Submitting Psychology Bills To Insurance: A Comprehensive Guide For Practitioners

Submitting a psychology bill to insurance can be a challenging and frustrating process. Mental health professionals often face an uphill battle when seeking reimbursement for their services, as the complex rules and regulations of the insurance industry make successfully submitting claims difficult. This process typically involves a large amount of information, including client demographic and insurance information, as well as the correct billing codes. While it is possible to outsource this task to a billing service or handle it manually, using a practice management software with therapy billing capabilities can streamline the process. Regardless of the approach chosen, understanding the basics of therapy billing and claims is essential for any clinician.

Understanding the basics of insurance billing for therapy

The process of insurance billing and claims filing is one of the most frustrating tasks therapists face. Here are the basics of insurance billing for therapy to help you get started.

Getting Credentialed with Insurance Companies

Medical credentialing is the process through which a therapist joins an insurer's provider panel. Therapists who are not credentialed with insurers cannot bill insurance directly, and instead, the client must seek reimbursement from the insurer, which is not guaranteed. Therefore, joining a provider panel is often a better option. Here are the steps to get credentialed:

• Make a list of the companies you want to be credentialed with, preferably the largest insurers in your area.
• Apply to become part of the insurer's provider panel through their website.
• Complete the Council for Affordable Quality Healthcare (CAQH) application.
• Follow up with each insurer to which you apply, as it can take several months to get approved.

Filling Insurance Paperwork

Once you're accepted to a provider panel, the insurer will provide a detailed guide to billing and information about covered services and rates. To properly bill for mental health services, you will need to select the right Current Procedure Terminology (CPT) code, which depends on the procedure and its length. Common CPT codes for therapy include:

• 90832: 30-minute psychotherapy
• 90839: 60-minute crisis psychotherapy
• 90847: 50-minute family psychotherapy when the primary client is present
• 96132: Neuropsychological testing services, such as evaluations for dementia or ADHD

Deadlines and Payment Schedules

The time you have to submit a claim for payment varies from insurer to insurer. Medicare and Medicaid typically require claims to be submitted within 365 days, while private insurers tend to set shorter deadlines, such as 90 days. To avoid missing deadlines, discern the shortest filing period and file all claims by that period.

Getting Insurance Payouts

There are several factors that can impact the wait time for insurance payments. To ensure you get paid as quickly as possible, discuss insurance policies with your clients, help them navigate insurance reimbursement, establish policies for when insurance denies a claim, and know the specific policies and billing requirements of the insurer.

Submitting Claims

Regardless of whether you outsource your therapy billing, use a biller, or use practice management software, understanding the basics of therapy billing and claims is essential. Here are the steps to submit a claim:

• Gather your client's information, including their full name, date of birth, insured's information, dates and place of service, diagnostic/ICD-10 code(s), and service code.
• Input your information, such as your service provider's NPI and taxonomy code, practice tax ID and NPI, and practice location.
• Double-check your claim for accuracy and ensure no information is missing.
• Know your claims submission deadline and establish a filing schedule.
• Send your claim electronically or by mail, and track your claim's status.

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 involves verifying your education, training, and professional experience to ensure you meet the company's internal requirements for serving as an in-network provider.

While credentialing can be a long and tedious process, it provides psychologists and therapists with access to a wider client base. Most people need to use insurance to afford therapy, so being listed as an in-network provider makes your services more accessible. Credentialing also gives you flexibility, allowing you to start your own practice or move locations without losing access to insurance panels. It can also give you leverage when negotiating salaries with employers.

How to get credentialed:

• Get organised: You will need to provide a lot of information, including a current license to practice in your state, proof of liability insurance, an NPI (National Provider Identifier) number, a Tax ID number or Employer Identification Number (EIN), a current resume or CV, professional references, and proof of any special certifications or qualifications.
• Complete the CAQH Proview application: The Council for Affordable Quality Healthcare (CAQH) runs a national database that most insurance companies use for credentialing. It collects relevant information and requires therapists to keep it updated. You can apply online.
• Identify insurance companies to apply to: Research which insurance companies are popular in your area and decide which ones you want to join. Consider factors such as reimbursement rates, approval times, and the company's reputation.
• Complete the application process: Each insurance company will have its own application process, which you will need to complete individually. Most companies have online applications.
• Follow up: After submitting your application, call the insurance company to confirm they received it and to ask about any additional information they may require.
• Be prepared to re-apply: Insurance panels are often full, and there may be a lot of competition. If you are rejected, don't lose hope. Appeal the decision, and if that doesn't work, plan to reapply every few months.
• Review the contract: Once you are approved by an insurance company, carefully read the contract. Understand the terms, including reimbursement rates, and don't be afraid to negotiate if you are unhappy with certain aspects.

Common challenges of the credentialing process:

• It is time-consuming and can take months to get approved.
• It is detailed, and you must ensure your application is complete and accurate to avoid delays.
• Insurance panels are competitive, so it is important to showcase your unique skills and strengths.

Resources for help with credentialing:

• Facebook groups such as "Insurance Billing and Credentialing for Mental Health Clinicians".
• Podcasts like "Insurance Answers".
• Online courses such as "Mastering Insurance".
• Blogs and websites like "Credentialing.com".
• Books such as "Starting Your Private Practice" by Maryanne Duan.
• Local and state professional organisations.

