Navigating The Complexities Of Billing Multiple Insurances In Psychotherapy: A Comprehensive Guide

Billing insurance for psychotherapy can be a complex and frustrating process, but it's a necessary one for therapists in private practice. The Mental Health Parity and Addiction Equity Act of 2008 prohibits insurers from discriminating against mental health services, meaning they must cover mental health care to the same degree as physical health care. This has expanded access to mental health care and increased earning power for therapists. However, the process of getting reimbursed by insurance companies can be challenging, with mental health practices often only collecting 85% of the money owed to them.

The first step in billing insurance for psychotherapy is to get credentialed with insurance companies. This involves a therapist joining an insurer's provider panel, which allows them to bill insurance directly. Without credentialing, the client must seek reimbursement from the insurer, which can be uncertain and time-consuming. The credentialing process typically involves applying to become part of the insurer's provider panel, completing the Council for Affordable Quality Healthcare (CAQH) application, and following up with the insurer.

Once credentialed, therapists need to understand the billing process, which varies depending on the insurance company. They must gather client information, including demographic and insurance details, and select the appropriate Current Procedure Terminology (CPT) codes for the services provided. Accurate and complete billing is essential to ensure prompt payment and avoid audits or removal from provider panels.

Therapists must also be mindful of deadlines and payment schedules, as these vary by insurer. Additionally, they should be prepared to handle denials, rejections, and appeals, which are common occurrences in the insurance billing process.

Understanding the basics of billing insurance for therapy

Billing insurance for therapy can be a complicated and frustrating process, but it's a necessary part of running a therapy practice. Here are the basics of billing insurance for therapy to help you get started:

Credentialing

The first step is to get credentialed with insurance companies. This is the process of becoming an approved provider on an insurer's panel. To do this, you will typically need to apply through the insurer's website and complete the Council for Affordable Quality Healthcare (CAQH) application. Getting credentialed can take several months, and you may need to follow up with the insurer to ensure your application is accepted.

Client Information

When billing insurance for therapy, you will need to collect certain information from your clients. This includes their full legal name, date of birth, address, gender, phone number, email address, and insurance information. It is important to have accurate and up-to-date information to avoid delays or rejections of your claims.

CPT Codes

Current Procedure Terminology (CPT) codes are used to bill for specific procedures. In therapy billing, you will need to select the appropriate CPT code based on the type of therapy provided and the length of the session. Common CPT codes for therapy include codes for individual psychotherapy, family psychotherapy, group psychotherapy, and crisis psychotherapy.

Diagnosis Codes

In addition to CPT codes, you will also need to include diagnosis codes on your insurance claims. These codes represent the mental health condition being treated, such as generalized anxiety disorder or depression. It is important to submit the most accurate diagnosis code for each session and update it if the diagnosis changes.

Insurance Plan

It is important to understand your client's insurance plan and verify their coverage. Check if mental health services are covered and if there are any specific requirements, such as pre-authorization or a limited number of sessions. Knowing the copays, coinsurance, and deductibles will also help you bill accurately and inform your clients about their financial responsibility.

Billing Process

The billing process can vary depending on the insurance company and your preferred method. You can typically submit claims electronically through the insurance company's website or provider portal. Alternatively, you can fill out a paper claim form and mail it to the insurance company. It is important to submit clean claims, which means ensuring that your claims are complete, factually correct, and formatted correctly to avoid administrative denials.

Payment and Reimbursement

After submitting a claim, it typically takes at least 30 days to receive reimbursement from the insurance company. The payment process can be influenced by various factors, including the accuracy of your claims and your client's insurance coverage. It is important to track your claims and follow up with the insurance company if there are any delays or issues.

Getting credentialed with insurance companies

Credentialing is the process of becoming a member of an insurance panel. The goal is to be listed as an in-network therapist by a specific insurance company. It is important to note that you need to apply separately to each insurance panel.

Credentialing can open up a whole new source of clients. While some can afford to pay for therapy out-of-pocket, most will need to use insurance. Credentialing also offers flexibility, as it follows you if you switch jobs.

The process of getting credentialed can be long and tedious. Here are the basic steps:

• Get organised: You will need to provide a lot of information to get on insurance panels. This may include a current license to practice in your state, proof of liability insurance, your National Provider Identifier (NPI), a resume, proof of any special certifications, a Tax ID Number, and professional references.
• Complete the CAQH Proview application: The Council for Affordable Quality Healthcare (CAQH) runs a national database that most insurance companies use for credentialing.
• Decide which insurance companies to join: Consider factors such as popularity in your area, reimbursement rates, and how long they take to approve applications.
• Apply to each insurance panel: You can find provider applications on insurance companies' websites.
• Follow up: After a week, call the insurance company to check that they received your application and to see if they need any additional information.
• Be prepared to re-apply: Insurance panels are often full, so be prepared to appeal and reapply.
• Once approved, read the contract carefully: Make sure you understand all parts of the contract, including reimbursement rates, and familiarise yourself with how to contact the right people and file claims.

Common Challenges of the Credentialing Process

• Time-consuming: It can take months to get approved, and even longer if additional information is required.
• Detailed: Make sure you fill in every section of your application, or it may be returned.
• Competitive: Insurance panels are competitive, so you need to stand out by offering qualities that other therapists don't, such as speaking another language or being able to work evenings and weekends.

