bill them for after their sessions are billed to completion.

The mental health needs of the patient may exceed the services the insurer is willing to pay for, making balancing an effective treatment plan with adequate reimbursement tough for mental health professionals. Our mental health insurance billing staff is on call Monday – Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. And these codes are important because they’re specifically for psychotherapy when they’re performed with another evaluation and management service.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. 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. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. If the client pays out of pocket, ensure you bill them accurately for the session. If feasible, consider implementing a client portal where clients can log in and update their information whenever necessary.

• Each session’s progress notes should clearly outline the session’s content, goals, and outcomes.
• And then the psychiatrist is also available to the primary care providers for ad hoc consultation for an hour or two throughout the week.
• And that was a little touchy at times, but overall it was a fine experience.
• Thus, if you’re using an eligibility solution provider, you still need to determine that yourself using the information presented to you.