Managing Your Practice: How To Bill Insurance As A Therapist

Navigating the intricacies of billinghow to bill insurance 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. 

Exploring billing options

While implementing a billing process is a requirement of any business, the process of medical billing can be a daunting one. 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: 

• 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.
• Alternatively, you can handle the billing process on your own, either manually or through the health plan's provider portal (if available).
• 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 knowledgeknowledge about billing, and develop familiarity with the CMS-1500 format.
• Consider utilizing practice management software that provides seamless therapy billing capabilities. IHowever, it's essential to research thoroughly, ensuring the chosen platform supports all the necessary functions for successful therapy billing.

Regardless of the chosen method, having a fundamental understanding of therapy billing and claims is essential for any clinician.

Important 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. 
• 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 as they 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.
• CPT Codes: Commonly known as service codes, Current Procedural Terminology (CPT) codes play a vital role in insurance claims. These codes assist insurance companies in identifying the specific types of treatment provided during therapy sessions.

Becoming an in-network provider

Whether The “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. 

As a practitioner, in-network agreements allow therapists to offer services at a reduced rate, creating more affordability for clients. 

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. TFurthermore, taking the time to identify which insurance providers offer the most competitive reimbursement rates is also recommended. 

Getting credentialed

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: 

• 1. Building trust between clients and medical professionals.
• 2. Demonstrating adherence to specific standards outlined by insurance companies.
• 3. Increasing the likelihood of collaboration with insurance companies.

The credentialing process encompasses several steps., including:

1. Review liability coverage requirements

1. Obtain professional liability coverage

2. Obtain malpractice insurance

2. Gather essential documents, including:

1. Details of professional liability coverage and malpractice insurance

2. Your practice license 

3. Practice tax ID number

4. A completed application form

3. Visit the insurer's website and submit an online application to join their list of approved providers.

4. Complete the Council for Affordable Quality Healthcare (CAQH) Pro View Application.

5. Self-report details about your education, training, and experience within the CAQH application.

6. Ensure you have compiled all necessary documents as specified in the first step.

7. Submit the gathered documents to the specific insurance company networks you intend to join.

8. 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 likelyssion is advised.

Prior Aauthorizations

Prior authorization, also known as preauthorization or precertification, is a cost-control process implemented by health insurance plans that requires 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 into this process, securing prior authorization can be challenging. However, it fills two essential objectives: 

1. Eensuring reimbursement for provided services and .
2. Ssafeguarding 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 ClaimSubmitting an insurance claim

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.

ToIn order to submit claims, it’s imperative to meet specific deadlines set by insurers, noting that these deadlines tend to vary amongst companies. To successfully fill out electronic claims forms, the following information is essential:

1. Provider's name
2. Practice tax ID
3. Client information, including full name and date of birth
4. Details aboutpertaining 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:

1. Cross-check every detail
2. Confirm that patient identifiers match the information on their insurance card
3. Review insurance requirements before form submission
4. 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 diagnosesdiagnosis 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 encompass:

• 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 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.