Managing Your Mental Health Therapy Practice: How To Bill Insurance As A Therapist
Navigating the intricacies of billing as a therapist can be a perplexing journey, riddled with complexities and nuances. Even seasoned professionals with extensive experience may find themselves overwhelmed, given that an estimated 80% of medical bills contain errors. The process involves a comprehensive understanding of insurance industry jargon, claim rejections, diagnosis codes, and more.
While billing insurance remains a common challenge in the field, understanding this valuable administrative process is crucial for running a successful practice, building your client base, and receiving proper compensation. For those running or looking to run a therapy practice, there are multiple bill options available. This article will explore the pros and cons of outsourcing, as well as current insurance billing basics.
How to bill insurance as a mental health therapist: Exploring insurance billing options
While implementing a billing process is a requirement of any business, the medical billing process can be daunting. For practitioners, the process involves navigating through various options.
While each avenue comes with a unique set of challenges and requirements, you may consider the following:
Outsourcing in mental health therapy billing
Opting for outsourcing in therapy billing is an option, but it involves collecting the necessary data for the biller and securely transmitting it. Additionally, the services of billers can come with a significant cost, which may affect how much you ultimately pay for billing support.
Handling the insurance billing on your own
Alternatively, you can handle the billing process on your own, either manually or through the health plan's provider portal (if available), ensuring all information is accurate so the insurer can pay you correctly and on time.
Using a clearinghouse to connect with the health insurance company
Another option is to use a middleman between healthcare providers and insurance companies, or a clearinghouse. However, you will still need to gather all the required data, possess billing knowledge, and develop familiarity with the CMS-1500 format.
Utilizing practice management software
Consider utilizing practice management software that can provide seamless therapy billing capabilities. However, it's essential to research thoroughly, ensuring the chosen platform supports all the necessary functions for successful therapy billing, including tools that help track when insurers pay.
Regardless of the chosen method, having a fundamental understanding of therapy billing and claims is essential for any clinician.
Important therapy and health insurance billing terms to know
When approaching the process of billing within the mental health care sector, it can be helpful to understand a few core terminologies including:
- Insurance Provider or Insurer: The entity providing financial coverage for medical services is important in insurance billing.
- Billing Claim: A formal request submitted by a healthcare professional to an insurer, seeking coverage for treatment costs.
- Claim Status: Communication between the insurer and the claiming party about the pivotal phase where claims undergo thorough processing and evaluation for validity before payment approval.
- Credentialing: The rigorous process confirming a therapist's qualifications and experience as a mental health professional, which is essential before participating in insurance billing.
- CPT Codes: Commonly known as service codes, Current Procedural Terminology (CPT) codes play a vital role in insurance claims. These CPT codes assist insurance companies in identifying the specific types of treatment provided during therapy sessions and help determine how much to pay.
Becoming an in-network provider
Whether “in-network” or “out-of-network” providers are considered “in-network” or “out-of-network” is determined by the establishment of contracts between therapists and insurance companies.
While out-of-network providers may have more freedom of choice for clients, lacking contracts with insurance companies often results in higher out-of-pocket costs for patients, who may need to pay more directly.
As a practitioner, in-network agreements allow therapists to offer services at a reduced rate, creating more affordability for clients.
Learning how to bill insurance: Building insurance partnerships
Finding the most advantageous insurance partnerships for your practice requires researching the demographic of clients you wish to serve. You may consider providing service locally or virtually. Additionally, it can be helpful to take note of the predominant employers in your area or consult with colleagues to learn about the insurance plans offered to employees.
If a substantial number of residents in your vicinity are covered by Medicare or Medicaid, joining those networks could be beneficial. Furthermore, taking the time to identify which insurance providers offer the most competitive reimbursement rates is also recommended.
Getting credentials
Credentialing serves as validation that a therapist is properly qualified to deliver mental health services. Attempting to become an in-network provider without proper credentials can be an arduous task. The process of credentialing is significant, as it is often responsible for:
- Building trust between clients and medical professionals.
- Demonstrating adherence to specific standards outlined by insurance companies.
- Increasing the likelihood of collaboration with insurance companies.
The credentialing process encompasses several steps., including:
Review liability coverage requirements
- Obtain professional liability coverage
- Obtain malpractice insurance
Gather essential documents, including:
Details of professional liability coverage and malpractice insurance
Your practice license
Practice tax ID number
A completed application form
Visit the insurer's website and submit an online application to join their list of approved providers.