Filling insurance paperwork

Filling out insurance paperwork can be a complex process, but it is a necessary step to get reimbursed for psychotherapy services. Here is a detailed guide on how to fill out the required forms:

The Claim Form:

The standard claim form used by health insurance companies in the US is the CMS (Center for Medicare and Medicaid Services) 1500, which consists of 33 sections. However, you don't need to fill out every section for a standard health insurance claim. Most online portals will only require you to fill out the necessary information.

Sections to Fill Out:

• Sections 1-3 and 5: These sections are for the patient's information, including their insured ID number, which is crucial for the claim to be accepted.
• Sections 4, 6, and 7: These sections are for information about the insured individual, which may be the same as the patient's information or could be a spouse or parent if the patient is on their policy.
• Section 10: This section usually requires "No" answers for most mental health claims.
• Section 11: Enter any group number if applicable; otherwise, leave it blank or enter "none".
• Section 11a: Fill in the insured's date of birth and gender.
• Sections 12 & 13: Simply write "Signature on file" along with the date of the first visit.
• Section 21: Enter the primary diagnosis using the ICD-10 code. If there are multiple diagnoses, you can list them, but only one is required.
• Section 23: If services require prior authorization, enter the authorization number here. Otherwise, leave it blank.
• Section 24a: Enter the date of service, using the same date for "From" and "To".
• Section 24b: Place of service, which is typically "11" for your office.
• Section 24d: Enter the CPT (Current Procedural Terminology) code for the type of session, such as individual psychotherapy or family therapy.
• Section 24d Modifiers: These are usually not used, but when required, they are two-letter codes that may be specific to the insurance company.
• Section 24E: Usually "A", indicating the diagnosis code line from Section 21.
• Section 24F: Enter the charges for the session. It is recommended to put the full rate here to show the discount applied by the insurance company.
• Section 24G: This is typically "1 unit".
• Section 24J: Your NPI (National Provider Identifier) number.
• Section 25: Your tax ID number.
• Section 27: Check "Yes" if you want the payment to come to you directly.
• Section 28: Total charge from Section 24F.
• Section 29: Any co-pays or payments made by the client.
• Section 31: Your name and the current date.
• Sections 32 & 32a: Your office location and address.
• Sections 33 & 33a: Enter the name of your practice.

Additional Information:

Once you have filled out the above sections, your claim form is ready to be filed. Double-check all the information, especially numbers, to avoid any errors. Using a clearinghouse like Office Ally can help identify any missing or incorrect information before submission.

Submitting the Claim:

You can submit your insurance claim through the insurance company portal, a clearinghouse, or an EHR (electronic health record system or practice management application). Each method requires different information, but the process is generally straightforward.

Reimbursement:

After submitting your claim, you can expect reimbursement from your insurance company, either directly to you or to your therapist, depending on the arrangements. This process can be done online or by mail, and it is essential to keep proper records and invoices to support your claim.

Deadlines and payment schedules

Medicare and Medicaid typically require claims to be submitted within 365 calendar days from the date of service. In contrast, private insurers often set shorter deadlines, with 90 days being a common timeframe. To avoid missing deadlines, it is advisable to determine the shortest filing period among the insurers you work with and then file all claims within that period. For instance, if one of the private insurers you work with allows only a 90-day filing period, consider submitting all claims within 90 days.

Therapists are generally entitled to reimbursement within 30 days of submitting a claim. However, coding errors or other issues can cause delays in reimbursement. Therefore, it is important to monitor the status of each bill you send out and follow up with the insurer if payment is not received within the expected timeframe.

To streamline the claims submission process, it is beneficial to establish a consistent claims filing schedule or protocol. Additionally, utilising technology and software solutions designed for mental health billing can greatly assist in managing deadlines and payment schedules. These tools can help you electronically submit claims, track their status, manage authorisations, and perform various other tasks related to billing and payment processing.

Getting insurance payouts

• Discuss insurance policies with your clients: Verify insurance coverage and reimbursement rates with new clients. Ask individuals to notify you if they switch insurance providers. This will help you keep track of their coverage and avoid any surprises later on.
• Help your clients navigate insurance reimbursement: Many insurers only provide coverage once a client has met their deductible. Discuss this with your client at the first therapy session so that they are aware they may need to cover some sessions out of pocket. If your client changes jobs, make sure they are informed about COBRA benefits, which will continue covering therapy while they seek new employment.
• Establish policies for when insurance denies a claim: Determine whether the client or the therapist is responsible for payment if the insurance company denies a claim. This will help you manage expectations and avoid financial surprises.
• Know the specific policies of the insurer: Different insurers have different requirements. Some may require pre-authorization for certain services, while others may only cover treatment if a specific condition is diagnosed. Familiarize yourself with the policies of the insurance companies you work with to streamline the reimbursement process.
• Know who to contact with billing questions: Dealing with insurance companies can be frustrating and time-consuming. Keep a log of previous calls and contacts so you know which strategies are most effective. This will help you navigate the process more efficiently and save time.
• Submit claims promptly: Most insurance companies have deadlines for filing claims, and late submissions may result in denied claims. Establish a claims filing schedule or protocol to ensure you don't miss any deadlines.
• Keep accurate records: Maintain documentation for each visit, including diagnosis codes, procedure codes, and dates of service. This information is crucial for submitting claims and may be requested by insurance companies.
• Follow up on denied or delayed claims: If you don't receive payment within the expected timeframe, follow up with the insurer. Stay calm and provide any additional information or corrections as needed.
• Consider using a billing service: If the insurance billing process becomes overwhelming, consider outsourcing your billing to a professional service. They can help ensure that your claims are submitted correctly and on time.

Frequently asked questions