Maximizing Reimbursement: Navigating Insurance Billing As A Supervising Psychologist

Billing insurance as a supervising psychologist can be a complex and challenging process. Mental health professionals often face difficulties when seeking reimbursement for their services due to the intricate rules and regulations set by insurance companies. To successfully navigate the billing process, psychologists need to understand the specific requirements and codes associated with mental health billing. This includes familiarising themselves with the Current Procedure Terminology (CPT) codes relevant to different therapy sessions, such as individual therapy, family therapy, and group psychotherapy. Additionally, it is important to determine eligibility and verify client information, including demographic and insurance details. Psychologists can also consider seeking assistance from billing experts or dedicated staff who specialise in mental health billing and insurance industry intricacies. By staying organised, proactive, and compliant with the latest regulations, supervising psychologists can optimise their billing practices and focus more on providing quality care to their patients.

Understanding 'incident-to' billing

Understanding incident-to billing

Incident-to billing is a way of billing for outpatient services provided by a non-physician practitioner, such as a nurse practitioner, physician assistant, or other non-physician provider. It allows non-physician providers to report services as if they were performed by a physician. This is particularly relevant for psychologists who are billing insurance for therapy sessions.

Incident-to billing is subject to various requirements and limitations. It is important to note that this billing method is specific to Medicare and may not be allowed by all insurance companies. Some private or commercial plans do not permit this type of billing. Therefore, it is crucial to review your insurance contract and confirm that incident-to billing is allowed before proceeding.

To qualify as incident-to services, the following criteria must typically be met:

• The services must be an integral part of the patient's treatment course and commonly rendered without additional charge.
• The services must be ordered by the supervising provider, who creates the treatment plan and remains actively involved in the patient's therapy.
• The supervising provider must be on-site in the office to render assistance during the session but does not need to be in the same room.
• The services must be provided under the scope of practice of both the rendering provider and the supervising provider.
• The place of service must be a non-institutional setting, such as a physician's office or a federally funded community mental health centre.
• The supervising provider and the non-physician provider must be employed by the same group entity billing for the service.
• The service must be of a type usually performed in an office setting and must be part of the normal course of treatment.

It is important to note that incident-to billing guidelines do not allow billing under the supervising physician's name when a new problem is addressed during therapy. In such cases, the non-physician provider will need to bill under their own provider identification number. Additionally, Medicare has stipulated that for incident-to billing to continue, the supervising physician must perform subsequent services reflecting their continued active participation in and management of the patient's care.

CPT codes for therapy

CPT (Current Procedural Terminology) codes are used by mental health professionals to identify and bill for their services. CPT codes are standardised across the healthcare industry and are regularly updated to reflect changes in the field.

There are three categories of CPT codes:

• Category I: These codes have descriptors that correspond to a specific procedure or service. They are typically five-digit numeric codes and are the most commonly used category.
• Category II: These alphanumeric tracking codes are supplemental and used for performance measurement. They are optional and not required for billing purposes.
• Category III: These are temporary alphanumeric codes for new and developing technologies and procedures. They are used for data collection and assessment and, in some cases, for payment for new services that do not meet the criteria for Category I codes.

When billing for therapy services, mental health professionals should use the CPT codes relevant to the specific type of therapy provided. Here are some commonly used CPT codes for therapy:

• 90832 – Psychotherapy, 30 minutes (16-37 minutes).
• 90834 – Psychotherapy, 45 minutes (38-52 minutes).
• 90837 – Psychotherapy, 60 minutes (53 minutes and over).
• 90846 – Family psychotherapy without the patient present, 50 minutes.
• 90847 – Family psychotherapy with the patient present, 50 minutes.
• 90853 – Group psychotherapy (not including multiple families).
• 90849 – Multiple-family group psychotherapy.
• 98968 – Telephone therapy (non-psychiatrist) – limited to 3 units/hours per application.

These CPT codes cover different types of therapy, such as individual, family, and group therapy, and specify the duration of each session. It is important for therapists to use the correct CPT codes when billing for their services to ensure proper reimbursement and avoid insurance audits.

Deadlines and payment schedules

Therapists can generally expect reimbursement within 30 days of submitting a claim. However, coding errors or other issues may cause delays. Therefore, it is important to monitor the status of claims and follow up with insurers if payment is not received within the expected timeframe.

To avoid missing deadlines, it is advisable to establish a consistent claims filing schedule or protocol. Additionally, keeping accurate records of client information, session details, and billing codes is essential for efficient claims submission and timely reimbursement.

When billing insurance companies, it is important to be aware of the different payment schedules and deadlines for each insurer. Staying organized and submitting claims promptly can help improve the financial health of your practice.

