Attention mental health care providers,
Now focus on providing your patients with the best care, and leave the billing headaches to us!
Ensure a seamless mental health billing process with the insurance companies and keep growing by utilizing your expertise and modern solutions.
We understand the concept can be challenging and confusing for those new to the field. Check out our beginner’s guide to mental health billing here if you are new to this field.
We have created a list of the top 10 mental health billing FAQs for you to help you better understand mental health billing services. If you still have questions, please contact us; we are here to help.
1. What is mental health billing?
Mental health billing is the process of submitting claims to insurance companies for reimbursement for mental health services such as counseling, therapy, and medication management. Mental health billing typically involves coding the services provided, submitting claims to insurance companies, and tracking payments.
2. Why is mental health billing necessary?
Mental health billing ensures that mental health care providers are reimbursed for their services and that the patients have easy access to the care they need.
3. Should I opt for reimbursement of payment or stick to the “cash-only” approach?
From experienced to newcomers, we recommend every mental health care provider should opt for reimbursement of payment regardless of the reimbursement rate.
Stick to the time limit as mentioned in a service’s CPT code. For instance, if you are billing for a 60-minute psychotherapy session, any time spent beyond that is free labor. Take advantage of these overages by claiming them and generating significant revenue.
4. Is mental health billing different from medical billing?
Yes, there’s a significant difference between mental health billing and medical billing.
- A mental health billing service involves billing for therapy sessions, psychiatric evaluations, and medication management for assessing and treating mental health disorders. On the other hand, a medical billing service mainly covers the billing of physical health services, such as office visits, tests, and procedures.
- Mental health billing involves different billing codes and modifiers than medical billing. Mental health services are often billed using Current Procedural Terminology (CPT) codes that are specific to mental health, such as psychotherapy codes (90834, 90837) and psychiatric evaluation codes (90791, 90792).
- The reimbursement rates and coverage limitations for mental health billing differ from those for medical billing. A mental health bill differs from a medical bill in a variety of ways, starting with the insurance plan coverage requirements to pre-authorization requirements or limitations on therapy sessions billed annually.
5. Are mental health sessions subject to pre-authorization?
The requirement for pre-authorization of mental health sessions differs from insurer to insurer.
Generally, pre-authorization for therapy sessions, routine visits, and an initial session are not required. It is possible that additional services, such as psychological testing, might need the insurer’s approval, and some insurers only allow a certain number of appointments without prior authorization.
However, you must always check with your insurer to avoid any confusion at a later stage.
6. As a counselor, how does COBRA affect me?
The Consolidated Omnibus Budget Reconciliation Act OR COBRA plan allows people who have lost their jobs time to find new jobs with new insurance plans without shedding their coverage.
Typically, if a patient is enrolled in a COBRA plan and has a previous plan that you billed, then you would continue to bill the patient under the previous plan.
Nonetheless, as long as the client makes payments to the COBRA insurer, the insurance company will backdate the COBRA if required.
7. Who can bill medicare for mental health services?
Medicare provides coverage and reimbursement for the following mental health services providers:
- Psychiatrists or other doctors,
- Clinical psychologists,
- Clinical social workers,
- Clinical nurse specialists,
- Nurse practitioners,
- And physician assistants.
As of 2023, in the final Medicare Physician Fee Schedule, Medicare will now let
- Licensed professional counselors,
- Licensed marriage and family therapists,
- And other practitioners provide mental health or substance use disorder services under the general supervision of a billing physician or non-physician practitioner instead of under their direct supervision.
8. Is there a time limit for filing a claim?
There are different time limits for making a claim depending on the insurer. Insurers are often required to file claims immediately after receiving services – for private insurers, this is often a 90-day rule. Others, however, are more lenient with their time limits when it comes to filing claims. It is recommended to always keep in check and stay updated with your insurer.
9. Is it best to outsource mental health billing?
It can be difficult to manage mental health billing for providers of mental health services. A number of providers utilize third-party billing services to manage their claims and revenue cycles.
Outsourcing mental health billing is advisable because:
- The experts will help you maximize your revenue through coding.
- To avoid missing submission deadlines or having your billing disorganized and behind schedule.
- Let the staff manage and claim your bills so you can focus on providing the best services.
10. Why should you use Preferred Billing for mental health billing?
You devote your time to providing therapy to clients since that is your core function. Our mental health billing services are tailored specifically to mental health practices and handled by our knowledgeable staff. As your vendor, we will take care of the entire billing process for you from beginning to end so that you do not have to worry about anything.