Mental Health Billing: Answers to Frequently Asked Questions

If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance. mental health billing No one gets into the mental health field because they enjoy wading through insurance industry bureaucracy. People become mental health professionals because they want to help others.

Your primary care physician is the main doctor you will see for most of your ailments that don’t require urgent care. If you want to see a specialist, you may need a referral from a primary care physician. Medicare mimics a private insurance plan and has deductibles and co-pays. Medicare is structured into four parts, and you may be eligible for one or more of the parts. Federal agencies will soon issue rules specifying the form, timing, and manner by which good faith estimates must be transmitted to insurers. The information in this FAQ is only meant to apply to communication with patients who are self-pay or uninsured.

Choosing a Mental Health Diagnosis

The billing process can be frustrating and generally a big sigh compared to treating patients; however, the sooner you start, the sooner you get paid. And if you’re worried you can’t complete the process solo, the billing features of medical practice management systems (PMS) or third-party medical billing services can provide invaluable help. A lot of time, mental healthcare professionals find it difficult to juggle between rendering patient care and filing claims.

The following are a few questions and answers commonly asked regarding mental health billing. These codes are also known as ICD codes, or the International Classification of Diseases, which are the required code set for billing purposes. The codes contain criteria for mental health disorders and conditions that are relevant to psychological use. CPT codes also contain E/M codes — Evaluation and Management codes — which are also often used. Thriveworks was established in 2008, with the ultimate goal of helping people live happy and successful lives. In addition to providing exceptional clinical care and customer service, we accomplish our mission by offering important information about mental health and self-improvement.

Billing Advice

A psychologist in a primary care setting is referred a patient from the primary care provider for difficulties adhering to management of diabetes. The psychologist sees the patient for an initial diagnostic assessment and determines that the patient’s primary diagnosis is diabetes. The psychologist https://www.bookstime.com/blog/travel-agency-accounting would bill CPT® code 96156; Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making). The psychologist then schedules a follow-up appointment to address difficulties with adhering to medication recommendations.

One type of plan is a standard indemnity policy, which gives people the freedom to visit a health care provider of their choice and pay out of pocket for their treatment. In the mental health billing process, there’s no such thing as gathering too much information. Request as many facts as possible, including the patients’ full legal names and current addresses. When a CPT code represents a less serious diagnosis or a less expensive therapy than was actually provided to a patient, this is known as undercoding. Upcoding refers to the assignment of a code by a provider for a patient that represents a more serious diagnosis or more expensive treatment than is actually the case.