Billing and payments can be complicated at the best of times. Whether you are managing self-pay clients who require a superbill or insurance claims, you need to be on top of the process to ensure your counseling practice thrives.
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As I’m sure you know, managing medical billing is one of the most complicated processes within the healthcare industry. To help simplify billing for you and your clients, we’ve created a counseling guide that breaks down the different components required for an efficient and effective system. First off: patient information. Because billing documentation is processed via insurance companies, it is essential that they contain the right information. If they don’t, this can lead to a rejected claim, which delays payment for your business. Obviously, this is a situation you want to avoid as much as possible. When you bill insurance companies, you need to include patient demographic information, including their name, date of birth, address, and sex (male or female). For insurance information, you need to include the patient’s subscriber ID with the alpha prefix. It is a common misconception that the patient’s phone number/email address and social security number are also included. Whilst it is definitely a good idea for your counseling practice to have records of this information, they aren’t required when you bill an insurance company.
When you submit any claim, you need to ensure that you are using the accurate CPT codes. Because these differ so widely depending on the methods of your counseling treatment plan, it is essential that you are apt at translating your services into the relevant codes. This can take a bit of time to perfect, and you should always double-check your codes before you submit the claim. In mental health, the three most commonly used codes are:
Although your codes will change depending on the specific aspects of your sessions, these will most likely be the three that you use more often. Once you know the codes, billing insurance companies is a fairly straightforward process.
There has been a recent surge in the number of counseling practices using telehealth to deliver their services, and if this is the case for you, there are a couple of things to keep in mind when it comes to billing. You should always use the most suitable codes, including 90791, 90834, and 90837, rather than including “telehealth” specific CPT codes. You also need to contact the relevant insurance company and determine what the Place of Service Code is for their business and the telehealth modifier that they use. If your claims do not use the right codes for these aspects, they will be rejected. This can be hard to keep track of, especially if you are out of network, but staying on top of these codes will ensure your claims are processed and you receive faster reimbursement.
After you have organized your claims, it is time to submit them. Unfortunately, this is the most complicated aspect of billing and it will inevitably take you a little bit of time before you have perfected the process. One of the best options for healthcare businesses is to use practice management software that integrates with billing services designed to streamline this process and reduce the possibility of rejections and denials.
After you have submitted your claim, you should wait four weeks before calling and verifying that they have been received. If they haven’t, you need to resubmit them as soon as possible. The majority of insurance companies have a 90-day timeframe in which your claims must be submitted, so staying on top of this is essential to receiving reimbursement. After your claims have been received, you can expect to wait approximately two to four weeks before payment.
Payment will arrive in the mail as a cheque for services, alongside an EOB. After receiving these, you need to document payment on your appointment list spreadsheet. This documentation should include the cheque number, the amount received by insurance, and the amount paid on the day of the session.
There are a number of different factors that can influence how quickly (or slowly) your business receives reimbursement. To ensure that this process is as smooth as possible and you are paid quickly, we recommend the following strategies;
The specific timeframe in which you are required to submit a claim varies between insurance providers. Medicare and Medicaid typically require submission within 365 days, and private provider deadlines are usually shorter. It is highly likely that as a counselor, you will be working with numerous deadlines at the same time. In order to ensure your claims are all submitted in time, you should work from the shortest deadline and remember; that the faster you submit your claims, the faster you’ll be paid. Further, it is generally a requirement that therapists must be paid within 30 days. If you have verified that your claims have been received and you still haven’t been paid in 30 days, you need to follow up with the provider. There are complications throughout the entire process of billing, and staying on top of these deadlines is the most effective way of ensuring you get paid quickly.
Learning how to handle denials, rejections and appeals is an important component of working in the healthcare industry. Denials and rejections can happen at two levels; the Clearinghouse or the insurance company. Your EHR system will alert you to whether the error occurred at the Clearinghouse level. If this is the case, there will most likely be a mistake in the documentation and you simply need to fix this and resubmit the claim. On the other hand, if the claim is denied at the insurance provider level, it will most likely be due to a more complicated reason. Some of the most common denial causes include missing a deadline, inaccurate ID, inconsistent data, and non-covered services. When you are fixing your denied claims, you need to be thorough and careful before efficiently resubmitting them. On the other hand, if your claim requires an appeal, there will be certain files that require filling. Contact a customer service representative and determine the steps you need to take in order to appeal your claim. Navigating denials, rejections, and appeals are undoubtedly the most complicated and difficult aspect of the billing process, but with the right amount of care and timing, there’s no reason why your claims won’t be processed effectively, leading to fast payment and good reviews.
Billing is complex and it can take counselors a lot of time before they feel comfortable with the process. Receiving timely payments is reliant on a good understanding of billing, client transparency (including informing patients about pricing updates), and knowing the relevant CPT codes. Provided you put in the effort to familiarize yourself with how to complete your claims carefully and submit them on time, there is no reason why you would experience rejections or denials. Learning how to effectively navigate billing will not only lead to faster payments, but will also demonstrate good organization and communication, facilitating the growth of your counseling practice.
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