We’re going to help you figure out the outline of mental health insurance billing. There will be many links to other resources, scripts, and templates to help do mental health billing for dummies. The selection should not be based on the number of diagnoses a patient has or the overall complexity of the patient’s physical and psychiatric illnesses.

• Call the same company using the same eligibility and benefits number and ask for claims processing and EOB accounting.
• Mental health billing’s distinctions arise from the nuanced characteristics of behavioral health services.
• Mental health billing is one of your most important tasks, yet it can be overwhelming and burdensome.
• Within the complexities of mental health billing, practitioners and institutions strive to provide quality care while ensuring financial sustainability.
• Instead, outsourcing provides transparency and allows you to monitor your practice from an automated standpoint.
• You need to gather your provider information, the client’s demographic information, and the client’s insurance card information.
• Also perform a new eligibility and benefits check for that client from Chapter 2 of this mental health billing for dummies guide.

If you mention the word “billing” to any mental professional, they’ll shutter. With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth. Learn how to run a successful private practice with tips from this 20-minute webinar session. You want to know you can call your billing admin, a real person you’ve already spoken with, and get immediate answers about your claims. It’s our goal to ensure you simply don’t have to spend unncessary time on your billing. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server.

Chapter 4:  EOB & Claims Processing

Sometimes, a therapist or psychiatrist will provide therapy sessions to a patient’s family, whether or not the patient is actually present. This service is sometimes considered for payment by the insurance company, depending on the situation, and documentation that it was a medically necessary service. When a CPT code represents a less serious diagnosis or a less expensive therapy than was actually provided to a patient, this is known as undercoding. Upcoding refers to the assignment of a code by a provider for a patient that represents a more serious diagnosis or more expensive treatment than is actually the case. Both undercoding and upcoding are strictly illegal as they do not accurately represent the services rendered and could be construed as fraud by the payers. However, if not intentional, these could also happen due to an untrained or inexperienced coders without much process knowledge.

This type of form replaced UB-92 forms in 2007 and it’s also sometimes referred to as CMS 1450. Fair warning, I’m about to bring in another general statistic to help paint the healthcare billing landscape. A more recent survey from 2021 determined that 85% of denials are preventable.

Why Mental Health Billing Can Be Complicated

With mental health becoming a bigger part of the healthcare landscape, billing rules and regulations are always changing. Many of the telehealth codes, for example, were added during the COVID-19 pandemic. The Centers for Medicare and Medicaid Services (CMS) continues to update its telehealth fee schedules. Billing for a 45-minute therapy session may not be as straightforward as billing for a yearly wellness check or lab test.

Review the EOB to ensure accurate payment and check for any denials or adjustments. If a claim is denied, identify the reason and take appropriate action to correct and resubmit the claim promptly. This may involve providing additional documentation or appealing the denial if necessary. COB refers to the process of determining which insurance plan has primary responsibility for covering a patient’s healthcare expenses when they have multiple insurance policies.

Explanation of Benefits (EOB)

The claims that come back to you with a denied status are particularly important. That way, you can easily tell the status of that piece of mail and whether or not the paper claim got to the payer’s address. Hopefully, you’re using at least an Excel spreadsheet in tandem with this process to record your results. Unfortunately, now we need to figure out what happened to the claim and whether or not the payer accepted it. Lucky, it’s a pretty straightforward process…you just need to know where to start.