How to Handle Insurance Billing for Group Therapy

Handling insurance billing for group therapy sessions can be a complex and time-consuming process, but it is an important aspect of running a successful mental health practice. In this blog, we will explore some best practices for handling insurance billing for group therapy sessions, including how to determine insurance coverage, how to create and submit claims, and how to handle denied claims.

First and foremost, it is important to determine whether or not a patient's insurance plan covers group therapy. This can usually be done by contacting the patient's insurance company or looking up their coverage information online, otherwise known as an eligibility and benefits check. The best practice would be to confirm this before seeing the patient in a group setting. It is also a good idea to familiarize yourself with any specific policies or exclusions that may apply to group therapy. Eligibility checks are something that Practice Solutions billers complete for you upon request when signed up for our billing services. Our billers are able to lend their expertise on interpreting insurance coverage so that you can communicate with your patients clearly and compassionately.

Once you have determined that a patient's insurance plan covers group therapy, the next step is to create and submit a claim. This process can vary depending on the insurance company, but generally, you will need to provide the following information:

Patient's personal and insurance information
Provider's information (including National Provider Identifier (NPI) number)
Date of service
Type of service provided (group therapy)
Diagnosis code(s)
Procedure code(s)
Amount charged for the service

For a more in-depth tutorial on how to fill out a claim form, read our blog post CMS Claim Instructions: A Step by Step Guide. It is important to ensure that all of this information is accurate and complete, as any errors or omissions could result in the claim being denied. Better yet, a Practice Solutions biller will carefully prepare, review and submit claims on your behalf when you are signed up for billing services. It is also a good idea to keep thorough documentation of all group therapy sessions, including attendance, duration, and any notes or observations made during the session. This will not only help you to accurately bill for the services provided, but it will also serve as a useful reference if any issues arise with the insurance company.

Once the claim has been submitted, it is important to follow up with the insurance company to ensure that it has been received and is being processed. If the claim is denied, it is important to carefully review the reason for the denial and take any necessary steps to resolve the issue. This may involve providing additional documentation or appealing the decision. Claim follow up and denial management are also included with Practice Solutions Billing Services.

There are several common reasons why insurance claims for group therapy sessions may be denied, including:

The service was not deemed medically necessary
The service was not covered under the patient's insurance plan
The claim was submitted with incorrect or incomplete information
The patient's deductible has not been met

If the claim is denied for any of these reasons, it is important to work with the insurance company and the patient to resolve the issue and get the claim approved. This is where detailed documentation and notes will come in handy, as this may involve providing additional documentation or appealing the decision.

It is also important to keep in mind that insurance reimbursement rates for group therapy sessions may be lower than for individual therapy sessions. This is because group therapy is generally considered to be less intensive than individual therapy and may be seen as a less costly treatment option. As a result, it is important to carefully consider the costs and benefits of offering group therapy and to communicate any potential financial considerations to patients upfront.

In conclusion, handling insurance billing for group therapy sessions can be a complex process, but it is an important aspect of running a successful mental health practice. By understanding insurance coverage, creating and submitting claims accurately, and following up on any denied claims, you can ensure that you are properly compensated for the group therapy services you provide.