You may feel overwhelmed, uncertain, or anxious about the process if you are new to mental health billing. Don’t be concerned; this is normal! The majority of mental health professionals are not trained to navigate the medical billing landscape. After all, billing is more closely related to business administration and finance than it is to healthcare. Nonetheless, behavioral health practices across the country are learning best billing practices and keeping the revenue cycle churning, and you can too. Here’s what FAQs every therapist should know before diving into mental health billing:
#1 Can the same client be billed for multiple sessions on the same day?
It is strongly discouraged to bill the multiple intake sessions with CPT code 90791. This is because, most of the time, this CPT code would be incorrect after the first session, resulting in possible insurance fraud but, more likely, a claim denial. However, if a patient has seen another therapist during the billing year, it is recommended to bill the intake code for your first session regardless, as it is your first session with the patient.
Further, if you see another family member, feel free to bill for the intake for that date as well. Without special permissions, the general rule is only one intake session, the first session, per patient. If you call the insurance company, you might be able to get authorization for more than one service per day. In fact, under special circumstances, if you have a psychiatrist on staff, it is perfectly acceptable for the psychiatrist to provide one service and you (the counselor) to provide another, for a total of two services.
#2 What should you do if a patient changes their insurance information without informing you?
This problem occurs far too frequently: a client fails to notify you of a change in their policy (or, in really bad cases, no policy at all). Typically, you will send the claim, wait for it to be paid, and then discover that it has been rejected. In this case, you must contact the patient and obtain their new insurance information. You will most likely encounter one of two scenarios:
A. They do not have insurance. In this case, you must try to collect payment directly from the patient.
B. They’ve implemented a new policy. In this case, you must re-file the claim using the new policy and hope that the session did not require pre-authorization. If it did, contact the insurance company to see if the authorization can be “backdated.” If the company says they don’t backdate authorizations, politely request an exception for this “once in a lifetime” situation. The insurance company may not care about you or your practice, but they will care about annoying a newly insured member who will be responsible for your clinical fees if the authorization is denied.
Finally, if you haven’t seen a client in a while, call the day of their session to see if they are still covered by their insurance plan.
#3 How long do mental health insurance payouts take?
It can take up to 30 business days from the date the insurance company receives the claim to receive the payout. However, this is not always the case. Blue Cross in Massachusetts, for example, typically pays claims within two weeks, while Aetna typically takes three weeks.
Nonetheless, the rule that insurance companies follow is that all claims must be processed within 30 days. If you think about it, after the first month of practice, providers usually don’t notice the delay because payments keep coming in.
#4 Do mental therapy sessions have to be pre-authorized?
Most insurance companies do not require authorization for a basic office visit, therapy session, or even the initial session. However, it is always advisable to investigate when in doubt.
Tufts insurance almost always requires claim authorization. In addition, in the case of psychological testing, you must always obtain authorization. Some insurance companies, such as Blue Cross of Massachusetts, allow up to 12 visits without authorization before requiring providers to obtain authorization for the next 12.
In general, authorizations are not required for basic tasks, but always double-check.
#5 Is Outsourcing Mental Health Billing the Best Option?
Billing for mental health services can be perplexing. To manage their claims and revenue cycle, many providers rely on third-party mental health billing services.
But is this a viable option for you, or should you hire in-house billers—or, for solo practitioners, handle it yourself?
The answer is dependent on your specific practice and goals. Outsourced mental health billing may be appropriate for your practice if:
- You have multiple providers and insufficient staff to manage the mental health billing.
- Time constraints prevent you from pursuing and resolving claim denials as thoroughly as you would like.
- You want experts to help you maximize your revenue through coding.
- You frequently miss submission deadlines or have the impression that your billing is disorganized and behind schedule.
Mental health billing does not have to be intimidating. The right tools and decisions will assist you in managing it effectively and obtaining the reimbursement you deserve.
24/7 Medical Billing Services streamlines your revenue cycle and allows you to recover past-due payments more quickly. Our fully integrated system eliminates unnecessary steps by auto-generating claims and tracking/reporting aging bills.