Our Mental Health Billing Beginner’s Guide is for new outpatient therapists who want to learn how to bill insurance. In this guide, you’ll discover what client info you need, how to check mental health benefits, send claims, and handle EOBs.
Mental health insurance claims need lots of info, but it doesn’t have to be too hard. Our guide starts with client info, covers common CPT codes for mental health, explains checking eligibility and benefits for behavioral health, and shows how to send claims.
These steps may not be just one step each, but with this organized guide on billing mental health insurance, let’s get started! In the end, you will also come to know the importance of hiring medical billing services in Illinois for better financial management of the practice.
Selecting a Mental Health Diagnosis
We won’t recommend using a single diagnosis code, though many therapists do this (e.g., anxiety or depression).
Your responsibility, when submitting an insurance claim, is to provide the most precise diagnosis for each session. If the diagnosis changes, update it on your claims forms.
If not, use our ICD10 Mental Health Diagnosis Code Search Tool to choose the most accurate diagnosis.
Great! You have all the patient and session info needed to file claims. Now, let’s check eligibility and benefits to make sure they have coverage that will pay you back.
Easy Steps to Check Mental Health Coverage
Do you need to find out if your insurance covers mental health services? Follow these simple steps:
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Call the number on your insurance card.
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Ask about your mental health coverage.
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Share your NPI and Tax ID to check if your provider is in-network.
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Provide the patient’s details: name, birth date, and subscriber ID.
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Find out the deductible, copay, and coinsurance for the patient.
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Get the claims mailing addresses.
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Stay calm during the process!
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If it’s too much, consider letting us handle it for you.
Now you have all the info you need to file claims, charge the patient, and send claims where they belong.
Simple Guide to Mental Health Billing: How to Get Paid
Unfortunately, this part can be frustrating and a bit tricky. There’s no easy way to do it quickly.
One affordable option is to use “Practice Mate” from Office Ally for submitting claims, even though it’s mainly for hospitals.
You can also try using software to put in the information and make the forms. Or, if you’d like help, you can contact us. We handle all the billing for you (not free, but it might reduce your stress and help you live longer).
No matter how you choose to do it, you’ll have to copy this info onto a CMS1500 form and send it to the insurance company, either electronically or on paper.
Once you’ve completed that step…
Call to Check Your Claims and Payments
If you sent your claims by mail, give it 4 weeks, then call to make sure they got them. If not, find out where to send them and try again.
It’s super important to get this done within the 90 days that most insurance companies require.
Once they say they got your claims, all you can do is wait for your payment. It usually takes two to three weeks for them to process your claims and send a check.
You’ll get something in the mail with your payment, and it’s called an EOB.
How to Deal with Mental Health Billing Denials, Rejections, and Appeals
Denials or rejections can occur either at the Clearinghouse or the insurance company level.
To check for Clearinghouse denials, use your EHR portal. Look for missing enrollment, incorrect subscriber ID, or wrongly filled details. We can assist you with this step.
Make sure your claim isn’t denied at the Clearinghouse by asking the insurance company if they have it on record. If they do, it has passed through the Clearinghouse. If not, you need to fix the issue at the Clearinghouse stage.
If the insurance company has your claim on record but denies it, figure out why. Common reasons include late submission, terminated coverage, benefit coordination problems, unauthorized sessions, or outdated provider information.
Take it step by step, claim by claim, and fix the claims with the insurance company.
If you need to appeal, contact customer support to get the necessary forms. Use the reference ID from your eligibility and benefits verification call to support your case.
Dealing with denials and rejections can be challenging. Many mental health providers opt for billing services like TheraThink to handle this task because it can be a headache and isn’t what you’re trained for.
Considering outsourcing this work to experts can also help to save you from unnecessary stress. Hiring third-party medical billing companies can help every specialty. Most primary care clinics have seen a rise in their revenue after partnering with medical billing firms.
Conclusion
Dealing with insurance claims can be a real hassle. We wish it was simpler because it leads to lost revenue, frustration, and inefficiency in healthcare. Firstly, selecting the mental health diagnosis is the main part, dealing with the code requires careful analysis and needs to put the most accurate code that relates to the medical condition. Secondly, timely claim submission is also a necessary part for timely reimbursement. Thirdly, timely follow up and timely appeals are also necessary to get reimbursement.
