Mental health practices that have contracted with insurance companies cannot balance bill their clients. They must accept the rate the insurer provides and write off any remaining balance. If you’re out of an insurer’s network, you may accept reimbursement from the insurer and then bill the patient for the rest.
Full Answer
Is mental health billing hindering your treatment process?
However, mental health billing can often hinder the treatment process if there are errors in the system, inaccurate or inefficient documentation and pre-authorization issues. One or more of these problems — and many other variables — can make it difficult for mental and behavioral health providers to operate their practice efficiently.
Can a mental health practice Bill an insurance company?
Mental health practices that have contracted with insurance companies cannot balance bill their clients. They must accept the rate the insurer provides and write off any remaining balance. If you’re out of an insurer’s network, you may accept reimbursement from the insurer and then bill the patient for the rest.
What is mental health billing for Dummies?
Mental health billing for dummies will teach you the billing terms you need to know, what information to collect, how to bill mental health insurance claims from start to finish, and what to do when it all messes up. Mental health insurance billing is a pain! We get it, it’s why we created a mental health insurance billing service after all.
Why choose psychiatric billing?
Psychiatric Billing’s exclusive focus on mental health-related billing ensures that its billing professionals have expert knowledge of the latest insurance rules, government regulations, and coding requirements.
What are modifiers in mental health billing?
Mental Health Modifiers are two digit alphanumerical codes used on CMS1500 insurance claims to signify identifying information about the provider rendering services. Mental health CPT code modifiers can describe the way services are rendered as well, telehealth modifiers as an example.
Can 90837 and 90832 be billed together?
It's important to note that if you are seeing a client for 60 minutes or under, make sure to bill using CPT codes 90832, 90834, or 90837 alone. Do not bill using add-on codes if sessions are not extended. Services performed outside of business hours.
Does Medicare reimburse me for psychotherapy?
Yes, Medicare covers mental health care, which includes counseling or therapy.
How do psychologists bill?
Some examples of common CPT codes for therapy include:90832: 30-minute psychotherapy.90839: 60-minute crisis psychotherapy.90847: 50-minute family psychotherapy when the primary client is present.90853: Group psychotherapy.96132: Neuropsychological testing services, such as evaluations for dementia or ADHD.
What does modifier 95 stand for?
synchronous telemedicine service renderedPer the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” Modifier 95 is only for codes that are listed in Appendix P of the CPT manual.
Can 99214 and 90837 be billed together?
The claim will be denied if box 24J or box 31 are filled out incorrectly. Medication management (evaluation and management) and psychotherapy Do not bill CPT codes 99201-99215 and 90832 or 90834 or 90837. It is acceptable to bill CPT codes 99201-99215 and 90833 or 90836 or 90838.
How does insurance reimbursement work?
Reimbursement: Private health insurers or public payers (CMS, VA, etc.) may reimburse the insured for expenses incurred from illness or injury, or pay the provider directly for services rendered. It is often misunderstood that coverage of a condition equates to full reimbursement for these services.
Who can bill CPT code 90837?
CPT code 90837 doesn't have to be billed by a licensed medical doctor. It's mainly used by licensed mental health professionals. Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90837.
What is the reimbursement rate for 90837?
What is the difference between the “facility rate” and “nonfacility rate” for telehealth services?CodeService2021 Facility Rate90832Psychotherapy 30-minutes$68.7490837Psychotherapy 60-minutes$132.6996132Neuropsych Test Eval$106.0896158Hlth Bhvr Intrv Indvl$58.971 more row•Dec 10, 2021
What is a CPT code for mental health?
The codes related to mental health (codes 90785-90899) are found in the Psychiatry section of the CPT code set and cover services provided by medical professionals, such as psychiatrists, as well as services that can be delivered by non-medical professionals such as licensed clinical psychologists, licensed ...
What is the CPT code 90837?
CPT® code 90837: Psychotherapy, 1 | American Medical Association.
