If you are a mental health professional working in private or group practice, you have your work cut out for you. Serving your clients well, and finding the time to handle all of the administrative tasks of your practice can become quite stressful.
Mental health professionals have billing needs that differ from other medical professionals. It is commonplace for many types of medical doctors to have large office staffs, with many administrators handling the billing and claims.
However, many (and perhaps even most) mental health practices run on much thinner financial margins than their “medical” counterparts, and therefore the burden of mental health billing often falls on the counselor, or a small office staff. Perhaps because of this, sadly, many practices collect less than 85% of the money they are owed from insurance companies.
You can do much better than this! With some perseverance, and a strong working knowledge of billing, you can expect to collect 96%, to as high as 99% of your claims. Here are some quick questions and answers that will save you time and money.
1. Is the reimbursement pay from the insurance company worth it?
Being a mental health professional can be difficult, and you want to be rewarded appropriately for your service. Is it worth it to bother with reimbursements from insurance companies? Should counselors just stick to a “cash-only” approach?
Some insurance companies pay poorly, but many pay quite well. Usually the larger private insurance companies: Aetna, Blue Cross, Blue Shield, and United Behavioral Health (and many more) pay the best. In general, Medicaid and Medicare reimburse lower than the private insurances.
Regardless of the reimbursement rate, it’s important to stick to the time limit provided in a service’s CPT code. For example, if you are billing for a 45-minute psychotherapy session, any time spent with clients after the 45-minutes is free labor. Those 15-minute overages add up!
2. Can I bill the same client for multiple sessions in one day?
Without special permissions, the rule is normally one session, per patient, per day. However, if you call the insurance company, you may be able to receive authorization for more than one service per day. Special circumstance: if you have a psychiatrist on staff, it is completely acceptable for the psychiatrist to provide one service, and then you (the counselor) to perform one service, totaling two services.
3. How long do insurance payouts normally take?
Typically, it can take 30 business days from the date the insurance company received the claim until the payout is received. But it does not always take that long. For example, Blue Cross in Massachusetts normally pays their claims within 2 weeks, and Aetna normally takes three weeks.
Still, the rule that insurance companies abide by is that all claims must be filled within 30 days. Thus, if you think about it, after the first month of practice, providers don’t usually notice the delay because payments are continuously flowing in.
4. What do you do if a patient changes their insurance information and does not tell you?
This problem happens too often; a client doesn’t let you know they have a change in their policy (or, in really bad cases, no policy at all). Typically, you will send the claim, wait for it to get paid, only to find out that the claim has been rejected.
In this situation, you need to connect with the client/patient, and get their new insurance information. You will probably run into one of two situations:
A. They don’t have any insurance. In this case, you have to try and get payment from the client directly.
B. They have a new policy. In this instance, you need to re-file the claim through the new policy, and hope that the session didn’t need pre-authorization. If it did, call the insurance company to see if they will “back date” the authorization. If the company says that they don’t back date authorizations, ask nicely for an exception to be made for this “one time” unique situation. The insurance company might not care about you and your practice, but they will care about annoying a newly insured member who will be on the hook for your clinical fees if they don’t grant the authorization.
Lastly, if you haven’t seen a client for a while, call the day of their session to see if the client is still active with their insurance plan.
5. How long do I have to submit an insurance claim?
This varies by insurance company, so it is always good to check with the insurance companies that you submit claims to. In some cases, time is of the essence – Aetna normally allows 90 days to file a claim. With other companies, you may have more than a year – Medicare typically allows 1 year to 18 months (but it depends on the state).
You really need to check with the insurance companies that you work with to make sure you get your claims in on time. If you provide the service, forget to submit the claim on time, and then try to submit the claim late, it will probably be denied.
6. Do sessions need to be pre-authorized?
Typically, with most insurance companies, a basic office visit, therapy session, even the initial session, do not need authorization; but it is always best to check to make sure. When in doubt, check it out!
Tufts insurance almost always requires authorization for a claim. Also, in the case of psychological testing, you always need to obtain an authorization. Some insurance companies like Blue Cross of Massachusetts allow up to 12 visits without authorization, and then providers are required to get an authorization for the next 12.
Generally, for the basic stuff, you do not need authorizations, but always check.
7. Can I bill a client for the balance?
If I am a healthcare provider and my service fee is $150 per appointment, but the insurance company only pays $75, can I charge the client/patient the balance?
If you are contracted with a particular insurance company, you cannot “balance bill” your clients. You will have to accept the insurances’ rate, and then write off the difference, for that particular service.
Being contracted with an insurance company is a give and take. Being in-network with an insurance company brings in more patients and clientele, and some evidence shows that your clients might even stay longer on average, but your hourly/session rate might be reduced.
For example, if $70.00 is your contracted rate with a n insurance company, for a 45-minute service, and the patient pays a $20 co-pay, the insurance will pay everything minus the $20 dollar co-pay (that is $50 dollars). So, if your cash-rate is $150.00 – you will get the $20 co-pay from the patient, and the of $50 from the insurance company; and that’s it! You cannot say to the patient, “You owe me an additional $80 bucks.”
If you are out of network and do not have a contract with an insurance company, then you can bill the patient for the remainder. But if you have a contract, you are contractually bound and cannot go over what they allow for that particular service.
8. How does COBRA affect me as a counselor?
A COBRA plan gives people, who may have just lost their job, time to find a new job with new insurance, without losing insurance coverage.
If a patient has a COBRA plan, and they had a previous plan that you had billed, then you would continue to bill them as normal. If a client has just lost his or her job, it may take a little while for the coverage to kick in, and the patient may show as inactive when you call the insurance company. However, the client still has insurance, and the insurance company will backdate the COBRA, as long at the client makes his/her COBRA payments.
9. What happens if a patient stops paying his or her COBRA dues?
If a patient fails to pay their COBRA (and some do, because it’s expensive), then they will lose their insurance coverage and your insurance claims will not get paid. COBRA gets renewed on a monthly basis, so you may want to call and check to see if your client is presently active under COBRA.
10. What is the hardest part of mental health billing?
The hardest part for providers conducting mental health billing is the variety of hoops that each insurance company makes the biller jump through. For counselors and other healthcare providers, time management becomes a major issue when one is trying to see patients and simultaneously file insurance claims. It takes time to learn what diagnosis codes work, and even where and how to submit each claim.
It gets complicated. Mental health billers find that insurance companies often have multiple addresses for each department, and it is sometimes hard to know what department to send claims to. If you happen to send the claim to the wrong department, it will reject. If you submit a paper claim for a company who only accepts electronic claims, it will be rejected. If you submit a claim to an insurance company that has decided to outsource its handling of behavioral health services to another company, the claim will be rejected. Billing is a detailed process to say the least.
To Bill, or Not to Bill
Mental health billing is not always an easy or straightforward process. However, with patience, perseverance, and maybe even a little training from someone who has done it before, you can tackle your practice’s medical billing.
Alternatively, mental health billing can be outsourced to a professional billing company. Some counselors find that they are better off delegating billing tasks, and offsetting the costs by spending the time that they would have spent billing insurance claims seeing a few more clients. The choice is yours!
Anthony Centore is a Counselor, is Private Practice Consultant for the ACA, and helps counseling practices across the US thrive. For more information on private practice and insurance panels go to http://thriveworks.com.