How To Bill Insurance For Therapy As Mental Health Facility

Having a new mental health facility is difficult. You need some time to learn the ropes, especially when it comes to patient and insurance billing. However, this is crucial for you to understand the accurate process because your entire facility runs on this revenue. So to enable you to become proficient in medical billing, we are here with a guide on how to bill insurance for therapy.

You might still be billing insurance companies for the patients. But doing it the right way is the key to generating your deserving revenue. 

Let’s dive into the detailed step-by-step guide on mastering the billing process and getting every claim approved with the right approach.

Overview of Insurance Billing

In order to understand how to bill insurance for therapy first you need to have basics about the process.

Mental therapy billing starts when a patient visits your facility for treatment. When all the services are rendered, for insured patients these treatments are recorded and filed into a document.

Some additional patient documents are attached. Also, an essential step here is that the treatments are converted into specific medical codes to make them readable by insurance companies. After completing the document, it becomes a “claim” and that is finally sent to the insurance companies.

Insurance payers then will have a look at the accuracy of the application and will decide whether to pay the amount or not. 

So therapy billing is based on this entire process. You have to submit claims and wait for the response. But if there are any errors in the claim, it will be rejected immediately. That’s why we emphasize you to learn how to bill insurance companies for mental health facilities.

Step 1: Verify Insurance Coverage

The first and foremost step in how to bill insurance for therapy is to make sure the patient has insurance coverage for the specific therapy treatment they visited you for.

It is a crucial step as it directly impacts the approval or rejection of the bill. If a patient’s insurance package doesn’t contain specific treatments, then payers would not pay for them. Instead, patients are responsible for the bill.

For this, you can directly contact the insurance payer and ask about patient coverage.

What Documentation is Needed to Verify Insurance?

Before conducting communication, you must ask the patient for some documents to ensure you have their complete information. Following are the records you will need to request:

Patient Information:

• Full name
• Date of birth
• Address
• Phone number

Insurance Information:

• Insurance company name
• Policy number
• Group number (if applicable)
• Insurance card (front and back copy)

Type of Coverage:

• Type of plan (HMO, PPO, EPO, etc.)
• Network status (in-network or out-of-network)

Coverage Details:

• The effective date of the policy
• Termination date (if applicable)
• Specific benefits of mental health services
• Coverage for specific services (e.g., individual therapy, group therapy, teletherapy)

After knowing these details, record them in your systems. You can further verify the coverage by communicating with the insurance payers and reconfirming the information the patients provide.

Step 2: Using Insurance Billing Codes

After the patient visit, you will begin with their services. Once all the therapeutic treatments are completed, prepare a claim application. But first, the treatments you listed have to be converted into medical codes.

These codes (i.e., ICD, HCPCS, and CPT) are a language used in healthcare to understand specific treatments given to the patient along with given conditions. With these codes, the payer understands that this patient received that medical treatment and how much they owe.

Common CPT Codes Used During Mental Therapy Billing

The following are daily CPT codes used when billing insurance companies for mental health services:

Diagnostic Evaluation

90791: Psychiatric diagnostic evaluation (without medical services)

90792: Psychiatric diagnostic evaluation (with medical services)

Psychotherapy

90832: Psychotherapy, 30 minutes with patient

90834: Psychotherapy, 45 minutes with patient

90837: Psychotherapy, 60 minutes with patient

Psychotherapy with Evaluation and Management (E/M) Services

90833: Psychotherapy, 30 minutes with patient when performed with an E/M service

90836: Psychotherapy, 45 minutes with patient when performed with an E/M service

90838: Psychotherapy, 60 minutes with patient when performed with an E/M service

Family and Group Therapy

90846: Family psychotherapy (without the patient present), 50 minutes

90847: Family psychotherapy (conjoint therapy) (with the patient present), 50 minutes

90849: Multiple-family group psychotherapy

90853: Group psychotherapy (other than of a multiple-family group)

Crisis Psychotherapy

90839: Psychotherapy for crisis, first 60 minutes

90840: Psychotherapy for crisis, each additional 30 minutes

Interactive Complexity

90785: Interactive complexity (used as an add-on code to the primary psychotherapy service)

Step 3: How to Bill Insurance for Therapy

After conducting coding of the medical treatment, the crucial process begins. And that is how to bill insurance for therapy or how to send them the bill following all their requirements.

