The Mental Health Parity and Addiction Equity Act of 2008 prohibits private insurers from discriminating against people with mental health diagnoses or providers who offer mental health services. In other words, insurers must now cover mental health care to the same degree that they cover physical health care. This legislation aims to expand access to mental health care. In many cases, it also offers greater earning power for therapists, who may be able to serve clients who cannot afford to pay for coverage on their own.
Here’s what you need to know about billing insurance for therapy sessions.
Medical credentialing is the process through which a therapist joins an insurer’s provider panel. Therapists who are not credentialed with insurers cannot bill insurance directly. Instead, the client must seek reimbursement from the insurer. Reimbursement is not guaranteed, and the client may have to jump through many hoops. In the meantime, the client is responsible for the bill, and the economic burden may cause a client to attend therapy less frequently. So joining a provider panel may be a better option for both the therapist and client.
Here are four steps to get credentialed:
After your CAQH application is accepted, you will need to re-attest to the information contained therein on a quarterly basis. Watch your mail for notices from CAQH so that you do not lose your credential.
You must bill insurance for each treatment session using the paperwork the provider requires. When you’re accepted to a provider panel, the insurer will provide a detailed guide to billing, as well as information about which services are covered and at what rates.
To properly bill for mental health services, you will need to select the right Current Procedure Terminology (CPT) code. The right billing code depends not only on the procedure, but also on the length of time it took. Some examples of common CPT codes for therapy include:
The American Medical Association’s current CPT manual provides updated billing codes, so ensure you have a recent copy, and use it as your guide. Online billing guides may not be fully accurate or may include outdated codes. Codes you have previously used may no longer be current, especially if it has been a while since you used them.
To ensure prompt payment, it is important to bill for the proper procedure. Consistently improper coding may trigger an audit, delayed payment, or even removal from a provider panel. Maintain documentation for each visit so you can support your billing claims, because insurers may periodically request additional documentation.
The amount of time you have to submit a claim for payment varies from insurer to insurer, so check your provider panel documents for clear guidance. Medicare and Medicaid typically require that claims be submitted within 365 calendar days from the date of service. Private insurers tend to set shorter deadlines.
Therapists who work with multiple insurers may be forced to juggle multiple deadlines. To avoid missing a deadline, it’s helpful to discern the shortest filing period, and then file all claims by that period. For example, if you work with a private insurer who offers only a 90-day filing period, consider filing all claims within 90 days.
Therapists must generally be reimbursed within 30 days. However, coding errors can delay reimbursement, so it’s important to keep track of each bill you send out. If you don’t receive payment within 30 days, follow up with the insurer.
Numerous factors can extend or shorten the wait for insurance payments. Some strategies that can ensure you get paid as quickly as possible include:
GoodTherapy.org offers education and training on the many challenges of insurance billing. Our marketing webinars frequently feature tips for billing, reimbursement, and running a profitable practice. You’ll also be listed in our mental health professional directory. To gain access to our vast array of resources, become a member today!
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