As a mental healthcare provider, you can do everything right up until you submit a claim, but all of your hard work will be undone if you don’t do it properly. For instance, after you provide a service, you should expect to receive a reimbursement from a claim. 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. If your practice has an online providers portal, you can also check there to discover and verify a patient’s benefits and eligibility for your services. If you know the available coverage for every patient before you provide services, it will be much easier for you to submit proper claims and minimize frustration for you and your patient.
When using time-based codes, make sure to document the exact start and end times of any face-to-face contact, as well as the details of any non-face-to-face clinical tasks completed on the same day. Many patients change insurance plans or reset deductibles, impacting how much each visit costs. Also, the American Medical Association rolls out changes to CPT® codes, and Medicare changes some rules around how to use certain codes. These codes are also known as ICD codes, or the International Classification of Diseases, which are the required code set for billing purposes.
The Role of Medical Record Documentation
Most insurance companies also base their reimbursements on the values established by CMS. This is a reason why mental health billing becomes complicated for providers, as it’s challenging to offer standardized treatment for all patients — making billing just as complex. Insurance companies have attempted to standardize billing for mental and behavioral health services to minimize payment in terms of the length of treatment, the number of treatments and the maximum number of covered treatments. Because insurers typically reimburse mental health care providers at lower rates than other providers, psychiatrists are less likely to participate in insurance plans, studies show. This forces patients to pay out of pocket, or, if their coverage includes mental health care, file an insurance claim to get partial reimbursement, assuming they’ve met their annual deductible. General Coding Psychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases.
Additionally, the medical record must include adaptations utilized in the session and the rationale for employing these interactive techniques. 2) Try using the MCD Search and enter your information in the “Enter keyword, code, or document ID” box. Your information could include a keyword or topic you’re interested in; a Local Coverage Determination (LCD) policy or Article mental health billing ID; or a CPT/HCPCS procedure/billing code or an ICD-10-CM diagnosis code. Try entering any of this type of information provided in your denial letter. Contractors may specify Bill Types to help providers identify those Bill Types typically
used to report this service. Absence of a Bill Type does not guarantee that the
article does not apply to that Bill Type.
American Hospital Association Disclaimer
If you decide to go this route, there are a few options available including the AAPC certification exam. There is also the National Association of Psychiatric Health Information Technicians (NAPRHT), which provides psychiatric medical coding certification. This certification exam must also be taken online or in a live class. Essentially, an incomplete or inaccurate medical record would reflect that medical and mental health services are unnecessary for the patient.
- Many health insurance plans also require pre-authorization, which means that patients must get permission before receiving coverage for some mental health services.
- When these services are billed to health insurance, it is often a simple task because routine checkups are frequently under one general charge.
- An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons.
- The first objective is increasing the number of counseling providers in high-need schools.
- You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents.