mental health billing for dummies

A timely filing limit is one of the most common requirements placed on claim submissions. More specifically, it’s the amount of time a payer allows claim submission after rendered service. If you aren’t enrolled to receive the status of your submitted claims electronically, you’ll receive an explanation of benefits (EOB) via the mail.

The last step in the mental health billing process is to rework your denials and submit them for an appeal. If you follow these best practices for your mental health billing, the tedious process will be more bearable. Hopefully this guide was a helpful introduction to mental health billing claims. An online “filter” that ensures the claims you are submitting are formatted correctly. Many insurance companies require providers to use an online clearinghouse. Procedure code 90791, along with and 90837, is one of the most frequently billed CPT codes for licensed behavioral health providers.

Why Mental Health Billing Can Be Complicated

Luckily, we’re going to learn together by breaking down the essentials of mental health billing in this definitive step-by-step guide. In other words, if you’re wondering if there are ways to improve your billing processes and increase the revenue for your mental health organization, there’s hope. Mental health billing is more difficult than medical billing, largely because of service variations not found in primary or specialty care. Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated. Or hire a billing service, submit your weekly appointments in 10 minutes, and focus on your private practice. If the claim has not been received, no corrected claim needs to be submitted, the original claim needs to be submitted.

mental health billing for dummies

Mental health insurances are very stringent when it comes to reimbursing the mental health services. On top of that, medical insurance for mental health will only have coverage up to a certain extent which makes it very hard for the medical professional. However, you’re in a unique scenario within the mental health space where you have to deal with MCOs, mental health EHRs and state-level government ordinances.

Mental Health Billing: Tips and Guidelines

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. A lot of time and energy goes into filing a claim with medical billing for mental health services, taking away time from patients. Learning more about the mental health billing process can make it easier for you to spend more time and energy on your patients and less on inconvenient discrepancies.

It also plays a vital role in maintaining people’s well-being and healing their emotional wounds. The following are a few questions and answers commonly asked regarding mental health billing. We’ll help you ensure you utilize the CPT Code modifiers that best describe the services you render and if you still need help, consider reaching out to our billing mental health billing service. For example, you may see a stabilized patient with a number of serious psychiatric and medical diagnoses on a regular basis to ensure that the patient’s condition has not changed. If, however, this same patient has decompensated since the last visit and changes are needed in the treatment regimen, a higher level of E/M is warranted.

Medical Billing & Coding For Dummies Cheat Sheet

Every insurance payer has a series of requirements required to receive reimbursement for claims. Fair warning, I’m about to bring in another general statistic to help paint the healthcare billing landscape. A more recent survey from 2021 determined that 85% of denials are preventable. Each denial or rejection can happen at one of two places, either at the Clearinghouse level or the insurance company level. The cheapest option is to learn how to use “PracticeMate” by OfficeAlly to submit claims, even though it is made for hospitals.

  • ANSI 837I is the accepted electronic format for facilities that have to use UB-04 claim submission forms.
  • Use digital claims processing when possible for better tracking of your claims and data and faster claims submission.
  • This is a factor when your practice has been in business for many years and you have already allocated sufficient resources toward purchasing and installing the application and then on staff training.
  • If, however, this same patient has decompensated since the last visit and changes are needed in the treatment regimen, a higher level of E/M is warranted.
  • IF YOU MUST bill claims via paper, ask about their claims address as well.

Well, in this alternative we have to call this number again and figure out the status of the claim you submitted. Remember way back in step 2 when I mentioned the phone call to the number on the back of your client’s insurance card? That means it should be able to alert you of errors you make during the claim submission process and correct the same automatically. After all of this and even after Medicare’s electronic submission requirement, some payers STILL don’t have claim submission web portals. If ALL of your patients had Health First Colorado as their payer, this wouldn’t be that bad of a manual process…but that’s not the case.