Mental Health insurance billing has several distinct differences when compared to other forms of medical insurance billing. Psychiatrists, psychologists, psychoanalysts, and counselors all have established client bases that return regularly to receive treatment, whereas a standard medical practice will only have a small minority of patients that require regular follow up.
Another key difference is the way in which counselors and therapists provide their services. In a standard medical setting, insurers and patients are billed per specific treatment. However, in the field of mental health services, insurers and patients are primarily billed for psychological testing, medical management, and therapy leading to added complications. Insurers have regulations in place about the length of the session they are prepared to pay for and the number of sessions that they will pay for each week or day, with the overall number of sessions being limited. These rules will differ depending on different insurers’ policies, and, frequently, the patient’s mental health requirements will exceed the level of services that the insurer will pay for. This makes balancing treatment plans with sufficient reimbursement a challenge for professionals in the field.
Should Practitioners Accept Insurance?
With all these issues in mind, it is easy to see why one of the problems faced by mental health service providers is whether they are prepared to accept medical insurance at all. While participating with insurance companies often represents an unappealing concept, and many mental health service providers would prefer to be a cash-only practice, in reality, most patients who have insurance coverage will choose to use a practitioner who will accept their policy and who will bill out their insurance.
The Hardest Parts of Mental Health Insurance Billing
By far, the most challenging element for mental health service providers who carry out their own billing is the number of hoops that billers must jump through when dealing with different insurance providers. Time management is a serious problem and trying to juggle patient appointments and filing insurance claims can be incredibly difficult. Ensuring you’re up to date on the various diagnosis codes and understanding how and where each claim should be submitted add additional elements of complication to this process.
Knowing which department claims should be sent to can be pure guesswork, and making a mistake can lead to rejected claims, wasted time, and lost money. For example, if paper claims are submitted to companies that only accept electronic claims, they will end up being rejected. If a claim is submitted to a company that has outsourced its mental health service claims to a third-party company, again, a rejection will be in the pipeline.
One of the major problems with accepting insurance is that practitioners have little time to ensure they are being paid on-time and in-full for every visit. Dealing with the issues that arise as a result of insurance billing can be extremely time-consuming and take mental health practitioners away from the most important element of their practice – their patients.
To guarantee that payment is being fully received, reliable systems need to be put in place for billing out, tracking, and time management. Following some simple best practice rules will reduce the issues associated with developing an effective system.
Always taking the time to pre-verify the eligibility of new patients is vital. This puts practitioners in a strong and clear position when it comes to sending claims, requesting authorizations, asking for co-payments, and determining outstanding deductibles.
Backing up information is essential for HIPAA, as well as for the practice’s own records. Taking a photocopy of both sides of patients’ insurance cards will ensure that all the information is accurate and that you have the correct number to call when verifying eligibility for patients.
Collecting as Much Information as Possible
When collecting information from patients, getting more detail than necessary to file a claim is always beneficial. Some of the key data to obtain include the insured’s date of birth and address, as well as his or her Social Security Number. Some other useful information is a work telephone number and all addresses for the past two years. This will ensure that you have all of the information you could possibly need when contacting the insurance provider.
Recording Telephone Calls with Insurance Companies
Every time you call a patient’s insurance provider, ask for the reference ID and operator’s name for the call. It is also wise to note down a few details about the conversation, including the name of the insurer, the date of the call, the telephone number you used, the name of the operator, and the call’s reference ID. You should consider adding this information to a spreadsheet prepared for this purpose. This allows you to cross-reference details should there be a problem with the insurer in the future.
One of the primary rules about mental health insurance billing is to file claims as quickly as possible. Always confirm that a claim for a new patient has been correctly filed after a three-week wait in the case of an electronic claim or a four-week wait for a paper claim. If it turns out that a claim is not being filed correctly, you can then resolve the problem quickly.
Bill insurance providers as quickly as possible to prevent a number of issues related to late payments. Many insurers have a 90-day cut-off date for claims, and you could lose a lot of money if you fail to submit claims in a timely manner.
Although dealing with mental health insurance billing can be a daunting, applying these best practices can help ensure that medical practices are getting the money that they have earned in a timely manner without the undue hassle. Alternatively, practitioners can look for a third-party billing service to handle the problem, thus freeing up more time and removing the burden of billing responsibility from the practice.
Talk to United Billing Group about your insurance billing challenges.