What are the new CPT codes for mental health 2021?
There are many CPT codes currently used by mental health professional that can be reported under the following categories:Health Behavior Assessment and Intervention (CPT codes 96156-96171)Psychotherapy Codes (CPT codes 90832-90863)Psychological and Neuropsychological Testing Codes (CPT codes 96105-96146)
Does CPT code 90837 require a modifier?
For Medicare, you can bill the traditional psychotherapy codes: 90832 (30 minutes); 90834 (45 minutes); and 90837 (60 minutes). You will also need to include the 95 modifier when submitting your bill.
Is 90837 an add-on code?
Since it is an add-on code it must be billed with 90837 or 90847 (90791 and 90834 are not allowed). Services performed outside of business hours.
Can 90837 be billed twice in one day?
Come back!" CPT code 90837 is another one of the most common CPT codes used by mental health professionals along with 90834 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.
What is CPT code 90832 used for?
Psychotherapy 3090832 – Psychotherapy 30 minutes. 90834 – Psychotherapy 45 minutes. 90837 – Psychotherapy 60 minutes. Some health insurance companies may consider 90834 as the standard psychotherapy session.
Types of Covered Mental Health Services
It's important to know the types of covered mental health services for your patients who may have varying insurance or medical coverage. For example, some insurance will only cover mental health services by specific providers, such as physicians, psychiatrists, clinical psychologists and clinical social workers.
The Role of Medical Record Documentation
Private practice billing services must include proper documentation. Everything transpiring between a patient and the mental healthcare provider should be in the medical record.
Diagnosis Coding
Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient. Diagnosis coding is documented to make it easier to categorize different mental disorders or diagnostic evaluations during therapy. These codes are essential for the billing process concerning insurance.
Why Mental Health Billing Can Be Complicated
There are many different mental health treatments and services with varying restraints that can make medical billing difficult. To break it down, let's compare it to routine checkups at a doctor for your physical health. In this case, most exams are pretty standard and similar.
Tips for Mental Health Billing
When learning how to bill for therapy services, there is always room for improvement and efficiency. Some elements can speed up insurance billing and ensure a reduction in errors — benefitting mental health providers and patients alike. Consider these mental health billing tips that can help make the process smoother.
Always Double Check Each Patient's Insurance
As with any mental and behavioral health industry procedure, it doesn't hurt to double-check yourself. If you have had issues with incorrect information in the past leading to claims issues, it's always best to implement double-checking in your practice. Confirming your patient's insurance is one of these areas where you want to be certain.
Perform a Verification of Benefits
As mentioned above, the verification of benefits (VOB) is important to confirm a patient's insurance coverage and the service they intend to receive. In this process, you can check your patient's policy for information that won't often be directly on their insurance card.
What is a beginner's guide to mental health billing?
Our Beginner’s Guide to Mental Health Billing is for the brand new and having-no-clue outpatient therapist looking to learn how to bill insurance companies. You will learn what client information you need, how to verify mental health benefits, create and submit claims, and account for EOBs.
How long is a CPT session for mental health?
It’s as straight forward as it seems: bill the intake code for their first session, and bill either a 45 minute or 60 minute session for the rest , depending on the length of their sessions.
What is the CPT code for Telehealth?
Do not pick a “telehealth” CPT code. 90791, 90834, 90837 are appropriate here. Call the insurance plan to verify the “Place of Service Code” used for billing with that company, most often POS Code 02, and the Telehealth modifier they are using, most often GT or 95.
What is 90847 in psychotherapy?
90847 – Family or couples psychotherapy, with patient present.
Why do mental health providers use TheraThink?
Fighting denials and rejections is the hardest part of billing. This is yet one more reason why mental health providers choose billing services like TheraThink to help. This is a headache you don’t deserve nor are your trained to handle. Consider outsourcing this work to experts.
How long do you have to file a claim with insurance?
