They can also identify related health problems and are used with CPT codes for billing insurance. ICD codes are listed in The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), generally known as the DSM-5, which gives therapists and psychiatrists the correct codes for billing. If you have tons of time and need to save money, use an EHR system without a billing team and submit and follow up with claims on your own. EHR software and insurance company website is different and we have no general way to suggest how to do so — please see documentation for each. Happy to do this whole process for you as every other billing service should. Refile claims that have been received and rejected, you normally have a longer time to refile claims as corrected.

These codes are used to identify specific procedures and services provided by healthcare professionals, including mental health practitioners. You use this tool every day, so why not make it a habit to check the “claim status” section that’s included with and provided by your clearinghouse? It’s already integrated with practically every payer that exists in the mental health billing world…so it can pull up the claim status for everything you’ve submitted through it. Our Beginner’s Guide to Mental Health Billing is for the brand new and having-no-clue outpatient therapist looking to learn how to bill insurance companies. You will learn what client information you need, how to verify mental health benefits, create and submit claims, and account for EOBs.

How Is Mental Health Billing Different From Medical Billing?

Explore the core elements of mental health billing and master best practices for precise coding and documentation, empowering practitioners and stakeholders alike. Traverse the dynamic interplay between insurance coverage and mental health billing on this pathway. The more specific your providers and billers can be about services rendered and diagnoses made at clinical encounters, the more you’ll get paid.

Alex is a psychologist and mental health billing expert, and helps mental health professionals collect more revenue as owner of ePsych Billing. Since a clearinghouse acts as a middleman between you and insurance organizations, they’re an essential piece of the mental health billing puzzle. After all of this and even after Medicare’s electronic submission requirement, some payers STILL don’t have claim submission web portals. 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.

Follow Up On Insurance Claims Processing

You’ll want to do this for each date of service (DOS) that you have submitted to ensure they are processing. If you don’t know which CPT codes to use for billing, refer to our popular and easy to read guide here. You are to charge them after the fact for their mental health billing for dummies patient responsibility payment per session as listed on the completed EOB your receive from filing your claims. Now it’s time to verify their insurance coverage and your network status in their plan, then their benefits based on all of that, via a phone call.

If you know the available coverage for every patient before you provide services, it will be much easier for you to submit proper claims and minimize frustration for you and your patient. 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. When these services are billed to health insurance, it is often a simple task because routine checkups are frequently under one general charge.

Somewhat Ideal: Payer Web Portals

Understanding their relationship is vital for practitioners, insurers, and policymakers working to improve access to comprehensive mental and emotional well-being care. Mental health billing’s distinctions arise from the nuanced characteristics of behavioral health services. Acknowledging these differences is essential for accurate reimbursement, effective treatment, and continued progress in destigmatizing mental health care. Payers and clearinghouses will allow you to track electronically-submitted claims on a user dashboard. Third-party billing services should provide you with regular status reports. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best.

There is a wide range of factors that contribute to the differences in these services. The length of a session, the location of services, the therapeutic approach, the age of the patient and their willingness to participate can all affect coding and billing. Appreciating the nuances that set mental health billing apart from traditional medical billing underscores the need for tailored approaches. Acknowledging the symbiotic relationship between behavioral health billing and mental health billing showcases the diversity and unity within psychological well-being services.

Mental Health CPT Code Cheat Sheet

Before providing services, verify the client’s eligibility for mental health benefits. Contact the insurance company or use their online portal to confirm coverage, co-payments, deductibles, and any pre-authorization requirements. This step ensures that both the client and the provider are aware of their financial responsibilities. Ensuring that all components of mental health billing are accurate and on time can be challenging. With ICANotes, you can worry less about getting your documentation right and spend more time with your patients. We offer a solution to the many complexities in the healthcare environment that make your job more difficult.