Billing for mental health services can seem daunting, especially if you’re just starting out as a therapist. However, understanding the basics will set you up for success when it comes to getting reimbursed for your services. That’s where this guide on Behavioral Health Billing Services can help. Read on and we will help you understand the most important pieces of information. 

Patient Information 

First, you’ll need to collect key demographic and insurance information from your patients including:

• Full legal name
• Date of birth
• Address
• Gender
• Subscriber ID number

While not required, also gather their phone number, email address, and take photos of the front and back of their insurance card. This additional information can be helpful when verifying benefits and submitting claims.

Common Mental Health CPT Codes 

The three most common CPT codes for mental health services are:

• 90791 – Initial assessment
• 90834 – 45-minute psychotherapy session
• 90837 – 60-minute psychotherapy session

Bill the initial intake code for the first visit only. After that, choose either the 45 or 60-minute code based on the length of subsequent sessions.

There are additional codes that may apply for family therapy, group therapy, and crisis counseling. Consult the definitive CPT coding guide for appropriate codes based on your specific services.

Choosing a Diagnosis Code 

When offering Behavioral Health Billing Services, you should be careful to pick the right diagnosis code. Select an accurate ICD-10 diagnosis code that aligns with the patient’s condition. Avoid using unspecified codes, as Medicare increasingly denies claims without a detailed diagnosis. Use our ICD-10 search tool to identify appropriate codes.

As the patient’s diagnosis evolves, update the code on the claim form accordingly. Using outdated diagnostic codes can lead to denials.

Verifying Benefits 

Before you see a patient for their first appointment, verify their mental health benefits by calling the number on the back of their insurance card. During this call, you can confirm:

• If you are in-network with their plan as a provider
• Deductible amounts and coverage details
• Any required pre-authorizations

Document all information gathered for reference when billing and following up.

Submitting Claims for Behavioral Health Billing Services 

Once you render services, it’s time to file for reimbursement by submitting a claim. You’ll need to fill out a CMS-1500 form either electronically or on paper. Key details to include:

• Patient & insurer information
• Date of service
• Applicable CPT code(s)
• Diagnosis code
• Your NPI and credentials

Make sure to send claims within the timely filing period specified by that payer to avoid rejections or non-payment.

Following Up 

It typically takes at least 2-3 weeks to receive claim payments after they have been received and processed by the insurance company. During this waiting period, call to confirm:

• Claim was received successfully
• Payment amount you can expect

Watch for explanation of benefits statements and payments in the mail around the same timeframe. Log all check numbers, amounts paid, and patient responsibilities for accurate bookkeeping.

Handling Denials

If any claims are denied, first determine the reason by reviewing documentation from insurance. Common causes include expired policies, timely filing issues, invalid patient information, and authorization requirements.

Carefully examine denial rationales and resubmit corrected claims when appropriate. For ongoing issues, you may need to file an appeal with documentation that supports your reasons for reimbursement.

While navigating the ins and outs of mental health billing takes effort, being knowledgeable about the key steps will help avoid critical mistakes. Leverage billing services if you need extra support getting everything submitted accurately. Staying on top of the details is crucial for getting paid for the meaningful care you provide.