It’s critical to submit them within the 90 day timely filing window most insurance companies hold you to (not all, but most).
Do you need to update your diagnosis on your insurance?
It is your duty, as demanded by submitting any insurance claim, to submit the most accurate diagnosis you possibly can for each session. If their diagnosis changes, you need to update it on your claims forms.
Why is mental health billing important?
Another important aspect of mental health billing is making sure that everything is properly documented in the medical record. This record is the basis of everything that is billed for the date of service, so it has to have all of the required documentation in order to support the procedure code that is billed.
What providers can bill for mental health?
Psychiatrists, Clinical psychologists, Clinical social workers, Clinical nurse specialists, Nurse practitioners, and Physician assistants. These providers can only bill for mental, psychoneurotic, and personality disorders.
Who can provide mental health services?
This means that insurance will only cover mental health services if they are provided by a certain type of mental health provider .
What is the medical code for psychotherapy?
90853: Group psychotherapy (other than a multiple-family group) 90857: Interactive group psychotherapy. As long as all of the mental diagnoses are considered treatable, and that the mental health service is considered medically necessary, then the medical insurance should pay for the mental health services as listed above.
What is a psychiatric diagnostic interview?
This interview is an examination of the patient's entire medical and mental health history, completion of a mental health status exam, an establishment of a provisional diagnosis, and an evaluation of the patient's willingness and ability to help solve the mental health problem.
Why are mental health services similar?
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.
What is individual psychotherapy?
Individual psycho-therapy is rendered to people who have the ability to understand and respond meaningfully to a provider's questions and comments. This communication is meant to help get rid of emotional disturbances, change patterns of behavior, and help the individual live a more normal healthy life.
What is mental health billing?
Working with a mental health billing company can help behavioral health practices improve their collection rates, often allowing practices to collect 96 percent or more of money owed to them. Psychiatric Billing Associates is a national mental health billing service that focuses on assisting psychiatrists, psychologists, social workers and therapists. In business since 1994, Psychiatric Billing has an excellent track record of providing services such as: 1 Insurance claims processing 2 Payment posting 3 Client billing and communications 4 Unpaid claims follow-up 5 Verification of Benefits
What is psychiatric billing?
Psychiatric Billing’s exclusive focus on mental health-related billing ensures that its billing professionals have expert knowledge of the latest insurance rules, government regulations, and coding requirements. The company is tech-focused and allows clients round-the-clock access to information such as claim status, client balances, authorization status, and more.
What to do if a session required pre-authorization and the client did not obtain it?
What should I do if a session required pre-authorization and the client did not obtain it? When a provider is contracted with an insurance plan, it is the provider’s responsibility for obtaining authorization. Patients often don’t know or don’t understand insurance requirements which is that is why it is critical to verify benefits and authorization requirements in advance. In the event that authorization is not obtained and you have already seen the patient, you may be able to convince an insurer to back date authorization. This will require some diplomatic skills on your part, as insurers are often loathe to do this. They may make some exceptions if the client is a new member and didn’t know about the need for pre-authorization or if you are extremely persuasive. If you don’t have a contract with an insurance plan, the patient can be billed in the event of non-payment from their insurance company.
How can psychologists improve their collection rate?
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.
How long does it take for mental health insurance to reimburse?
How long do insurance reimbursements typically take? In most cases, it will take at least 30 days from the date the insurer receives a claim to when your mental health practice will receive reimbursement. Some insurers move faster, with turnaround times of two to three weeks, but, as a rule, 30 days is what most practices can expect.
How to avoid wasting time on mental health claims?
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.
Why is it important to verify benefits and authorization requirements in advance?
Patients often don’t know or don’t understand insurance requirements which is that is why it is critical to verify benefits and authorization requirements in advance. In the event that authorization is not obtained and you have already seen the patient, you may be able to convince an insurer to back date authorization.
Who can bill BHI codes?
