Medical Billing & Coding For Dummies Cheat Sheet

mental health billing for dummies

Double-checking patient insurance can also help you identify authorization requirements or any changes in their plan or coverage — as many patients may forget to inform you of changes. Verifying this essential component will also help you learn how to bill insurance companies for counseling accurately. Double-checking can lead to more efficient processes in your practice or clinic.

  • Some involve coverage issues, others are easy fixes, like outdated or missing information.
  • Ensuring that all components of mental health billing are accurate and on time can be challenging.
  • The allotted time today’s date of service from which you can file a claim.
  • You can fill out the UB-04 electronically or on paper, and several software programs have a current version of the form and instructions on how to complete it.

This may take some additional time on your part, but it will be worthwhile when you can avoid common mistakes. If you want to check your patient’s coverage, you can perform a verification of benefits (VOB). This procedure will give you a better idea of your patient’s insurance plan and provide them with treatment and services accordingly.

How to Read Mental Health Eligibility Verification Data

The image above is a screenshot of Health First Colorado’s claim submission web portal. Lucky, it’s a pretty straightforward process…you just need to know where to start. Sometimes when eligibility responses come back it will explain what’s “in-network” and “out of network”. They’re a 5-digit code that the Department of Health and Human Services (HHS) created to instill uniformity. Once scrubbed, your claim is ready for submission to a payer for reimbursement. Rejections are better to receive than denials because they happen sooner and don’t affect your bottom line nearly as much.

mental health billing for dummies

The type of form you’re required to submit to the payers you work with depends on what type of behavioral health organization you work for. 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. Luckily, we’re going to learn together by breaking down the essentials of mental health billing in this definitive step-by-step guide. In other words, if you’re wondering if there are ways to improve your billing processes and increase the revenue for your mental health organization, there’s hope.

Reading Payer Contracts for Key Medical Billing and Coding Details

You see, the average initial claim denial rate in Q3 of 2020 alone hit over 11%. At the time that was an all-time high and the survey that that statistic came from suggested that denial rates weren’t mental health billing for dummies slowing down. We have a guide called “How to Check Mental Health Eligibility and Benefits” at this link which contains a script and thorough questions to ask so you gather all necessary information.

We also recommend saving copies of any forms you file, including invoices and superbills. If you are not billing your add-on codes for 90+ minute intake sessions, consider hiring us as your mental health insurance billing service to help; we are experts. However, regardless of the services you provide, it’s always a good idea to check that your patient is covered for the mental health services they need. Performing a VOB can also help you determine the amount that your patient’s insurance company will pay for the services they are seeking. To do this, you can call the patient’s insurance company provider using their account number to get a better idea of their benefits. As with any mental and behavioral health industry procedure, it doesn’t hurt to double-check yourself.

CPT Code 90791 Description

That being said, we recommend snapping a front and back photo of their insurance card for your records. ● +90840 ­ Add­on code for an additional 30 minutes (75 minutes and over). Take your expertise to the next level by reviewing our Definitive Guide to Mental Health CPT codes.

If you don’t want to use one centralized EHR system, you can file claims to each insurance company’s website via the submission guidelines in Chapter 2. Procedure code 90791, along with and 90837, is one of the most frequently billed CPT codes for licensed behavioral health providers. For many owners and managers of behavioral health practices, it makes perfect sense to outsource their medical billing. If a patient fails to pay their COBRA (and some do, because it’s expensive), then they will lose their insurance coverage and your insurance claims will not get paid. COBRA gets renewed on a monthly basis, so you may want to call and check to see if your client is presently active under COBRA.

For complex services like a 70 minute emergency call and then a two hour emergency session at their home, you might have absolutely no idea how to bill that situation. If you aren’t sure how to submit the claim accurately, consider asking a colleague or hiring an expert. When retroactive authorization can be awarded, do so and when not, fill out the necessary paperwork to request authorization. IF YOU MUST bill claims via paper, ask about their claims address as well. Ask if this client has active coverage, including the effective date.