An Overview of Mental Health Billing

Mental health billing can be quite complicated depending on a variety of factors. In this blog, we are going to take you through the key factors that separate your practice from collecting payment from an insurance company. By the end of reading this blog, you will have a blueprint for billing insurance in your private practice.

Credentialing

Credentialing with insurance companies is one of the largest barriers to receiving payment from insurance companies. Credentialing for you and your practice can look different depending on the situation and the goals that you have for your practice. We will take you through some best practices for credentialing yourself and your practice as well as Credentialing therapists within your practice.

In order to credential with an insurance company properly, you must be organized with your documentation. Credentialing is the process of becoming a network provider for a particular insurance company. Insurance companies will not remit payment to a provider that has not verified that they are qualified to provide therapy services to clients. Therefore this process is all about proving that you are who you say you are. The more organized you are with the key documents included in credentialing the better.

Taking your time to fill out the insurance applications is another critical step in the process. Applications to become an in-network provider are long and can require a lot of brain space. It is important that you schedule plenty of time to make sure that you are filling out the application properly. We recommend having all of your documentation organized to make this process easier but it will still require a few hours to fill out an insurance application the way that you would like to be credentialed.

How you credential with the insurance company depends on your goal. If you are a solo provider and want to remain a solo provider without hiring therapists you can credential yourself with your type one NPI, your Social Security number or your tax ID, and not obtain a group NPI for your practice. This is a very simple way to credential with the insurance company but is not flexible for growth as a practice. If you are looking to grow your practice we would recommend obtaining a group NPI for your practice and obtaining a tax ID for your practice, then credentialing your group and credentialing yourself as an individual under the group.

Claim Submission

Claim submission happens after you credential with the insurance company. This part of the process can be straightforward but we have a few things that we would recommend that you watch for when you go to submit claims.

We recommend that you check the NPI and tax ID that you were using when you submit the claim. Based on your credentialing that information can differ based on the insurance. Quality checking your claims for accuracy is always a good idea before submitting the claims. We also recommend that you check the eligibility and benefits of your client before you submit a claim. If something has changed with your client’s insurance that will cause problems when you go to submit a claim.

Finally we recommend that you check for any relevant modifiers based on the service that you provided. Some insurances have different guidelines based on telehealth rules and some have different modifier guidelines based on your place of service if you didn’t see your client in an office.

Familiarizing yourself with each insurance company that you were in network with and the requirements that they have for submission is necessary in order to get paid.

Payment Posting

Once you have submitted a clean claim to the insurance you will likely receive payment from the insurance company. With that payment, you will find something attached to the payment called an explanation of benefits. This document explains where the money should be applied. Most of the time insurance companies pay claims in batches for multiple different client sessions. Because the payment applies to different people on different days the insurance company provides guidance on where the money should be applied. This also tells you where you need to follow up on unpaid claims.

This process will involve decoding each insurance company's specific language that they use to communicate payment and denials. This is where a professional biller usually provides their value. A biller with extensive knowledge of insurance denials and payment posting will be able to cut through the ambiguity of each insurance company and render payment quicker than you could. Not only payment velocity but also saved time in frustration is a value to you as you grow your practice.

If you have not employed the services of a professional biller then you will need to carefully review the explanation of benefits and carefully apply the payments as directed by the insurance company. You will also need to follow up on claims from this point forward.

Follow-Up

Just because you have received payment from the insurance company and have applied it within your electronic health record system does not mean that the process ends there. Revenue cycle management is a process that is ongoing but ends with a follow-up of unpaid claims. No matter how long you have been in private practice you will at some point experience when an insurance company does not pay a claim or somehow bungles the claim process. This is where you will need a forensic and academic process of following up on claims and ensuring payment to your practice.

Depending on the situation, follow-up on claims that are unpaid can take months if not years to resolve, and this part of the process consumes unknown hours of clinician time every year. If you have hired therapists in your practice this is one area where having an admin or a biller can provide invaluable services to them.

Conclusion

Revenue cycle management and mental health billing can be a valuable and enjoyable part of owning a private practice. Not only can you provide your services at a cost affordable rate to your clients and the general public but you can also depend on the insurance company to be a valuable partner in the growth of your private practice. Managed poorly the revenue cycle management of your practice can be an incredible pain point that you feel not only in time cost but also in financial burden as well. Feel free to reach out if you need help or consultation on the revenue cycle management process within your private practice. Our experts would be willing to answer any questions that you have!