The BHI codes can be billed (directly reported) by physicians and non-physician practitioners whose scope of practice includes evaluation & management (E/M) services and who have a statutory benefit for independently reporting services to Medicare . This includes physicians of any specialty, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives. Generally, we would not expect psychiatrists to bill the psychiatric CoCM codes, because psychiatric work is defined as a sub-component of the psychiatric CoCM codes. However, General BHI could be billed by a psychiatrist who furnished the services described by the general BHI code and met all requirements to bill it.
What is a behavioral health care manager?
As noted in the CY 2017 PFS final rule, (81 FR 80231), the behavioral health care manager is a designated member of the care team with formal education or specialized training in behavioral health (which would include a range of disciplines, for example, social work, nursing, and psychology), but Medicare did not specify a minimum education requirement. They may or may not be a professional who meets all the requirements to independently furnish and report services to Medicare. The behavioral health care manager must be available to provide services face-to-face with the beneficiary, have a continuous relationship with the beneficiary, and have a collaborative, integrated relationship with the rest of the care team. He or she must also be able to engage the beneficiary outside of regular clinic hours as needed.
What is a referral for BHI?
The BHI services require that there must be a presenting psychiatric or behavioral health condition that, in the clinical judgment of the treating physician or other qualified health professional, warrants “referral” to the behavioral health care manager for further assessment and treatment through provision of psychiatric CoCM services or General
What is a BHI code?
The BHI codes allow for remote provision of certain services by the psychiatric consultant and other members of the care team. For CoCM, the behavioral health care manager must be available to provide face-to-face services in person, but provision of face-to-face services is not required. The BHI codes do not describe services that are subject to the rules for Medicare telehealth services in the narrow meaning of the term (under section 1834(m) of the Social Security Act).
What is the difference between BHI and CCM?
There are substantial differences in the potential number and nature of conditions, types of individuals providing the services, and time spent providing services. CCM involves care planning for all health issues and includes systems to ensure receipt of all recommended preventive services, whereas BHI care planning focuses on individuals with behavioral health issues, systematic care management using validated rating scales (when applicable), and does not focus on preventive services. CCM requires use of certified electronic health information technology, whereas BHI does not. In most cases, we believe it would not be difficult to determine which set of codes (BHI or CCM) more accurately describe the patient and the services provided. As we state in the final rule, the code(s) that most specifically describe the services being furnished should be used. If a BHI service code more specifically describes the service furnished (service time and other relevant aspects of the service being equal), then it is more appropriate to report the BHI code(s) than the CCM code(s).
Do you need prior consent for BHI?
Prior beneficiary consent is required for all of the BHI codes, recognizing that any applicable rules continue to apply regarding privacy. The consent will include permission to consult with relevant specialists, including a psychiatric consultant, and inform the beneficiary that cost sharing will apply to in-person and non-face-to-face services provided. Consent may be verbal (written consent is not required) but must be documented in the medical record.
Can BHI be used in both facility and non-facility settings?
Yes, the BHI codes are priced in both facility and non-facility settings. The POS on the claim should be the location where the billing practitioner would ordinarily provide face-to-face care to the beneficiary.
Who Can Provide Mental Health Services?
Types of Covered Mental Health Services
- 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. The types of covered mental health services are: Psychiatric Diagnostic Interview This interview is an examination of the patient's entire medical and mental …
Medical Record Documentation
- Another important aspect of mental health billing is making sure that everything is properly documented in the medical record. This record is the basis of everything that is billed for the date of service, so it has to have all of the required documentation in order to support the procedure code that is billed. Some of basic things that need to be ...
Diagnosis Coding Considerations
- One other consideration that has to be kept in mind is the diagnosis code itself. There is an entire chapter in the ICD-9 (diagnosis) coding manual, which deals with mental health diagnoses. There is also another book, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which deals specifically with mental health diagnoses. Even though the DSM-IV deals …