Billing Insurance For Mini-Mental Examinations: Understanding Coverage And Reimbursement

Billing insurance for mental health services can be a complex and challenging process for providers, with many factors that can make it difficult to operate their practices efficiently. Mental health professionals often face an uphill battle when seeking reimbursement for their services due to the intricate rules and regulations of the insurance industry. This complexity is further compounded by the wide range of clinical settings and therapeutic interventions involved in mental health services.

One critical aspect of billing insurance for mental health services is understanding the applicable codes, such as Current Procedural Terminology (CPT) codes and International Classification of Diseases (ICD) codes. CPT codes are used to bill for specific procedures, such as psychotherapy or psychiatric diagnostic interviews, and are based on the length of the session and the presence of the patient's family. ICD codes, on the other hand, are used for diagnosing patients and are essential for insurance billing.

Another important consideration is pre-authorization, which is required by many health insurance plans for certain mental health services. This process determines if a service is medically necessary and can prolong the insurance billing process. Additionally, accurate and up-to-date medical record documentation is crucial for supporting the diagnosis and procedure code billed to insurance.

To optimize reimbursement and streamline the billing process, mental health providers can consider hiring trained staff who understand the intricacies of mental health billing and insurance industry regulations. Outsourcing mental health billing services to external providers or utilizing specialized software can also reduce the administrative burden and improve efficiency.

Mental health billing for small practices

Mental health billing can be a challenging and time-consuming process, especially for small practices with limited resources and administrative support. However, understanding the billing process and implementing efficient systems can make it easier for small practices to navigate the complexities of insurance reimbursement. Here are some essential tips for mental health billing for small practices:

Understand the Basics of Mental Health Billing:

• Know the Difference between Medical Billing and Mental Health Billing: Mental health billing differs from medical billing in several ways, including preauthorization requirements, staffing arrangements, standardized billing procedures, and superbill creation. Familiarize yourself with these differences to navigate the mental health billing process effectively.
• Understand Diagnosis and Procedure Codes: Familiarize yourself with ICD-10 (International Classification of Diseases, 10th Edition) codes, which indicate the patient's diagnosis, and CPT (Current Procedural Terminology) codes, which specify the treatment provided. Proper coding is critical for accurate billing and reimbursement.
• Verify Patient Information and Insurance Coverage: Always collect and verify patient demographic and insurance information, including full legal name, date of birth, address, insurance subscriber ID, and contact information. This information is crucial for accurate billing and insurance claims.

Optimize the Billing Process:

• Conduct Verification of Benefits (VOB): Before a patient's first visit, verify their insurance coverage and benefits by contacting the insurer or using their online portal. This step helps you and the patient understand their coverage limits and potential out-of-pocket expenses.
• Maintain Detailed Medical Records: Proper documentation is essential for billing and insurance reimbursement. Ensure that all patient encounters, diagnoses, treatment plans, and progress notes are accurately recorded in the medical records. This documentation supports the diagnosis and procedure codes used for billing.
• Submit Claims Promptly and Accurately: Stay organized and submit claims within the required time frames to avoid delays or rejections. Use the correct billing format, codes, and insurer-specific requirements to streamline the claims process.
• Stay Organized with Software Solutions: Utilize mental health billing software or electronic health record (EHR) systems to streamline billing tasks, such as creating superbills, submitting claims, tracking authorizations, and managing patient information. These tools can save time and reduce administrative burdens.
• Outsource Billing Services: Consider partnering with a reputable mental health billing service or company to handle the complexities of insurance billing. Outsourcing can free up your time, improve reimbursement rates, and allow you to focus more on patient care.

Best Practices for Efficient Billing:

• Always conduct a VOB to verify insurance coverage and benefits.
• Make and store copies of insurance cards and other relevant forms for reference.
• Collect comprehensive patient information, including full legal names, addresses, and contact details, to avoid billing delays.
• Take detailed notes during and after insurance communications, including reference IDs and representative names, to streamline future billing inquiries.
• Avoid delays in the billing process. The sooner you submit claims, the sooner you can receive reimbursement.

By following these tips and implementing efficient systems, small mental health practices can improve their billing processes, increase reimbursement rates, and ultimately focus more on providing quality care to their patients.

The Mental Health Parity and Addiction Equity Act

The MHPAEA requires that insurance coverage for mental health conditions, including substance use disorders, be no more restrictive than insurance coverage for other medical conditions. This means that deductibles, copays, out-of-pocket maximums, and treatment limitations for mental health or substance use disorders must not be more restrictive than corresponding requirements or parameters offered for medical and surgical benefits. The MHPAEA also prohibits private insurers from discriminating against people with mental health diagnoses or providers who offer mental health services.

The MHPAEA has made some significant changes, including:

• If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to MH/SUD benefits must be no more restrictive than those that apply to substantially all medical/surgical benefits.
• MH/SUD benefits may not be subject to any separate cost-sharing requirements or treatment limitations that only apply to such benefits.
• If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, and the plan or coverage provides for out-of-network medical/surgical benefits, it must provide for out-of-network MH/SUD benefits as well.
• Standards for medical necessity determinations and reasons for any denial of benefits related to MH/SUD benefits must be disclosed upon request.

