Outpatient Mental Health Coverage

Mental health services aim at ensuring the personal well-being of patients on a more emotional level. Practices that render mental health services must incorporate several treatments and a huge variety of components in order to ensure smooth processing of both patient care and billing. If there are any errors in the billing process, it can critically hinder the treatment process, thereby largely affecting patient care. The first thing to find out is what mental health benefits your insurance policy offers.

Many Medicaid polices are subcontracted out to lower paying organizations. This can skew data downward in comparison to brands that to not facilitate a Medicaid plan in that State. APA is dedicated to improving population health, along with advocating for financial incentives that support psychologists’ involvement in these efforts. A population health approach, or preventive health approach, mental health billing focuses on improving the health, health equity, safety, and well-being of entire populations, including individuals within those populations. Providing general BHI services is an important part of addressing population health. Even if community mental health centers or local nonprofits don’t have a pro bono program, they may know of other resources available to you in your community.

Clearinghouse Rejection

Filing claims involves submitting each date of service with all this information one by one. Each insurance company has their own online portal to submit claims, some terrible, some fairly okay. Having the customer service phone number isn’t essential for submitting claims, but is necessary to gather eligibility and benefits information and to verify claim status and payment amounts. Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated.

Your clearinghouse should be able to help with the denial recovery process by explaining what happened, pointing out errors, and generating appeals letters or resubmitting corrections to payers. Health insurance organizations don’t make this entire process easy, but they have their rules. The unique payers that still cling on to paper stand no chance against the most ideal alternative for claims processing. After all of this and even after Medicare’s electronic submission requirement, some payers STILL don’t have claim submission web portals. If ALL of your patients had Health First Colorado as their payer, this wouldn’t be that bad of a manual process…but that’s not the case.

Mental Health Reimbursement Rates by Insurance Company

Your clearinghouse should also keep a record of your denials and place them within work queues to kick off the appeal process. The claims that come back to you with a denied status are particularly important. Hopefully, you’re using at least an Excel spreadsheet in tandem with this process to record your results. Well, in this alternative we have to call this number again and figure out the status of the claim you submitted.

You will have a greater understanding of your patient’s insurance program after this process enabling you to treat and serve them appropriately. Try to avoid companies that require the use of taxonomy codes, license level modifiers, EDI enrollments, and prior authorizations. This does dramatically limit the companies you can work with, but it will save you time, headache, and frustration.

Least Ideal: Calling Payers

Insurance companies can be more likely to require pre-authorization before agreeing to cover specific mental health treatments, adding another layer of complexity to the process. Free Clinics . . . . . . provide safety net services, which are intended to help people who are ineligible for Medicaid and Medicare but can’t find affordable health insurance. They are often found in hospitals or as stand-alone facilities in densely populated areas of poverty. Some, but not all, free clinics provide mental health services in addition to preventative general health and maintenance.

To make this process easier, identity the insurance company’s preferred filing method and the window of time they allow for filing claims. You will certainly want to file your claim within that window of time, or you run the risk of a prolonged claims process. To stay ahead of this, you can ask the insurer about their preferences for receiving claim filings when you go through the VOB procedure.

Ask How to Bill Claims Online

Both undercoding and upcoding are strictly illegal as they do not accurately represent the services rendered and could be construed as fraud by the payers. However, if not intentional, these could also happen due to an untrained or inexperienced coders without much process knowledge. ICANotes’ mental health billing software can simplify the billing process for your practice. Our software can integrate with your current clearinghouse or billing provider, or you can choose to use it with one of our partners. Due to the COVID-19 pandemic, telehealth services for mental health care have become increasingly common. If you see patients for telehealth visits, you must bill correctly to minimize denials and speed up reimbursement.

You will received EOBs in the mail along with a check for those dates of service. The CPT indicates a 45- to 55-minute session, and the CPT code indicates longer sessions. To sum things up, the Blue Cross and Blue Shield network across the United States is one of the highest reimbursing and most competitive plans to work with. https://www.bookstime.com/ Investigate which companies are paying the most in your State by asking your colleagues. Some companies, such as many of the BCBS plans, require you to establish a business, E-IN, and group NPI. In our experience, the higher the reimbursement rate, the higher your license level need be to become in-network with that company.

In this scenario, general BHI cannot be reported, because the primary diagnosis is not a mental health condition. In surveys conducted in 2020 and 2021, APA set out to better understand how Covid-19 impacted mental health treatment and the work of practicing psychologists. The results showed that many psychologists were experiencing increases in workload and the demand for anxiety, depression, and trauma-related treatment, longer waitlists, and a low capacity for new patients. CMS cited these findings in their 2023 proposed and final rule, in their discussion regarding their goal to improve access to and quality of mental health care services.

• If you work for a smaller business, you will want to talk to the person who arranged the health care.
• If you dig into the points mentioned in this article, you will get where you want to be – having your practice receive the deserving reimbursements on time.
• You should do the same – just ask your contact for the reference ID and their name.
• Though this practice is often done intentionally to help save patients money for their services, it is illegal.
• Many health insurance plans also require pre-authorization, which means that patients must get permission before receiving coverage for some mental health services.
• This technology could be supplied by your EHR, clearinghouse, or a different third-party.

To avoid these situations, it’s a good idea to evaluate clients’ insurance coverage before each visit, if possible. By contacting insurers and making sure that clients’ coverage is still in effect and has not changed, mental health professionals can stay informed and avoid wasting time on rejected claims. This can be labor intensive, but the time it will save makes it worthwhile.