Billing 101 for Mental Health Professionals

This way, if you have to contact the payer again (and you almost certainly will), you’ll have a traceable record of all billing steps you’ve taken to date. In either case, you should have your National Provider Identifier (NPI) and tax identification number (TIN) readily available. You should also understand the type of information required in each section of the form, since different payers may require different information. If the average denial rate for submitted claims is more than 11%, you should expect to lose that much revenue. Luckily, this is another area where your clearinghouse can save the day. You see, some clearinghouses (like ours) can automatically accomplish multiple claim submission process alternatives exactly for this unique scenario.

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Familiarity with Mental Health EHRS

ICD-10 Codes  — The World Health Organization (WHO) publishes and updates the IDC-10 code set. The U.S. then developed a clinical modification (ICD-10-CM) for medical diagnoses based on the WHO’s ICD-10 set. These codes describe diseases, signs and symptoms, abnormal findings, complaints, and external causes of injury or diseases. An ICD-10 code essentially tells payers why you provided a patient with the services you did. 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.

If your clearinghouse finds an error, it will reject it and notify you of the same. ANSI 837P is the accepted electronic format for practices that have to submit under the CMS1500 form. However, if you think that the claim is correct as it is, you can write a letter or fill out a specific payer form. Whether you send this to the payer by mail or upload it to their portal, this process of disputing a denial is called an appeal. 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.

How to Handle Mental Health Billing Denials, Rejections, and Appeals

Republicans who have a connection to Medicaid have more favorable views of the program and are more likely to say the program is primarily one that helps people pay for health insurance. States have flexibility in how to deliver services to enrollees, but comprehensive managed care is the dominant delivery model covering seven in ten enrollees in 2020 and managed care plans now serve most Medicaid beneficiaries. mental health billing Those plans are responsible under their contracts with states for ensuring adequate provider networks. The Biden Administration issued two proposed rules focused on ensuring access to services in Medicaid and addressing access financing and quality in Medicaid managed care in May 2023. Medicaid is an entitlement, which means that individuals who meet eligibility requirements are guaranteed coverage.

Having a reliable and instant eligibility tool is a great start. It’s also helpful if your eligibility tool can automate some of the processes for you (this is especially helpful for those small practices). Ideally, the tool can automatically check patient benefits for the week’s schedule and notify you if there are any issues or expired plans. Verifying benefits is the most important part of the revenue cycle management (RCM) process. If you don’t understand the patient’s coverage before their appointment, you could lose the claim from the get-go.

Out-of-network benefits

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. Consider this a crash course on mental health billing for dummies. The list of codes that mental and behavioral healthcare providers must know is essential for billing purposes and services.

  • We provide physician-designed technology that increases reimbursements and reduces administrative costs for behavioral health practices.
  • To sweeten the deal, the form that you sent came with a return envelope and form for the payer to fill out and resend to you about the claim’s status.
  • The unique payers that still cling on to paper stand no chance against the most ideal alternative for claims processing.
  • 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 is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS).
  • Here are the most common codes that you’ll encounter as a therapist.

For example, people suffering from diabetes or chronic cardiac conditions often develop depression and anxiety that is outwardly clear. On the other hand, those suffering from depression or bipolar disorder may have no outward physical signs of illness — making their treatment mental health-based instead of behavioral. Medicaid covers 41% of all births in the United States, nearly half of children with special health care needs, five in eight nursing home residents, 23% of non-elderly adults with any mental illness, and 40% of non-elderly adults with HIV.

What are the types of mental health services?

This information will tell you how to seek and receive payment for your services, so if you get it wrong, you’ll face delays receiving revenue. When you have copies of your patients’ cards on file, you minimize the chances of such errors. We also recommend saving copies of any forms you file, including invoices and superbills.

Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Get timely payments with electronic coordination of benefits (COB) when a patient is covered under more than one insurance plan. So we are at the end of our time, just about, and so I want to thank you both for joining us this evening, spending part of your evening with us and our participants. And so our upcoming webinar is scheduled for Thursday, October 22nd.


So this could mean potentially eight or more five-minute or two-minute encounters over the course of the month being accumulated and billed as one charge. And then in addition, this is technically a medical service for all billing purposes. And now, before I dive in any further, I want to emphasize that NM chose this model because it best met our patients’ and organization’s needs. So the remainder of this presentation is not a recommendation for collaborative care, but instead an example of a successful implementation and some key takeaways. Our guide to mental health billing will first discuss your client information, then the most frequently used mental health CPT codes, how to verify eligibility and benefits for behavioral health services, and finally how to submit claims.

And some of them can actually be conducted even before the patient has a particular issue or condition, particularly when it comes to preventative medicine, which I think is going to be extremely important right about now. Physician experts discuss how to bill and get paid for behavioral health care services. This webinar highlights how the provision of these services is a valuable use of physician time and effort and will provide broad introduction to behavioral health billing and coding. Physicians are provided with both accurate and actionable information and real-world examples.

Clearinghouse Rejection

It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Health benefits and health insurance plans contain exclusions and limitations. And to be able to report that work of the physicians and the QHPs, and our non-physicians as well, in many cases.

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