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This includes not only a copy of their insurance card, but also their name, address, date of birth, phone number, SSN, marital status, and employer).
If there is ever a discrepancy between parties, you always have proof.
Always correct errors, whether it be spelling error or coding error, and then re-submit the denied claim.
More and more insurance companies are using email and online filing instead of paper and fax filing, but you must inquire with each insurance company as they do not tell you when they make such changes.
When you call insurance companies, never forget to jot down the phone number, name of the representative you spoke to, what they are going to do and when, and a reference number.
When entering data into your software of choice, click the back button in the software rather than the browser back button, or you will tend to lose all the information you entered into the page and have to do it all over again.
Check for and collect prior to acceptance any remaining deductibles, co-payments, and co-insurance responsibilities, and verify any prior authorization for planned procedures.
Oftentimes a patient’s information will change if they have a new policy or they have lapsed on their insurance policy and have no insurance, and it’s up to you to contact them and either get payment or refile a claim with the new policy.
The Centers for Medicare & Medicaid Services offers free courses on how to bill for and work with Medicare here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/WebBasedTraining.html
You must have a system in place that promptly notifies you of receivables and allows you to easily access information about claims when necessary.
If you’re unclear about something while on the phone with an insurance company, do not hesitate to ask them for assistance–they are more likely to give you an answer if you just ask.
You can easily Google diagnosis codes these days when doing your own mental health billing, and may not have to always resort to the DSM.
Some insurance companies don’t have just one address per department, or may choose to suddenly assign another company to handle its mental health billing services, and increases the chances of sending a claim to the wrong recipient and having the claim be denied.
A large majority of insurance claims and all Medicare claims are processed electronically, and as a result, 98% of those claims are reimbursed within 30 days, so it’s crucial that you understand the software in order to get paid in a timely manner.
You should receive payouts from claims 30 days or less after the insurance company receives the claim.
Free email providers are not HIPAA-compliant, so avoid getting a potential violation by having an email as YourName@YourDomain.com (GSuite is one option) rather than YourName@gmail.com, for instance.
Insurance companies will give you anywhere from 90 days to 18 months to file an insurance claim, so it’s up to you to know the various deadlines and submit your claims on time, or else they will most likely be denied.
Medical documentation should be reviewed immediately and checked for thoroughness, and claims should be submitted within 72 hours.
When applying a quick fix to a denied claim, try faxing it over to the insurance company for the fastest results.
It’s better to submit claims directly to Medicaid, Medicare, and Blue Cross Blue Shield, as clearinghouses can charge 40 cents for each of those respective claims submitted to them and/or may limit the number of claims you send them.
In order to create an Aging Report, you must be consistently posting your paid claims in your software and keeping a list of unpaid claims at the same time.
You only get reimbursed once you provide supporting documents with the bill, but understand that each insurance company needs different kinds of supporting documents.
In addition to your therapeutic duties, you must ensure claims get to the insurance company and perform proper follow-up procedures while also appealing claims that haven’t been paid–have an organized system in place.
You must accept the rate that insurance companies give you if you are in-network and not try to collect the difference if your cash-rate is larger than what the insurance company quotes you at–you can only collect said remainder if you’re out-of-network.
Don’t submit implied codes, codes that are not documented by medical necessity, unbundle codes for the sake of additional reimbursement, or select a procedural code that is similar to the actual service provided.
Insurance companies make money by investing premiums that can be debited monthly, and the longer it takes for you to get paid, the more insurance companies earn from its investments.
Oftentimes claims will be rejected at the clearinghouse, insurance companies will be updating their systems, or your billing software will malfunction for you, but it’s important that you express these problems to the companies that provide these services with courtesy and compassion–you’re on the same team!
While typically you can bill clients for only one session per day, you may be able to authorize multiple sessions in a single day if you call the insurance company and see if there are special circumstances.
Always call and ask what information needs to be corrected or entered in.
You can only bill to a secondary insurance after the primary insurance claim is handled.
When you have a contract in place, there is no reason for you to be underpaid, so always follow up and appeal when necessary.
While most insurance companies don’t require pre-authorization, some always do and others only during specific circumstances–you must know the regulations for every insurance company.
Never use regular email when sending client info–it’s against HIPAA rules.
Keep a list of phone numbers, websites, and username/passwords of not only insurance companies, but also clearinghouses.
Learn how to fill out a CMS 1500 form here: https://www.beaconhealthoptions.com/pdf/administrative/Tips_for_Completing_the_CMS_1500.pdf
If and when a claim is rejected, you must take care of fixing the rejection immediately, for you will never be informed about these claims from the insurance company in the future.
Always check whether planned procedures need prior authorization.
You should be monitoring your accounts receivable daily, making sure claims have been received while monitoring aging reports and taking action on any outstanding accounts–or source out your mental health billing to someone who will stay on it.
If you have a diagnostic code question, make sure to contact your software vendor for the answer.
All patient information must be protected, including demographic, insurance, and billing information, as well as treatment notes.
If you are out-of-network, 60% of the negotiated fee with the insurance company is reimbursed, whereas if you are in-network, 80-100% is reimbursed.
You must constantly make sure your patients under COBRA plans are renewing them monthly, or your insurance claims will end up unpaid.
You should call insurance companies that have claims over 60 days old, and always verify important information like the claim number, amount of payment, date of payment, etc.
Employee Assistance Programs can provide an untapped source of income, so call insurance companies and ask about their EAP coverage.
Get software that allows you to view, print, and post all ERA files effortlessly, such as Office Ally.
When you know the contracts you have with insurance companies inside and out, you will be able to handle claims faster and deal with any changes or updates that may be made to said contracts.
To find the latest CPT codes go to: https://psychcentral.com/lib/cpt-codes-for-psychology-services/
Know when the total number of sessions approaches its limit, don’t forget to call the insurance company in order to get approval for more visits.
If you have multiple outstanding claims in your Aging Report, inquire about all of them in one single call.
Any time with clients over your service’s CPT code isn’t covered by insurance, so make sure you’re not working pro bono–that is unless you want to.
Alex is a psychologist and mental health billing expert, and helps mental health professionals collect more revenue as owner of ePsych Billing.
Discuss your billing issues with a mental health billing specialist and workplace psychologist, get to root of what is causing problems with your billing, and come up with a solution that will allow you to focus more on your practice, while simultaneously increasing your bottom line.