Resources for Help with Credentialing

• Facebook group: Insurance Billing and Credentialing for Mental Health Clinicians
• Podcast: Insurance Answers
• Online course: Mastering Insurance
• Blog: credentialing.com
• Webinar: GoodTherapy
• Book: Starting Your Private Practice by Maryanne Duan
• Local and state professional organisations

Filling in insurance paperwork

Step 1: Collect Client Information

Before you start filling out any insurance paperwork, you'll need to gather some essential information from your client. This includes:

• Full legal name
• Date of birth
• Address
• Gender
• Social Security Number (rarely required)
• Phone number
• Email address
• Insurance information, including the subscriber ID with the alpha prefix (record both letters and numbers)
• A copy of their insurance card (front and back)

Step 2: Choose the Right CPT Code

Once you have all the necessary client information, the next step is to select the appropriate Current Procedure Terminology (CPT) code for the service provided. CPT codes are used to describe the procedure performed and the length of the session. Here are some common CPT codes for psychotherapy:

• 90832: 30-minute psychotherapy
• 90834: 45-55 minute individual psychotherapy
• 90837: 56+ minute individual psychotherapy
• 90839: 60-minute crisis psychotherapy
• 90846: Family or couples psychotherapy without the patient present
• 90847: Family or couples psychotherapy with the patient present
• 90853: Group psychotherapy (not family)

Step 3: Fill Out the Insurance Claim Form

Now it's time to fill out the actual insurance claim form. You can usually find the form on the insurance company's website. The standard claim form for outpatient medical and psychiatric services is the CMS-1500 form. Here's the information you'll typically need to provide:

• Provider's name and address
• Provider's tax ID number (TIN, EIN, FEIN, or SSN)
• Diagnosis code ("ICD")—for example, "F41.1" for Generalized Anxiety Disorder
• Procedure code ("CPT")—for example, "90834" for Individual Psychotherapy, 45 minutes
• Provider's NPI number (if applicable)
• Place of service ("Office" is typically code "11" for psychotherapy in the therapist's office)

Step 4: Submit the Claim

After you've completed the insurance claim form, it's time to submit it. Most insurance companies allow you to submit claims online through their website. Alternatively, you can mail the completed form along with a copy of the therapist's bill to the insurance company. Make sure to keep track of the submission deadline, as it varies from insurer to insurer.

Step 5: Follow Up

Don't forget to follow up on your claim to ensure it's been received and processed. If you submitted the claim by mail, wait about four weeks before calling to verify that it has been received. If there are any issues or delays, contact the insurance company to resolve them.

Deadlines and payment schedules

Medicare and Medicaid typically require that claims be submitted within 365 calendar days from the date of service. On the other hand, private insurers usually set shorter deadlines, often around 90 days. To manage multiple deadlines effectively, it is recommended to file all claims within the shortest filing period offered by any of the insurers. This helps streamline the process and reduces the risk of missing a deadline.

Once a claim is submitted, reimbursement is typically expected within 30 days. However, it is important to keep in mind that coding errors or other issues can cause delays in reimbursement. Therefore, it is crucial to monitor each bill sent out and follow up with the insurer if payment is not received within the expected timeframe.

To optimize the billing process and improve the chances of timely reimbursement, it is beneficial to invest in high-quality technology. Utilizing software specifically designed for mental health billing can streamline the process by enabling electronic billing to primary and secondary insurers, tracking claim status, generating invoices, and managing authorizations. Outsourcing billing services to qualified vendors is another option to consider, as they can assist with submitting clean and timely claims, tracking their progress, and managing denials.

Additionally, it is important to establish a consistent claims filing schedule or protocol to avoid missing submission deadlines. This involves gathering all the necessary client and service information, including CPT codes, diagnostic codes, and provider credentials. By staying organized and proactive, therapists can improve their chances of receiving timely reimbursement and maintain a stable revenue stream for their practice.

Getting insurance payouts

Discuss Insurance Policies with Clients

It is important to verify insurance coverage and reimbursement rates with new clients. Ask individuals to notify you if they switch insurance providers. Discuss their insurance deductible and whether they will need to cover some sessions out of pocket. If a client changes jobs, inform them about COBRA benefits, which will continue covering therapy while they seek new employment.

Help Clients Navigate Insurance Reimbursement

Explain insurance reimbursement processes to your clients, including any applicable deductibles, copays, or coinsurance. Review the client's past payments and any amounts due or denied by insurance. Inform them about the possibility of denied claims and establish policies for handling such situations.

Know the Specific Policies of the Insurer

Familiarize yourself with the insurer's requirements, such as pre-authorization for certain services or specific conditions that must be met for coverage. Know whom to contact with billing questions, and keep a log of previous calls and effective strategies.

Stay Organized and Meet Deadlines

Keep accurate records of client information, session details, and billing codes. Track your claims and their status to ensure timely submission and follow-up. Each insurer has different deadlines for filing claims, so establish a filing schedule to avoid missing submissions.

Consider Outsourcing Billing

Consider hiring trained staff or using a mental health billing service to handle insurance billing. This can improve collection rates and free up your time to focus on patient care. However, this option incurs additional costs, so weigh the benefits against the expense.

Frequently asked questions