Getting credentialed with insurance companies

The process of credentialing is when an insurance company verifies your education, training, and professional experience. It ensures that you meet their internal requirements to serve as an in-network provider on their panel.

Credentialing is especially vital for psychologists and therapists. It provides flexibility to start a private practice or move to a new location without losing access to insurance panels. It also gives you leverage to negotiate a higher salary, as you are not as dependent on your employer for billing insurance. Credentialing can also open up your practice to a wider range of clients, as most people need to use insurance to afford therapy.

• Prepare for Credentialing: Ensure you meet the basic requirements, including having a current license to practice in your state, proof of liability insurance, an NPI (National Provider Identifier) number, and a CV detailing your employment history.
• Complete the CAQH Proview Application: The Council for Affordable Quality Healthcare (CAQH) runs a national database that most insurance companies use for credentialing. It is recommended to apply online.
• Research and Decide on Insurance Companies: Identify reputable insurance companies that are popular in your area and offer competitive reimbursement rates for mental health services. Consider factors such as the company's reputation, reimbursement rates, and approval time.
• Apply to Insurance Panels: Submit your application, resume, and letter of intent to the selected insurance companies. A well-crafted resume and letter of intent that highlights your unique skills, availability, and specialties will increase your chances of being accepted.
• Follow Up: After submitting your application, call the insurance company to confirm its receipt. Inquire about the next steps and expected timeline for follow-up.
• Be Prepared to Re-Apply: Insurance panels often have limited spots, so be persistent. If your application is rejected, appeal the decision or reapply after a few months.
• Review the Contract: Once accepted by an insurance company, carefully review the contract. Understand the terms, including reimbursement rates, and don't be afraid to negotiate if needed.

Challenges and Tips:

• The credentialing process can be time-consuming and detailed, so it is essential to stay organized and patient.
• Keep copies of all submitted documents and follow up regularly to ensure your application is complete and moving forward.
• Insurance panels are competitive, so highlight any unique qualities you possess, such as speaking another language, working unconventional hours, or having specific niche expertise.
• Consider seeking help from credentialing services or peers who have gone through the process.

Getting insurance payouts

Understanding Insurance Policies

Firstly, it is essential to discuss insurance policies with your clients. Verify insurance coverage and reimbursement rates with new clients, and request that they notify you of any changes in their insurance providers. Understanding their coverage will help you determine the expected payment amounts and prevent surprises later on.

Helping Clients with Reimbursement

Navigating insurance reimbursement can be daunting for clients. Inform them that many insurers only offer coverage once they have met their deductible. Explain this during the first therapy session so they are aware that they may need to pay for some sessions out of pocket. If a client changes jobs, inform them about COBRA benefits, which will continue their therapy coverage while they look for new employment.

Establishing Policies for Denied Claims

It is important to establish clear policies for when insurance denies a claim. Decide whether the client or the practice will be responsible for the payment in such cases. Communicate these policies to your clients upfront to avoid confusion or disputes later.

Knowing Specific Insurer Requirements

Different insurers have specific policies and requirements that you must follow. For example, some insurers require pre-authorization for certain services, while others will only cover treatment if a specific condition is diagnosed. Familiarize yourself with the requirements of the insurers you work with to avoid delays or issues with reimbursement.

Knowing Whom to Contact

Dealing with billing questions and errors can be time-consuming. Keep a log of previous calls and contacts to know which strategies are most effective. Knowing whom to contact and the best way to reach them can save you time and streamline the billing process.

"Incident-to" Billing

In some cases, you may be able to bill for services provided by a supervisee under your supervision. This practice is known as "incident-to" billing. However, this is only allowed in certain situations and may not be permitted by all insurance companies. Medicare routinely allows this, while most private or commercial plans do not. Check with each insurance panel to determine if "incident-to" billing is allowed and ensure you meet the necessary criteria.

Timely Filing of Claims

Each insurer has its own deadline for submitting claims, so it's crucial to stay on top of these deadlines to avoid missing out on reimbursement. Submit claims promptly and adhere to the shortest filing period offered by any of the insurers you work with to stay organized and efficient.

Accurate Coding and Documentation

To ensure prompt and accurate payment, use the correct Current Procedure Terminology (CPT) codes when billing for mental health services. Inaccurate coding can lead to delays or issues with reimbursement. Maintain detailed documentation for each visit to support your billing claims, as insurers may request additional information.

Outsourcing Billing

Consider outsourcing your billing to a mental health billing company. They have trained staff who understand the complexities of mental health billing and insurance reimbursement. While there is an additional cost associated with hiring a billing company, it can save you time, improve your collection rate, and allow you to focus more on patient care.

Frequently asked questions