With insurance reimbursement rates getting lower and the cost of operations increasing, managing a mental health practice can be overwhelming. The pressure is even more intense with billing because if it's not handled properly, it could mean loss of revenue as well as the risk of payer scrutiny.
“At this point, I have a mix of insurance and private pay patients, and I do my billing completely by myself,” says Rebecca Weiler, LMHC. “I have used an external billing agency in the past. Then, I was responsible for taking the co-payments and any self-pay by myself at appointments, but as far as billing insurance was concerned, I went through them.”
Whether you decide to do it all on your own or go through a billing agency, getting paid while maintaining an ethical relationship with your patients can be a tough balancing act.
Tips on Insurance Reimbursement
- Keep detailed documentation: Asides from a patient’s personal information, detailed records of a patient’s diagnosis, the type of therapy provided, patient’s progress, the aim of the therapy, and the duration of the therapy sessions should be kept.
- File on time: It’s vital that you submit your insurance claims within the allowed time, otherwise they will be denied. Because it varies from insurance companies to insurance company -anywhere from 90 days to 18 months-, you should always check with the individual insurance companies you’re contracted with for direction. Better still, create a fixed billing schedule for your practice. That way no claim gets submitted late. It could be every 15 days or every month, as long as it is followed strictly and is well below a 90-day cycle. “I bill the insurance companies per session and feel it is a fail-safe way to do things. There's more processing up-front, but it ensures that I’m getting the full cost of the services I provide, and nothing slips through the cracks,” says Weiler.
- Update patient information regularly: Patients can change their insurance policies and forget to inform you. To avoid your claim getting rejected, you should verify your patient's coverage and eligibility for specific services each time you provide that service.
- Track your claims: Claims filed should be tracked and followed up on at regular intervals. This way, it’s ensured that if there’s a problem with the claim—the patient changed policies, doesn't have insurance anymore, or it has been denied for another reason—it’s caught and can be remedied before the time limit is exceeded.
- Verify all new or potential patient information directly: “Some insurance companies have online platforms where you can run the potential patients’ information, like their member number or birthday, and get their benefits,” says Weiler. “On one hand, this can be very convenient as we don't have to spend hours on the phone trying to get to the right person trying to verify benefits, but on the other hand, sometimes the information pulled up online is not correct. And so I've had situations where I didn't get paid, and I had to submit appeals to insurance companies to try to get reimbursed.”
- Find out when pre-authorization is needed: Most insurance companies do not require pre-authorization for basic or initial therapy visits. However, for situations like having multiple sessions in a day or going over 45 minutes in a session, different insurance companies have different rules. You should always check beforehand whether pre-authorization is needed. Unfortunately, you can’t always know when you’ll need to go beyond 45 minutes with a client. “To bill for sessions over 45 minutes, some insurance companies require pre-authorization, which has to come before the appointment. We don't always know when a client comes in that there’ll be a need for that. So it's challenging to get reimbursed after the fact,” says Weiler.
- Educate support staff: If you have support staff at your practice that helps you carry out your billing, be sure to educate them on the right medical codes for every service. Keep them updated on coding changes. Doing this ensures that:
- You avoid under-coding or up-coding
- The service code always matches the pre-authorization granted
Transitioning From Accepting Only Private Pay to Accepting Insurance
To get the best out of deciding to accept insurance, you should get credentialed by some insurance companies and become an in-network provider. And to set your practice up for success, you should do the following before applying for credentialing with an insurance company:
- Find out which insurance companies are popular in the area you serve
- Find out which insurance companies cover for mental health services
- Ensure you’re providing accurate information about your practice
You can still accept insurance and submit claims for your services if you are not credentialed by any insurance company. However, you are limited to payment only by patients whose insurance policies provide for out-of-network benefits.
Billing the right way makes sure that all providers, including mental health providers, get paid for all the services they provide and no revenue is lost.
To learn more about how Kareo can help independent mental health providers streamline their insurance billing and patient collections and run a more successful practice: