The Mental Health Parity and Addiction Equity Act of 2008 prohibits private insurers from discriminating against people with mental health diagnoses or providers who offer mental health services. In other words, insurers must now cover mental health care to the same degree that they cover physical health care. This legislation aims to expand access to mental health care. In many cases, it also offers greater earning power for therapists, who may be able to serve clients who cannot afford to pay for coverage on their own.
Here’s what you need to know about insurance billing for therapy sessions.
obtain accreditation from insurance companies
Medical accreditation is the process by which a therapist joins an insurer’s panel of providers. therapists who are not accredited with insurance carriers cannot bill insurance directly. instead, the customer must seek reimbursement from the insurer. the refund is not guaranteed and the customer may have to go through many hoops. in the meantime, the client is responsible for the bill and the financial burden may cause the client to attend therapy less frequently. so joining a panel of providers may be a better option for both the therapist and the client.
here are four steps to get accredited:
- Make a list of the companies you want to become accredited with. with hundreds of insurers in the united states, it’s best to choose the largest insurers in your area. You may also want to ask other therapists about their experience working with specific insurers. some may offer higher payouts or make the accreditation process easier.
- request to be part of the insurer’s provider panel. Most insurers offer an application on their website. many insurers will give you a caqh number, which will allow you to complete a caqh application.
- complete the council application for affordable quality healthcare (caqh). Most major insurers require the CAQH application as part of their accreditation process. You will need to apply to the insurance company for accreditation, receive a CAQH number, and only then can you complete the CAQH application. caqh will then send the request to the insurance provider.
- Follow up with each insurer you apply to. Approval can take several months and you may need to provide additional information. tracking ensures that you are made aware of any app issues as quickly as possible.
after your caqh application is accepted, you will need to re-certify the information contained in it on a quarterly basis. keep an eye on your email for caqh notices so you don’t lose your credential.
fill out insurance paperwork
You must bill insurance for each treatment session using documentation required by the provider. When you are accepted into a provider panel, the insurer will provide you with a detailed billing guide, as well as information on what services are covered and at what rates.
In order to correctly bill mental health services, you will need to select the correct current procedural terminology (cpt) code. the correct billing code depends not only on the procedure, but also on the time it took. Some examples of common cpt codes for therapy include:
- 90832: 30-minute psychotherapy
- 90839: 60-minute crisis psychotherapy
- 90847: 50-minute family psychotherapy when primary client is present
- 90853: group psychotherapy
- 96132: Neuropsychological testing services, such as evaluations for dementia or ADHD
- discuss insurance policies with your clients. verify insurance coverage and reimbursement rates with new clients. ask people to notify you if they change insurance providers.
- help your clients manage insurance reimbursement. many insurers only offer coverage once the client meets their deductible. Discuss this with your client at the first therapy session so they know that you may have to cover some sessions out of pocket. If your client changes jobs, make sure they know about Cobra benefits, which will continue to cover therapy while your client looks for a new job.
- Establish and discuss policies for when insurance denies a claim. Is the customer responsible for payment?
- know the specific policies an insurer requires you to follow. For example, some insurers require prior authorization for some services or will only cover treatment if it diagnoses the client with a specific condition.
- know who to contact with billing questions. You can easily spend several hours with a single billing error if you call, wait on hold and jump from department to department. keep a record of previous calls and contacts so you know which strategies are most effective.
The current American Medical Association CPT Handbook provides up-to-date billing codes, so make sure you have a recent copy and use it as a guide. online billing guides may not be completely accurate or may include outdated codes. The codes you previously used may no longer be up to date, especially if it has been a while since you used them.
To ensure timely payment, it is important to bill for the proper procedure. constant incorrect coding can trigger an audit, delayed payment, or even removal from a vendor panel. Keep documentation of each visit so you can support your billing claims, as insurers may periodically request additional documentation.
payment terms and schedules
The amount of time you have to file a claim for payment varies from insurer to insurer, so check your provider’s panel documents for clear guidance. Medicare and Medicaid generally require claims to be submitted within 365 calendar days from the date of service. private insurers tend to set shorter terms.
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Therapists who work with multiple insurers may be forced to juggle multiple deadlines. To avoid missing a deadline, it’s helpful to discern the shortest filing period and then file all claims before that period. For example, if you work with a private insurer that offers only a 90-day filing period, consider filing all claims within 90 days.
Therapists should generally be reimbursed within 30 days. however, coding errors can delay reimbursement, so it’s important to keep track of every invoice you send. If you don’t receive payment within 30 days, follow up with the insurer.
get insurance payments
Numerous factors can extend or shorten the wait for insurance payments. Some strategies that can ensure you get paid as quickly as possible include:
goodtherapy.org offers education and training on the many challenges of insurance billing. Our marketing webinars frequently feature tips for billing, reimbursement, and running a profitable practice. You will also be listed in our directory of mental health professionals. To gain access to our wide range of resources, become a member today!
See also: Why aren’t hearing aids always covered?
- centre, a. (2012, December 17). get on the insurance panels: prepare for the process. retrieved from https://www.counseling.org/news/aca-blogs/aca-member-blogs/aca-member-blogs/2012/12/17/getting-on-insurance-panels-preparing-for-the- process
- centre, a. (2012, December 17). mental health billing: 10 common questions and answers. retrieved from https://www.counseling.org/news/aca-blogs/aca-member-blogs/aca-member-blogs/2012/12/17/mental-health-billing-10-common-questions-and- answers
- coding and reimbursement. (North Dakota.). retrieved from https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
- cpt codes for psychiatric and psychological procedures. (April 8, 2019). retrieved from https://hmsa.com/portal/provider/zav_pel.bh.cpt.500.htm
- How do I file a claim? (North Dakota.). Retrieved from https://www.medicare.gov/claims-appeals/how-do-i-file-a-claim
- the addiction equity and mental health parity act (mhpaea). (2016, October 27). retrieved from https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html