🚨 ALERT! 🚨 Dive into this behemoth of a blog – it's almost as lengthy as your insurance forms, but way more fun and packed with golden nuggets for all you DIY insurance billers out there!
Insurance billing can often feel like navigating a maze for therapists who handle their own billing. With the different CPT codes, policies, and regulations to keep track of, ensuring you're compensated correctly can be intimidating. Here are tips and tricks to make the billing process simpler to help you sidestep common snags:
Get Familiar with Your Client's Insurance Policy
Understand Coverage: Before the first session, understand what mental health services are covered under your client's policy. Familiarize yourself with deductibles, copayments, coinsurance, and any therapy-specific exclusions. You can get all this information by doing a verification of benefits and documenting the information you collect from the insurance company. This is additional work up front, but it can save a lot of time later if there are issues with the client’s insurance.
In-Network vs. Out-of-Network: Know whether you're an in-network (you have a negotiated agreement with the health insurance company) or out-of-network (you haven’t set up any negotiated pricing agreements with that insurance company) provider for your client's insurance.
If you are an out-of-network provider, make sure you explain to your client what this means. Here’s an example of how you might inform your client: “The fee for each session is [X amount]. This would be an out-of-pocket expense, meaning payment is due at the time of service. I accept credit cards, checks, and cash.”
“If you’d like to request reimbursement from your insurance, I can provide you with a detailed receipt called a superbill, which you can submit to your insurance company. They may cover a portion or all of the costs, based on your plan. You’ll want to check with your insurance company directly to see what your out-of-network benefits are.”
Organize and Thoroughly Document
Use your EHR for your insurance billing: This can help manage client information, session notes, billing details, and insurance claims in one place. Many EHR systems come with integrated billing capabilities. This can automate claim submissions, check for billing errors, and send reminders for unpaid invoices, reducing manual administrative work.
Keep Detailed Records: Store all relevant billing documents, such as session notes, insurance correspondence, and Explanation of Benefits (EOB), directly in your EHR.
Track Conversations: When discussing anything related to billing with insurance representatives, maintain a log with dates, representative names, the reference number for that call, and summaries of the conversation.
Master the Art of Coding
Familiarize yourself with common codes for therapists: Therapy billing codes can be complicated. As a reminder, here are some common CPT codes that you can use:
90791- Psychiatric or psychological intake interview without medical services (often used for the intake appointment)
90832- Individual psychotherapy, 30 minutes
90834- Individual psychotherapy, 45 minutes
90837- Individual psychotherapy, 60 minutes
90846: Family psychotherapy without the patient present
90847: Family psychotherapy with the patient present
Double-Check Your Entries: Mistakes, even minor ones, in coding can lead to unpaid or delayed claims. Always review your claim forms for errors or omissions before submission. If you offer telehealth, don’t forget to add your modifiers! Some common modifiers are 95 (indicates that service was delivered via telehealth) and GT (before the 95 modifier became more common, the GT modifier was frequently used to indicate services provided via telehealth. Some insurances might still require or accept this).
Be Proactive with Claims
Submit Promptly: Timeliness is key. Submit your claims as soon as possible to avoid missing submission deadlines set by insurance companies. Most private insurance companies have shorter windows typically ranging from 90-180 days from the date of service. However, some may allow up to a year or more, especially if the delay is justified. For Medicare claims, the general rule is that providers have up to one calendar year from the date of service to submit claims. The timeframe for Medicaid claims differs by state but normally ranges from 90-365 days. If you’re a contracted provider with an insurance company, your agreement will typically specify the timeframe within which you must submit claims.
Follow-up: If a claim isn't paid within a typical timeframe, proactively contact the insurance company. This helps in resolving possible issues early. Typically, for private insurance, if 30 days have passed since submitting a claim without receiving payment or communication about the claim’s status, you should follow up. With Medicare claims, if you haven’t received payment or a response within 14-30 days of submission, it’s a good idea to initial a follow-up. Finally, with Medicaid claims, given the variability between states, a good rule of thumb is to wait 30-45 days before following up.
When following up, you’ll want to make sure you follow the guidelines below:
Check your records first. Before contacting the insurance company, make sure the claim was sent, and verify if you’ve received any electronic notifications or correspondence regarding it.
Contact the insurance company. Call the insurance provider helpline. Have the necessary information ready including the client’s name, date of birth, policy number, date of service, claim number (if available), your Tax ID #, and your NPI.
Document everything. Whenever you make a call, note the date, the representative's name, the reference number for the call, and the core of the discussion.
Resubmit if necessary. Sometimes claims get lost or aren’t received. If the insurance company has no record of the claim, you’ll likely need to resubmit. Remember to note on the insurance claim that this is a resubmission (this is line 22 in a CMS 1500).
If the claim is denied or requires further information, address the issue as soon as possible to expedite processing.
By following these guidelines and staying organized, you can make insurance billing a more straightforward part of your practice. Streamlining your administrative processes does more than just increase efficiency, it eases many of the pressures and burdens that often come with manual, messy billing methods. For many therapists, the complexities of billing can be a major source of stress. It’s not just about sending out a claim but navigating the difficult web of insurance requirements, codes, and follow-ups. When the process is not optimized, the number of errors increases, leading to rejected claims, delays in payments, and financial uncertainties. Over time, these challenges can compound, resulting in feelings of being overwhelmed, especially if you’re trying to resolve billing discrepancies while also sustaining a full client load.
Navigating the nuances of insurance billing can be difficult. If you ever feel the need for support, know that we’re here to offer a helping hand. Our team is well-versed in the details of the billing process, ensuring accuracy and timeliness. Should you wish to discuss how we might assist, please don’t hesitate to reach out. We’re here to support your practice’s journey, however, you see it.
Take care,
Kim and Ashley
