Billing Strategies For School Psychology Residents: Navigating Insurance Claims

Billing insurance for therapy sessions can be a challenging and frustrating process. Mental health professionals often face difficulties when seeking reimbursement for their services due to the complex rules and regulations set by insurance companies. To successfully navigate the billing process, therapists need to understand the required client information, applicable CPT codes, and the steps for submitting and tracking claims. This includes gathering essential client details, such as their full name, date of birth, address, and insurance information. Additionally, therapists need to select the appropriate CPT codes that correspond to the type and length of the therapy session.

The billing process can be outsourced to a dedicated employee or a billing professional, although this adds to the operational costs. Alternatively, therapists can handle billing manually or through health plan portals, clearinghouses, or practice management software. Regardless of the chosen method, a basic understanding of the billing process and claims submission is crucial for any clinician to ensure accurate and timely reimbursement for their services.

Understanding the billing lingo

The world of insurance billing can be daunting, especially for those new to private practice. The billing process involves a lot of jargon, and it can feel like learning a foreign language. However, understanding the billing lingo is crucial if you want to successfully submit claims and get reimbursed for your services. Here are some key terms and concepts to help you navigate the world of insurance billing:

• Current Procedural Terminology (CPT) codes: These are standardised codes that indicate the type of service provided, such as an intake interview or a psychotherapy session. CPT codes are typically tied to the length of the service, such as a 60-minute or 45-minute session.
• Diagnosis codes: In addition to CPT codes, you will also need to provide a diagnosis code for each session. This code represents the medical condition or issue that the patient is seeking treatment for. For example, you might use a diagnosis code for an adjustment disorder or a specific type of anxiety or depression.
• National Provider Identification (NPI) number: This is your unique identifier as a therapist. You will need this number when interacting with insurance companies and submitting claims.
• Council for Affordable Quality Healthcare (CAQH): The CAQH is an organisation that collects and maintains the information needed for therapists to get credentialed by insurance companies. The CAQH application is typically part of the credentialing process, and you will need to provide detailed information about your qualifications, training, and malpractice insurance.
• Credentialing: This is the process of becoming an in-network provider on insurance panels. By getting credentialed, you can bill insurance companies directly, rather than having your clients seek reimbursement.
• CMS-1500 form: This is the standard claim form for outpatient medical and psychiatric services. It includes sections for the therapist's information (such as NPI number and practice address), as well as the client's information (name, address, date of birth, insurance information, etc.).
• Clean claim: In the billing industry, a "clean claim" refers to a claim that is complete, factually correct, and formatted correctly. Insurance companies are required to deny claims that are missing information or are incorrectly formatted.
• Copay: This is the amount that the client is responsible for paying out of pocket for each session. The insurance company will pay the remaining amount to the therapist.
• Deductible: The amount that a client must pay out of pocket before their insurance company starts covering the cost of treatment.
• Explanation of Benefits (EOB): A document sent by the insurance company that explains the claims status and how much was paid. This document is typically sent along with the reimbursement cheque.
• Superbill: An invoice that itemises the services provided to the client. This can be useful for tracking purposes and can also be provided to clients who are seeking reimbursement from their insurance company.

Understanding these terms and concepts is essential for successfully navigating the insurance billing process. While it may seem overwhelming at first, with time and practice, you will become more comfortable with the billing lingo and processes.

Getting credentialled with insurance companies

The process of getting credentialled with insurance companies can be confusing and time-consuming, especially if you are new to private practice. Credentialing is the process of getting networked with insurance companies, often described as "getting on insurance panels". It is a necessary step to ensure that you can bill insurance companies directly for your services and increase the number of patients who can access your services. Here are the steps to get credentialled with insurance companies:

• Prepare for Credentialing: Before starting the credentialing process, it is important to establish your business structure (LLC, S-Corp, PC, etc.), obtain your tax ID, professional liability insurance policy, and National Provider Identifier (NPI) number. Ensure that you are fully licensed in the state where you will provide services and create a profile with the Council for Affordable Quality Healthcare (CAQH). Keep your CAQH profile up-to-date and complete the CAQH application, which is used by many major insurance companies as part of their application process.
• Research Insurance Companies: Identify the insurance companies you want to be credentialled with. This may depend on your service area and the insurance companies that provide the most patient base in your region. Popular national insurance plans include Aetna, Blue Cross Blue Shield, Cigna, United Healthcare, Humana, Medicare, and Medicaid.
• Obtain Necessary Information: Gather all the necessary information required for the credentialing process, including your business address, phone and fax numbers, NPI numbers, EIN letter from the IRS, full legal name of the business, provider specialties, standard work hours, and CV.
• Acquire and Complete Applications: Obtain applications from the insurance companies you have selected and complete them thoroughly. This process can be lengthy, taking up to 10 hours per panel. Ensure that all required documents are included and that there are no missed signatures or incorrectly completed pages, as this can cause delays.
• Submit and Follow Up on Applications: Submit your completed applications electronically, if possible, and follow up with the insurance companies regularly to ensure that your application is being processed correctly. Insurance companies may lose or misplace applications, so it is important to stay on top of the process.
• Contracting Phase: Once your credentialing application is approved, you will move to the contracting phase. This phase determines the terms of your agreement with the insurance company, including the fee schedule and reimbursement rates. Review the contract carefully before signing to ensure it aligns with your business needs.
• Maintain Credentials: After you have successfully completed the credentialing and contracting phases, remember to maintain your credentials by regularly updating your CAQH profile and responding to any re-credentialing requests from insurance companies. Failing to respond to these requests can lead to network termination.