Complete the Council for Affordable Quality Healthcare (CAQH) Pro View Application.
Self-report details about your education, training, and experience within the CAQH application.
Ensure you have compiled all necessary documents as specified in the first step.
Submit the gathered documents to the specific insurance company networks you intend to join.
Complete the application process diligently, as it may seem extensive and time-consuming.
Unless there are changes to your information, you will typically only need to complete this credentialing process once. However, it’s important to note, that while the overall process is similar across many insurance companies, subtle differences may exist. Verifying the requirements with each company before submitting to make your working relationship more functional is advised.
Prior authorizations from the insurance company
Prior authorization, also known as preauthorization or precertification, is a cost-control process implemented by health insurance plans that require therapists and other healthcare providers to obtain advance approval from the health plan before delivering a specific service to the patient. This process is generally necessary to qualify for payment coverage.
Due to a lack of standardization in this process, securing prior authorization can be challenging. However, it fills two essential objectives:
- Ensuring reimbursement for provided services
- Safeguarding clients from unforeseen out-of-pocket expenses.
Along with educating and advocating for healthcare providers, the American Medical Association offers prior authorization practice resources and tip guides.
Submitting an insurance claim for the billing
Submitting claims to insurance companies is a critical component of mental health billing, requiring precise execution. This process is typically done electronically and involves completing insurance claim forms with detailed and specific information, including the correct CPT code, to ensure proper pay from the insurer.
Important things to remember when submitting claims
In order to submit claims, it’s imperative to meet specific deadlines set by insurers, noting that these deadlines tend to vary among companies. To successfully fill out electronic claims forms, the following information is essential:
- Provider's name
- Practice tax ID
- Client information, including full name and date of birth
- Details pertaining to each therapy session, such as the date and corresponding service code
It’s important to ensure the accurate completion of claim forms, as even minor errors could lead to claim rejection by the insurance company. This can generally be achieved by adhering to the following guidelines:
- Cross-check every detail
- Confirm that patient identifiers match the information on their insurance card
- Review insurance requirements before form submission
- Verify that the codes used accurately represent the services provided.
Common billing codes for therapists
Current Procedural Terminology (CPT) codes serve the purpose of designating and categorizing diagnoses and treatments. These codes indicate both reasons for treatment and methods of treatment. By utilizing standardized codes when filing electronic claims with an insurance provider, the billing process can be streamlined, ensuring proper reimbursement.
Examples of common CPT codes in therapy
- 1. 90834: Individual psychotherapy for a 45-minute session
- 2. 90837: A 60-minute psychotherapy session
- 3. 90791: Initial diagnostic interview or assessment, without additional medical services.
Managing denied claims
Claim denials occur when a claim has been processed but is ultimately rejected. Denials can be attributed to simple mistakes or keystroke errors, or they may be linked to services provided that aren't covered by benefits.
Claim rejections and denials pose significant challenges for therapists. While it is possible to appeal a rejection or denial status, successfully overturning a decision requires supporting documents, such as session notes and treatment plans. These documents help to illustrate the necessity of services and enhance the likelihood of receiving payment.
Takeaway
By utilizing resources and adhering to best practices, such as accurate record-keeping, efficient tracking, client education, and maintaining updated credentials, you may better navigate and streamline your practice’s billing process. Using the correct CPT code and submitting each claim properly can help ensure you get paid on time.
How do you bill insurance in simple practice?
Learning how to bill insurance in simple practice is an important step for many individual providers in their own practice for their clients. To begin, therapists may need to verify a client's insurance plan and confirm the insurance coverage of the plan with the insurance provider or health insurance company. The client's information should be accurate and complete, and the correct taxonomy code and CPT code or common CPT codes used for each service must be included when submitting a claim.
A therapist may have the option to become an in-network provider by completing the credentialing process with insurance companies, or like others, therapists may remain out-of-network providers and offer out-of-network billing options. It can be very important to keep track of the claims submission deadline, co-pays, and appropriate documentation requirements to avoid denied claims or claim denial from insurance companies.
Handling insurance billing also means managing different administrative tasks, such as following up on reimbursement rates and ensuring that they receive payment on time. Many therapists may need more time to learn these systems to maintain a smooth workflow and provide affordable, quality healthcare to their clients.
How does insurance billing work?
Insurance billing allows therapists and mental health service providers to bill insurance companies for the service treatments they offer clients. First, a therapist may need to verify the insurance coverage under the client's health plan by performing eligibility checks and asking for the insurance card details to double-check the client's information.