First, you will have to prepare the claim application. As we discussed, you have to add all patient information in the application along with accurate codes. You will also have to attach some documents with the claim, which we will discuss below.

At the end, review the application for accuracy. Carefully read all the codes. You must use the latest code versions for the services, for which you need to be updated with new code developments as well as code removals.

Which Documents are Needed to Be Attached With the Claim?

Following are the basic documents and pieces of information you must make sure to provide to the insurance payers along with the claim submission:

Patient Information:

• Full name
• Date of birth
• Address
• Contact information
• Insurance policy number
• Group number (if applicable)

Provider Information:

• Provider’s name
• Provider’s credentials
• National Provider Identifier (NPI)
• Tax Identification Number (TIN)
• Facility information (if applicable)

Service Details:

• Date of service
• Type of service provided (e.g., individual therapy, group therapy)
• Duration of the session

Coding Information:

• CPT codes for the services rendered
• ICD-10 codes for the patient’s diagnosis
• Any necessary modifiers

Clinical Documentation:

• Progress notes for each session
• Treatment plans and updates
• Patient intake forms
• Initial assessment and diagnosis

Authorization Information:

• Pre-authorization approval details (if required)
• Number of sessions authorized

Billing Information:

• Itemized list of services provided
• Corresponding charges for each service
• Records of payments received
• Outstanding balances

Supporting Documentation:

• Copy of the patient’s insurance card (front and back)
• Referral forms (if applicable)
• Explanation of Benefits (EOB) from previous claims

What Are the Common Methods for Submitting Claims?

Claims can be submitted through different processes and each has its pros and cons. The way you submit the application also makes an impact because insurance payers nowadays want optimized claim submission. 

Let’s see what are the two ways you can file the claim:

Electronic Submission

This is the most efficient way of sending claims to your insurance payers without any hurdles. All you have to have is the insurance company’s portal to which you can send the claim electronically. They will receive the application promptly and begin with their review work.

Another way is through the Electronic Health Record system. It enables you to generate claims electronically and automatically submit them. These systems are best for error-free submission because they integrate with current healthcare systems and fetch patient records directly.

Paper Submission

Though paperwork is an old method, it is still highly used in many mental health facilities to submit claims. They write claims and print bills manually and then send to the payer.

However manual coding can have a high number of errors. So it is crucial to maintain attention to detail while creating the claims on your own.

However, this type of claim submission is more useful when electronic health systems are down and you are running out of time to bill insurance payers before a certain date.

Some Legal Considerations To Keep In Mind

When learning how to bill insurance for therapy, besides dos you must know the don’ts of submitting claims. Some regulatory authorities are there that make sure healthcare facilities comply with specific rules to protect the patient’s health and fulfill legal and financial obligations to keep working.

Here is a short yet crucial list of a few things you must implement while conducting mental health therapy billing:

• Get the consent of the patient before sharing information.
• Make sure that data is transmitted and stored securely.
• Steer clear of downcoding or upcoding services.
• The False Claims Act must be followed.
• Verify that services are required for medical reasons.
• Use precise units and modifiers.
• Observe the laws in your state regarding mental health services.
• Follow Medicare and Medicaid regulations.
• Follow the terms of the insurance provider’s contract.
• Bill in accordance with rates and fee schedules.
• Get informed permission before beginning treatment or mental health billing.
• Give patients a clear understanding of their financial responsibilities.

Mastering Insurance Billing

Knowing how to bill insurance for therapy and medical treatments is a must if you want to earn stable revenue. The process not only requires listing medical services and creating a claim to submit. Instead, it requires precision at every stage, overall considerations to follow, constant tracking, and resolving payer issues if any. 

So don’t worry. From now on, you won’t face any claim denial. All your claims will be approved if you learn how to bill insurance companies following our steps.