Filling insurance paperwork

Filling out insurance paperwork can be a complex and frustrating task, but it is a necessary step to get reimbursed for your services. Here are some detailed instructions on how to fill out insurance paperwork, specifically for school psychology residents:

Step 1: Gather Client Information

First, you will need to collect some basic information about your client. This includes:

• Full legal name (spell it correctly)
• Date of birth
• Address
• Gender
• Social Security Number (rarely required)
• Phone number
• Email address
• Subscriber ID with the alpha prefix (record both letters and numbers)
• A photo of the front and back of their insurance card

Step 2: Verify Insurance Eligibility and Benefits

Call the insurance company using the customer service phone number on the insurance card to verify the client's mental health benefits. You will need to provide the following information:

• Your National Provider Identification (NPI) number
• Your client's name, date of birth, and subscriber ID
• Your Tax ID number to check if you are in-network
• The client's deductible, copay, and coinsurance information
• The claims addresses

Step 3: Choose the Correct CPT Code

Current Procedural Terminology (CPT) codes are used to describe the type of service provided and the length of the session. Common CPT codes for therapy include:

• 90791: Intake session
• 90834: 45-55 Minute Individual Therapy Session
• 90837: 56+ Minute Individual Therapy Session
• 90846: Family or couples psychotherapy, without the patient present
• 90847: Family or couples psychotherapy, with the patient present
• 90853: Group Psychotherapy (not family)
• 90839: Psychotherapy for crisis, 60 minutes (30-74 minutes)

Step 4: Fill Out the CMS-1500 Form

The CMS-1500 form is the standard claim form for outpatient medical and psychiatric services. It requires the following information:

• Client's personal information (name, address, date of birth, etc.)
• Physician's name, address, and telephone number
• CPT code for the service provided
• Diagnostic code (ICD-10 code)
• Date and place of service
• Your NPI number, taxonomy code, practice tax ID, and practice location

Step 5: Double-Check and Submit the Claim

Before submitting the claim, double-check for any typos or missing information. Each insurance company may have different deadlines for filing claims, so be sure to submit the claim promptly. You can submit the claim electronically or by mail. Keep a copy of the sent claim and track its status.

Step 6: Follow Up on Payment

After submitting the claim, it typically takes around 30 days to receive reimbursement. If you do not receive payment within this timeframe, follow up with the insurer. You should receive either a paper check or an electronic transfer, along with an Explanation of Benefits (EOB) document.

Deadlines and payment schedules

Therapists working with multiple insurers need to manage various deadlines efficiently. To simplify this process, determine the shortest filing period and submit all claims within that timeframe. For example, if a private insurer allows only 90 days for filing, it is advisable to submit all claims within 90 days to avoid missing deadlines.

Therapists are generally entitled to reimbursement within 30 days. However, coding errors can cause delays, so maintaining a record of each bill sent is essential. If payment is not received within 30 days, follow up with the insurer to inquire about the status.

To ensure prompt payment, it is crucial to select the appropriate Current Procedural Terminology (CPT) code for each treatment session. The billing code depends on the procedure performed and the duration of the session. Examples of common CPT codes for therapy include 90832 for 30-minute psychotherapy and 90839 for 60-minute crisis psychotherapy.

Getting insurance payouts

• Discuss insurance policies with your clients: Verify insurance coverage and reimbursement rates with new clients, and request that they notify you if they switch insurance providers. This will help you keep track of their coverage and avoid any surprises down the road.
• Help your clients navigate insurance reimbursement: Inform your clients about their insurance coverage and any deductibles they need to meet. Let them know that many insurers only provide coverage once the deductible has been met. Additionally, if your client changes jobs, make sure they are aware of COBRA benefits, which will continue covering therapy while they seek new employment.
• Establish and communicate policies for when insurance denies a claim: Determine whether the client or the therapist will be responsible for payment if a claim is denied. Communicate this policy clearly to your clients to avoid confusion or disputes later on.
• Know the specific policies and requirements of the insurer: Different insurers have different rules and requirements. For example, some insurers require pre-authorization for certain services, while others will only cover treatment if a specific diagnosis is provided. Familiarize yourself with the policies of the insurers you work with to ensure compliance and avoid delays in reimbursement.
• Keep track of billing questions and contacts: Dealing with insurance companies can be a maze of phone calls and transfers. Keep a log of previous calls and contacts so you can navigate the system more efficiently in the future. This will help you save time and avoid frustration.
• Hire a billing professional: Consider outsourcing your billing to a professional who specializes in mental health billing. They can handle the credentialing process, submit claims on your behalf, and ensure that you are following the correct procedures and using the appropriate codes. This can save you time and reduce the risk of errors in your billing.
• Stay organized and accurate: Maintain accurate and up-to-date records for each client, including their personal information, insurance details, and treatment history. Double-check all information before submitting claims to avoid errors and delays in reimbursement.
• Be mindful of deadlines: Different insurers have different deadlines for submitting claims. Keep track of these deadlines and submit your claims in a timely manner to avoid delays or denials of reimbursement.

Frequently asked questions