In some cases, therapists may be part of an insurance panel as an in-network provider or operate as out-of-network providers. Therapists who accept insurance must use the correct taxonomy code or specific CPT code or ask for the common CPT codes when submitting a claim to the health insurance company or insurance provider. Filing claims on time and meeting the claims submission deadline can be very important to avoid experiencing rejected claims or denied claims.
Some therapists may need to manage some administrative tasks to ensure everything is right, including tracking payment, handling paperwork, and reviewing reimbursement rates or the contracted rate set by the insurer. It is important for many therapists to double-check every detail before submitting the claim to determine whether this setup is in their own practice or another practice location.
This guarantees that insurance benefits are used properly and that the provider is paid for the care delivered to the clients.
How do therapists get paid by insurance?
Insurance companies pay or reimburse therapists after filing claims for each service provided to clients. The therapist or the mental health service provider must first accept insurance and be enrolled with an insurance panel or offer out-of-network services. They may begin by completing eligibility checks to confirm and double-check the client's health insurance coverage.
During insurance billing, therapists should include important details such as their license number, taxonomy code, CPT code, and service date. It is very important to double-check all information to avoid rejected claims. Once the claim is approved, the insurer may process the payment based on the client's benefits and the therapist's agreement with the insurance provider.
Managing administrative tasks, such as paperwork and accurate insurance billing, is important on the part of the service provider. Ultimately, therapists choose whether to handle billing themselves or seek help to ensure they get paid on time for the specific service availed by the clients.
Can an unlicensed therapist bill insurance?
An unlicensed therapist can't bill insurance companies. A health service provider typically must be licensed and credentialed with the insurance panel to accept insurance and file a claim. Insurance billing may not be allowed without a license, and any attempt to bill for a service may result in rejected claims.
Licensed therapists use a CPT code, taxonomy code, and accurate paperwork that includes the service date and information about the clients when submitting a claim to the insurance provider or insurer. Only those who meet the standard requirements are eligible to receive pay through health insurance and cover benefits for their clients.
While therapists choose different paths in the profession, billing insurance usually requires meeting specific qualifications.
How do you bill your clients?
First, to bill clients with insurance, check if you accept insurance policies from their specific company and are on the insurance panel for that insurance provider. It is important to verify their benefits with the insurer and use the correct CPT code and your taxonomy code when filing claims from that insurance provider. Make sure all paperwork is accurate and includes the date of service and the client's information. Once the claim is submitted, wait for the insurance companies to pay. Consider creating a short and quick video to help clients understand the process.
How do I submit a bill to insurance?
To submit a bill to insurance after a service. First, you need to make sure you’re a provider on the insurance panel. Then, check your clients’ benefits and information with their insurer to confirm coverage. When ready to bill, use the correct CPT code and your taxonomy code on the claim form. Fill out all required paperwork and file the claim directly with the insurance companies. If accepted, the insurance companies will pay according to the client’s plan.
How do you charge a client for simple practice?
First, to charge clients for a simple practice or service, create a bill based on the service provided. If you accept insurance as one of your modes of payment, check their benefits with the insurance companies. Then, as a provider, use the correct CPT code to create a claim and start filing claims for insurance billing for those insurance companies. Once processed, the clients or the insurance will pay for the service.
How do I make an insurance invoice?
To make a general or common insurance invoice, create a bill with the correct CPT code for the service and the client's information. If you accept insurance and are on the insurance panel, include the client’s benefits information. This invoice will be used for insurance billing and to submit a claim so the insurance provider can pay for the service.
How does client billing work?
Client billing works by creating a bill for each session or service conducted. Some professionals may accept cards or cash for payment. If you accept insurance, you’ll also submit a claim using the correct CPT code for insurance billing. After processing, either the client or the insurance will pay the amount due.
Which insurance is billed first?
When you accept insurance, the primary insurance is always billed first. Submit a claim with the correct CPT code to the primary insurer for proper insurance billing. Once they pay, you can bill any secondary insurance if needed.
Thanks for the feedback!
- Previous Article
- Next Article
- Addiction Treatment That Can Lead To The Best Recovery Rates
- Therapist Practice Management Software: A Vital Tool For Mental Health Therapists
- Therapist Tools And Software For Better Mental Health Practice Management
- Navigating Insurance Panels For Therapists: How To Get Approved By Insurance Companies And Start Taking Insurance
- Taking Insurance In Your Practice: The Pros And Cons Of Accepting Insurance