Obtain eligibility and benefits and make sure you know how to submit claims and where. EHR software and insurance company website is different and we have no general way to suggest how to do so mental health billing for dummies — please see documentation for each. Use digital claims processing when possible for better tracking of your claims and data and faster claims submission. Normally digital options to have a cost, for EHRs, so consider your options in choosing an online tool. You will need the claim ID or claim number for each date of service to refile your claims.
- For behavioral health practices, establishing consistent documentation workflows is key to sustainable billing operations.
- Our dedicated RCM team brings deep expertise in behavioral health billing and works proactively to minimize denials, shorten reimbursement cycles, and maximize collections.
- If you have questions, contact the insurance provider directly to see what coding they accept for various telehealth treatments.
- Proper submission and follow-up are essential for maintaining a smooth billing process and ensuring that your practice receives the compensation it deserves.
- A lot of time, mental healthcare professionals find it difficult to juggle between rendering patient care and filing claims.
- These services span a wide range of therapeutic interventions and clinical settings, from individual therapy and psychiatric evaluations to group counseling and medication management.
- If your clearinghouse doesn’t have electronic connections to the Medicaid MCOs within your state, you won’t be able to submit claims that use Medicaid as their insurance.
How to Check Eligibility and Benefits for Mental Health
For reimbursement on a claim, you have to file the correct claim code with the right insurer and submit the claim along with the correct billing format. If the insurance company has a preferred filing method, make sure you comply with it and the time frame set forth by the insurer. 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? It’s already integrated with practically every payer that exists in the mental health billing world…so it can pull up the claim status for everything you’ve submitted through it.
Use A Billing Service
But getting mental health billing right is important for making sure you get paid fairly for your work and that your patients aren’t burdened with unexpected costs. This is yet one more reason why mental health providers choose billing services like TheraThink to help. If you want to focus on providing healthcare rather than processing claims, you can hire a billing company to handle your claims.
Claim Scrubbing
On average, most clean claims are processed and paid within 14 to 30 days of submission. Timely claim submission improves cash flow and reduces the risk of timely filing denials. Double-check for common errors such as incorrect NPI, provider credentials, place of service codes, and client demographic mismatches. If you are using an EHR or clearinghouse, those systems can pre-scrub your claims to minimize rejections. Accurate diagnosis coding is a critical part of behavioral health billing. Insurers use diagnosis codes to determine whether a service is medically necessary and reimbursable.
- When a CPT code represents a less serious diagnosis or a less expensive therapy than was actually provided to a patient, this is known as undercoding.
- This further place greater emphasis on efficient and accurate billing practices.
- Using outdated, incomplete, or non-specific codes can lead to claim denials, payment delays, and compliance risks.
- Mental health billing can differ significantly between clinics and individual practitioners due to factors related to scale, resources, and operational structure.
- Knowing more about mental health billing guidelines can allow you to focus your time and energy on your patients and less on the problematic issues.
- Inadequate documentation increases audit risk, delays payments, and can ultimately compromise compliance.
What causes insurance to deny mental health claims most often?
You will learn what client information you need, how to verify mental health benefits, create and submit claims, and account for EOBs. In most cases, insurers don’t require preauthorization for initial visits or basic behavioral health sessions. In some instances, retained earnings various payers have different rules (e.g., over 45-minute sessions or multiple sessions for one client in a day).
Go back to your EHR, online portal, or paper claims and refile these claims. For complex services like a 70 minute emergency call and then a two hour emergency session at their home, you might have absolutely no idea how to bill that situation. We recommend reading and using Barbara Griswald’s book Navigating the Insurance Maze as a primer on how to submit paper claims correctly. If you aren’t sure how to submit the claim accurately, consider asking a colleague or hiring an expert.
- 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).
- Ensure you refile claims in a prompt manner to make the timely filing window for claims submission.
- For example, mental health services often use different coding systems, such as ICD-10 codes for mental health disorders, which are distinct from those used for physical ailments.
- HIPAA mandates strict patient data privacy and security measures, affecting how billing information is handled.
- So, your clearinghouse should have direct contacts to reach out to on your behalf regarding any issues with your claims.
- From administrative bottlenecks to payer-specific rules, these challenges can slow down reimbursement, increase claim denials, and drain valuable time from patient care.
Types of Mental Health Services
It is not always easy to know if you’ve met https://reurbsc.com/?p=3292 the required elements to code appropriately for the required reimbursement. It could be a good idea to break down the process into steps for new and established patients. As mentioned above, submitting the form is painful enough the first time; there’s no point in doing your job twice as hard and having to submit a second, third, or even fourth corrected claim. Mental health billing differs from general medical billing in several key ways. While both involve managing insurance claims and reimbursement, mental health billing requires specific coding and documentation tailored to the nuances of mental health care. Mental health billing may seem daunting initially, but new providers can navigate the complexities smoothly with the right strategies.
