Complete Guide to Mental Health Billing Updated for 2022

mental health billing

Thus, if you don’t have a clearinghouse that has specific processes in place to help you with each of those mental health billing-related aspects, you should seek a new one. Since you and your staff work within your PM/EHR daily, the most ideal process to submit mental health claims to all of your client’s payers is through it. To make this submission method even less appetizing, Medicare requires that mental health providers use electronic billing. If you have a client who comes in for an appointment for an ailment or service that isn’t covered by their insurance provider, you’re going to receive a denial on their claim that you submit.

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They use this information to make decisions about which treatments are most effective. This data can help individuals coordinate behavioral health treatments from different professionals and prevent unnecessary or ineffective treatments, lowering premiums for MCO members. If a mental health provider’s fee for a service is higher than an insurer’s reimbursement, the provider must accept the amount offered in most cases.

Therapeutic Services by Psychiatrist

And in taking a look with many of our coding experts, these are the ones that came to top of mind. Certainly every patient has unique circumstances, but when you’re taking a look here, we’ve really got codes that cover a wide swath. The fee-for-service billing model is one of the most common types of billing. Organizations submit reimbursements for each service, like counseling, individual therapy, or group therapy.

mental health billing

So, this really took the clinicians away from providing behavioral health care, which is not a great use of our already limited behavioral health resources. So, we took their experiences and really focused on simplifying and integrating the necessary billing features. So the key takeaway here is that we focused on integrating the time capture feature into a clinically value-adding tool.

Tips for Mental Health Billing

To learn more about how software can make behavioral health billing easier, contact us at Foothold Technology. Further, if you see another family member, feel free to bill for the intake for that date as well. Without special permissions, the general rule is only one intake session, the first session, per patient. If you call the insurance company, you might be able to get authorization for more than one service per day.

The other set of codes that really comes in with the evaluation and management group is behavior change interventions. So you get a chance to connect with that patient before it gets to be a medical problem. And it’s nice to note that there are facilities there, and depending on who’s reporting this, this may be an option. Again, if you have a patient who maybe they haven’t gotten to the stage where a full fledged behavioral health broad program is needed, you have the chance to intervene early. Reconciling billing to services involves finding the fee for each service you can expect from the insurer. If you don’t receive the amount owed, you can resubmit the claim and ask for the difference.


With this free guide, you’ll learn the key metrics that inform your practice’s financial performance and how best to optimize them to support practice growth. You will received EOBs in the mail along with a check for those dates of service. That being said, we recommend snapping a front and back photo of their insurance card for your records. If you know you want to work with our team of billing experts to get your problems sorted right now, simply drop us a line. The CPT indicates a 45- to 55-minute session, and the CPT code indicates longer sessions.

  • However, if you file an incorrect code or accidentally file it to the wrong insurer, you can be denied or run into other billing issues.
  • The sensitive nature of substance abuse treatment can also provide challenges.
  • Now, right now during the public health emergency, we all know that there are a number of waivers that CMS has enacted for additional services to be provided during the PHE in a telemedicine environment.
  • An EHR, electronic health record, is more comprehensive and can be used for a patient across multiple health practices.

Immediate family members or caregivers attend therapy sessions to learn about the disease and how to care for a family member who has a particular ailment, diagnosis, or other mental health difficulties. This service may be provided with or without the patient’s presence and is occasionally reimbursed. Verifying benefits is the most important part of the revenue cycle management (RCM) process. If you don’t understand the patient’s coverage before their appointment, you could lose the claim from the get-go.

ICD-10-CM Codes that DO NOT Support Medical Necessity

You do important work, and you deserve a comprehensive platform to manage your practice, billing and insurance claims, all in one place. The nice thing is that at least it’s gone from no coverage to some coverage horizontal analysis financial definition of horizontal analysis and some level of the payment parity. So there are differences, but you also want to make sure that you report that place of service and the modifier 95 appropriately when you’re using the other codes.

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Staying on top of these changes can be challenging, especially if you run a small practice with limited staff. But if you’re not aware of these changes, you could be submitting incorrect claims that hamper your revenue cycle and slow down reimbursement. With mental health becoming a bigger part of the healthcare landscape, billing rules and regulations are always changing. Many of the telehealth codes, for example, were added during the COVID-19 pandemic. The Centers for Medicare and Medicaid Services (CMS) continues to update its telehealth fee schedules.

Integrating billing and payments with a general ledger (GL) helps save time and effort for individuals and providers. With the right mental health billing software, you can access information from many insurers, providers, and individuals and communicate with other organizations quickly and easily. Billing integration encourages communication among providers and insurers, improving treatment quality and preventing billing inaccuracies. Typically, mental health patients and insurers receive bills for treatments such as therapy, psychological testing, and medical management. The biggest challenge of mental health billing is that it’s not uncommon for the mental health needs of a patient to be larger than the services that the insurer will cover.

How do you bill psychological testing?

– The first hour of psychological evaluation is billed using 96130 and each additional hour needed to complete the service is billed with the add-on code 96131. – CPT Time Rules allow an additional unit of a time-based code to be reported as long as the mid-point of the stated amount of time is passed.

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