Despite the existence of the MHPAEA, people seeking coverage for mental health and substance use disorder care continue to face greater barriers when seeking benefits than when seeking medical or surgical benefits. Many insurance providers continue to fall short of providing equal footing between mental health conditions and physical health needs.

CPT codes for billing

CPT codes are an essential part of the billing process and enable you to get paid while steering clear of insurance audits. These codes also document the exact service that your patient received, which determines how much you will be reimbursed. The Current Procedural Terminology (CPT) code set contains over 8,000 codes and is published and updated annually by the American Medical Association. The codes communicate to payers what procedures need to be reimbursed.

There is no CPT code for the Mini Mental Status Exam (MMSE). Payment for assessing these functions is included in the payment for the evaluation and management service. An E/M service includes consultations, hospital visits, and new or established patient visits.

However, there are CPT codes for other mental health services, such as:

• 90832: 30-minute psychotherapy
• 90839: 60-minute crisis psychotherapy
• 90847: 50-minute family psychotherapy when the primary client is present
• 90853: Group psychotherapy
• 96132: Neuropsychological testing services, such as evaluations for dementia or ADHD
• 96103: Psychological testing administered by a computer, with qualified healthcare professional interpretation and report
• 96120: Neuropsychological testing administered by a computer, with qualified healthcare professional interpretation and report
• 99483: Cognitive assessment and care planning

When billing for mental health services, it is important to select the right CPT code, as this depends not only on the procedure but also on the length of time it took.

Pre-authorization

The process for obtaining pre-authorization varies by insurer but typically involves the submission of administrative and clinical information by the treating physician, and sometimes the patient. This may include verifying the patient's insurance coverage and the service they intend to receive. It is important to note that pre-authorization does not guarantee that the insurance company will cover the full cost of the service. Most plans will also require that the patient meets their deductible, pay a co-pay, and/or pay co-insurance.

In the context of mental health services, pre-authorization can prolong the insurance billing process and prevent a patient from receiving timely treatment. It is recommended to always check if pre-authorization is required before working with a new client, especially for non-standard therapy sessions. This can help save time and ensure that the patient receives the necessary care without delays.

To streamline the pre-authorization process, it is essential to have accurate and up-to-date patient information, including insurance coverage and personal details. Additionally, familiarity with the insurer's preferred filing methods and windows of time for submitting claims can help expedite the process.

While pre-authorization can be a useful tool for controlling spending and promoting cost-effective care, it has also faced scrutiny due to its potential impact on patient care and costs. There have been calls for greater transparency and regulation in the use of pre-authorization across all forms of health coverage.

Insurance reimbursements

The process of seeking reimbursement from insurance companies for mental health services can be challenging due to the complex rules and regulations of the insurance industry. Mental health professionals often face difficulties in successfully submitting claims, which can result in delayed or reduced payments. Understanding the reimbursement process and following the necessary steps can help ensure timely and accurate insurance reimbursements.

Understanding Insurance Reimbursement for Mental Health Services

Mental health billing involves seeking reimbursement from insurance companies for services provided to patients. This process can be complex due to the varying requirements and restrictions of different insurance plans. It is important to familiarize yourself with the specific coverage, limitations, and requirements of the patient's insurance plan.

Verifying Patient Insurance Coverage

Before providing any mental health services, it is crucial to verify the patient's insurance coverage. This includes checking their insurance plan, benefits, and any pre-authorization requirements. By performing a Verification of Benefits (VOB), you can confirm the patient's coverage for the intended service and determine the amount the insurance company will pay. This step helps avoid rejected claims and unpaid bills.

Submitting Claims Properly

Submitting claims accurately and within the specified time frame is essential. Identify the insurance company's preferred filing method and the window of time allowed for filing claims. Use the correct billing format and common claims forms, such as the UB-04 form for mental health clinics. Properly submitting claims reduces the risk of prolonged claims processing and potential billing issues.

Understanding CPT Codes

Common Procedural Technology (CPT) codes are crucial for billing purposes. These codes describe the length of the session, the presence of the patient or family members, and the specific service provided. Accurate CPT coding ensures proper reimbursement, avoids insurance audits, and documents the exact service received by the patient. Examples of CPT codes for mental health services include 90832 for 30-minute psychotherapy and 90853 for group psychotherapy.

Following Up on Claims

After submitting a claim, it is important to follow up with the insurance company to ensure timely reimbursement. Therapists must generally be reimbursed within 30 days. However, coding errors or other issues can cause delays. Keep track of each bill sent out and follow up with the insurer if payment is not received within the expected timeframe.

Navigating Insurance Policies

Discuss insurance policies with your clients to ensure a smooth reimbursement process. Verify insurance coverage, reimbursement rates, and deductible requirements. Inform clients about their responsibility for payment if their insurance denies a claim. Help them understand their coverage limits and any pre-authorization requirements.

Outsourcing Mental Health Billing Services

Consider outsourcing mental health billing services to specialized companies or using billing software. Outsourcing can reduce the administrative burden on your staff, speed up insurance claims processing, and increase cash flow. Outsourced billing services provide transparency and allow you to monitor your practice's financial aspects while freeing up time to focus on patient care.

Frequently asked questions