Comprehensive Guide for Mental Health Billing- Part 3
In Comprehensive Guide for Mental Health Billing- Part 2, we discussed different types of mental health services and who are authorized to provide them. While working with Mental health professionals we receive a lot of questions related to medical billing so in part 3 we have grouped those frequently asked questions along with its answers.
- How is mental health billing different than medical billing?
The way therapists and counselors provide services is greatly different than the way services are provided by other medical professionals. For example, in a medical setting, patients and their insurers are billed for specific treatments, such as an x-ray or a lab test. Mental health professionals often face an uphill battle when seeking reimbursement for the services they provide. The rules and regulations of the insurance industry make successfully submitting claims a difficult and frustrating process. As a result, mental health practices often only collect 85 percent of the money owed to them.
In the mental health field, patients and insurers are billed primarily for therapy, medical management, and psychological testing services. Insurers have rules about how long a session they’ll pay for, how many they’ll pay for per day or week, and often a maximum number of treatments that they will pay for. 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.
Related Article: A COMPREHENSIVE GUIDE FOR MENTAL HEALTH BILLING- PART 1
- What’s the time limit on filing a claim?
This varies from insurer to insurer. Some insurers require claims to be filed very soon after services – 90 days is often a rule among private insurers. Others are more lenient with their time limits. For example, Medicare usually allows providers to file claims within a year to 18 months after services are provided. Knowing the insurers you work with and their claims submission rules will help you avoid having claims denied because of late submission.
- 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.
- What should I do when clients don’t inform me about changes to their insurance plans?
In many cases, clients aren’t even aware of changes to their insurance plans. Yes, insurers send out letters explaining the changes, but these letters are often difficult to understand and are rarely read. In other cases, clients have changed jobs and gotten a new plan or have lost their coverage. 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.
- 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 are 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 backdate authorization. This will require some diplomatic skills on your part, as insurers are often loathed 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.
- Do most sessions require pre-authorization?
This is something that varies from insurer to insurer. In most cases, an initial session or regular office visit does not require pre-authorization. More extensive services such as psychological testing may require approval from the insurer. Also, some insurers allow a set number of visits without authorization before requiring authorization for any subsequent visits.
- Can I bill clients for more than one session per day?
Most insurers are pretty strict about the one session per client, per day rule. Under some circumstances, mental health practices may be able to obtain approval for more than one service in a day. For example, if the practice has a psychiatrist and counselor on staff, the psychiatrist may perform one service, and then a counselor may perform another, and the insurer may reimburse for both. Or if the patient has to travel a long distance for an appointment and needs a longer session. Staying in contact with insurers and having good diplomatic skills will help in these situations.
Related Article: A COMPREHENSIVE GUIDE FOR MENTAL HEALTH BILLING- PART 2
- Is it okay to bill claims under another provider’s name and NPI number?
This happens a lot in group practices where not all the providers are credentialed with all the insurance plans. A therapist who sees a blue shield patient may not be paneled with that insurance but will bill under the name and number of another provider in the group so he can get paid. Sometimes it is acceptable to bill this way if you use a billing modifier (Q6) on the claim that indicates the provider is “supervising” care by another clinician. You’ll need to pay close attention to your payer contracts in order to bill for non-credentialed providers correctly. If your new provider is not replacing anyone and if the health plan requires only credentialed clinicians provide services, you cannot bill for services rendered by that provider. A practice would be in violation of their contract with the health plan. In some cases, the health plan will only require physicians to be credentialed; in others, plans require all providers (physicians and mid-levels) be credentialed and tied to the contract.
- Should I go cash only?
Some insurers have good reimbursement rates for mental health services, while others have low rates and rules that make getting paid extremely difficult. In some areas, the low-paying insurers may be the dominant carriers, and few clients in the community may have better plans.
When considering whether to join a network or accept payment from insurers, it’s important to evaluate their pre-approval rules and their limits for payment. In some cases, the low payments and hassles of dealing with insurers make it more profitable to switch to a cash-only model and accept lower payments from clients or establish an income-based sliding scale.
E2E Medical Billing Serivces is known for fast, efficient, and effective mental health billing services. To know more about our mental health billing services call us at 888-552-1290 or write to us at [email protected]