Mental Health Modifiers: The Definitive Guide 2023

To ensure the financial health of your mental health practice, fast, efficient, and effective mental health billing services are essential. Behavioral health providers should be aware that many commercial insurance companies and state Medicaid programs outsource their mental health claims to an outside third party. This is important because the claims address on the card isn’t always the correct address and if you submit to the wrong address your claims will be rejected.

You are to charge them after the fact for their patient responsibility payment per session as listed on the completed EOB your receive from filing your claims. A claim that uses previous billing information to make changes to future billing for that same service date. This form enables you to do advanced changes to your claims and billing. We do this for free, but here is a guide and script on how to do eligibility and benefits calls yourself. Documentation for CPT Code for an diagnostic evaluation must reflect a face to face meeting and this code requires a face to face meeting based on Medicare’s requirements. This means that only medically licensed professionals, such as a psychiatrist, can bill 90792.

Reasons Why You Should Avoid Medical Transcribing Services

We also recommend saving copies of any forms you file, including invoices and superbills. We get it, it’s why we created a mental health insurance billing service after all. Our mental health insurance billing service, TheraThink, calls to verify on your behalf to find out.

The process by which you fill out a CMS1500 form with your client’s demographic and insurance information, your provider information, and the appointment information. You call that company to inquire if they have active coverage, if you can see them based on your relationship with that insurance company, and if so, what their copay, deductible, or insurance looks like. James regularly works with therapists and mental health practitioners in helping them to better handle the challenges of Managed Care. These rates are at the upper level of reimbursement for CPT Code and because Medicare is picking these rates, they are specifically for LCSWs. CPT Code is typically billed for the initial intake appointment a client will have. Subsequent sessions will be billed with procedure codes and 90837, depending on the appointment duration.

Claims Submission and Reprocessing:

If not, the billing process will get tougher to handle than ever, errors will accumulate and the claims might get rejected even. With the level of patient frustration that may rise along with the inaccuracies, practices also might encounter significant deterioration in their efficiency. It’s important to know the types of covered mental health services for your patients who may have varying insurance or medical coverage. For example, some insurance will only cover mental health services by specific providers, such as physicians, psychiatrists, clinical psychologists and clinical social workers.

If your clearinghouse doesn’t have electronic connections to the Medicaid MCOs within your state, you won’t be able to submit claims that use Medicaid as their insurance. This is mostly because every payer has a different web portal to submit claims and they usually don’t provide the best user experience. So, although you’re technically submitting your claims electronically in this sense, it’s STILL a very manual process. In other words, it’s like a second set of eyes reviewing your claims before you submit them so that you don’t receive a denial. Essentially, you submit your claims to a clearinghouse, it runs your submission through a series of automated tests and alerts you to any errors.

Manage your time wisely:

It gets complicated so it’s important to have a biller who makes sure that the claims are filed correctly to avoid payment delays. Psychiatrists, psychologists and therapists can improve their collection rate by hiring trained staff who understand billing for mental health services and the ins and outs of the insurance industry. The extra cost of hiring someone will be offset by the increase in revenue from seeing more patients and building your practice.

• You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%.
• Request as many facts as possible, including the patients’ full legal names and current addresses.
• Be sure to document both the total time and the time spent counseling and/ or coordinating care, as well as specifying what you educated the patient about or what care was coordinated.
• This type of form replaced UB-92 forms in 2007 and it’s also sometimes referred to as CMS 1450.
• If you’re interested in exploring how our mental health counselor billing software can streamline your practice’s operations, please contact us to schedule a free demonstration.

Although it seems straightforward, it’s worth mentioning that you bill for the first appointment first and then refer to the other codes based on session length. Gathering the information from your clients is only the first step, it’s also your responsibility to ensure that it’s accurate, up-to-date and eligible. If you submit a claim to a payer after the timely filing limit lapsed, you’ll receive a denial. Your NPI is a 10-digit number that’s used to identify you to other healthcare partners and payers. Eligibility doesn’t say what providers are “in-network” and “out of network”. Thus, if you’re using an eligibility solution provider, you still need to determine that yourself using the information presented to you.

Understand CPT Codes

It’s often a much more complicated affair due to the nature of the patient population being served as well as the way these patients receive insurance coverage. At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. APA’s Practice Management HelpLine often receives calls from members whose use of the higher-level CPT medical evaluation and management (E/M) codes is being questioned by payers. CPT is an acronym for Current Procedural Terminology and a CPT code is a 5-digit number code signifying the types of services you’re providing as a health service provider. Our behavioral health CPT code cheat sheet gives you a short list of the most used codes.

• You should bill on the basis of time only if more than 50 percent of the entire visit meets the CPT definitions for counseling and/or coordination of care.
• If you are struggling to find out the place of service code or modifier to use for your insurance claims, this is something we provide as part of our billing service free of charge.
• That includes questioning claim rejections, pursuing full payment of partially-reimbursed submissions, and following up on approved claims that have yet to be paid.
• Now it’s time to check eligibility and benefits to ensure they have coverage that will reimburse you.
• On top of that, medical insurance for mental health will only have coverage up to a certain extent which makes it very hard for the medical professional.
• Diagnosis coding allows mental health professionals to identify different treatments, diagnoses or actions given to the patient.

If you want to spend as little time as possible, use a billing service. Happy to do this whole process for you as every other billing service should. Use digital claims processing when possible for better tracking of your claims and data and faster claims submission. Normally mental health billing digital options to have a cost, for EHRs, so consider your options in choosing an online tool. Save any dates of service that never made their way to the insurance company. Perhaps you submitted online, check your portal to see if claims are accounted for in your account.

When you start working for a new client, always check if preauthorization is required before providing any non-standard session. It’s always best to check benefits before the first session and re-validate at the start of the year when coverage renews or if your client’s insurance changes. If you’ve filed a claim and had it denied because the client is no longer covered by his or her old plan, you’ll need to contact the client and get their new information. If they don’t have insurance, you’ll need to try to get payment from the client.

You should bill on the basis of time only if more than 50 percent of the entire visit meets the CPT definitions for counseling and/or coordination of care. These rates are for Medicare and do not represent a guarantee of payment from any company, rather this is public data published by CMS.gov annotating a national rate schedule for mental https://www.bookstime.com/ health CPT codes. 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.