A mental health professional is a provider who diagnoses mental health conditions and provides treatment.
Provider at least has a master’s degree or more advanced education, training, license, and credentials. You must be sure that the provider you choose is licensed to provide mental health services.
A psychiatrist is a provider (M.D / D, O.) who specializes in mental health. He deals with the diagnosis and treatment of mental health disorders. He also provides psychological counseling called psychotherapy.
However, a psychologist (Ph.D., Psy.d, Ed.D.) is trained in psychology. A science that deals with ideas, emotions, thoughts, and behaviors.
A therapist is a term for trained professionals, often licensed, who provide treatment and rehabilitation to people.
He helps patients to make effective decisions with overall support. A therapist’s education, professional credentialing, and licensing should be essential.
Guidance for therapists about mental health billing
Mental health billing is not included in the job title of therapist. He must focus on his business and care for the patient’s health. Medical billing outsourcing companies help them with mental health billing services to keep the focus on patient health.
But, if anyone wants guidance about mental health billing, this information will benefit him.
He needs to learn what important information he needs about a client. How does he verify the benefits covering mental health? And how does he generate the claims and submit them to the correct payer?
Collect patient demographic and insurance information
- Patient’s full legal name.
- Patient’s DOB (date of birth).
- Patient’s SSN (social security number).
- Address of Patients.
- Patient’s marital status.
- Patient’s race.
- Patient’s gender.
- Patient’s phone number / E-mail address.
- Payer name.
- Correct the claim address and phone number of the insurance company.
- Group number, policy type (the insurance plan, i.e., dual plan, etc.)
CPT codes that are often used in mental health billing
- 90791 initial code for new patient establishment.
- 90834 individual therapy sessions 45-55 minutes.
- 90837 individual therapy sessions 56+ minutes.
- 90846 couples or family psychotherapy without the patient present.
- 90847 family or couple psychotherapy with the present patient.
- 90853 group psychotherapy.
- In telehealth services, medical billers use modifiers (95, GT) with CPT codes and (POS-02) codes to explain the place of service.
Diagnosis codes
Providers are advised to use the most appropriate and accurate updated ICD codes for correct claim submission.
Submitted claims with old ICD codes or incorrect ICD codes may become the cause of rejected claims by the payer.
How to verify eligibility and benefits for mental health care?
Medical billers must verify the patient’s eligibility and benefits coverage before claim submission.
Many payers have an online portal where the biller or provider can verify the patient’s eligibility before claim submission.
If there is no portal to verify the patient’s eligibility, then they call the payer to verify the eligibility. After verification of eligibility, they submitted the claim to the correct payer.
It is a significant part of the medical billing process. If we skip this step, it can become the main reason for claim denials, which may affect the revenue cycle management process.
How to submit claims?
Many software exists in the market, providing providers with solutions to create a claim and submit it to the insurance company. You need to put the correct information during using of any software.
You must also transcribe the information in CMS 1500 form and send it electronically or physically to the insurance company.
Verify the claims receipt and payment information:-
Once you submit the claim to the insurance company, you must wait a month. After that, if they have yet to receive the claim, verify it and resubmit the claim with the correct information if needed.
In the timely filling window, you must submit them within 90 days after the service date. Once it’s verified that claims are received, you must wait for one month or until payment.
If claims are paid, you will receive EOBs (explanation of benefits) that hold all information about checks, allowed amount, paid amount, adjustment, and service date.
How handled denial, rejections, and appeals in mental health billing?
In all types of medical billing, we mostly faced two types of denial. It would help to verify that the clearing house or the insurance company denied it.
You must verify whether the claim is rejected by the clearing house or denied by the insurance company. If it is a denial by the clearing house, it is normal.
You can fix this denial by calling the software house and correcting the patient’s information, and resubmitting to the correct payer with the correct information.
If it is denied, you find the reason by asking the insurance company to fix the denial, resubmit the claim, or appeal it to the insurance company.
Joshua is a staff writer at Health Magazine Lab covering fitness, gym, and health clubs. He is interested in how technology changes physical activity and health.