Accurate and consistent billing practices can make the difference between having your mental health practice succeed or struggle and solidifying a strong process for this is one of the best things you can do for the health of your business.
You might think that because you see many patients, you’ll be financially successful, but only billing, both insurance and your clients, ensures you get paid what you should be for your services and creates reliable cash flow for your business.
Ideally, insurance would be billed automatically, and clients would pay on time for anything not covered. Unfortunately, that doesn’t always happen, and unless you work on improving your billing process, it will create issues for your business sooner or later.
In this post, we’ll focus on the importance of understanding your billing from the back end and tips for improving the overall billing process, so you can focus on what matters most: providing quality care to your clients.
Understanding Billing From the Backend
Here are a few things to note to get billing right, because even minor mistakes can cause a delay.
Know the Right Codes
CPT codes describe tests, evaluations, treatments, and any other medical procedure a healthcare provider performs for a patient. They are used when submitting insurance claims to indicate the procedures to be reimbursed. Also, note that the service’s length also changes the CPT code you’ll use.
ICD-10 codes describe diseases, signs and symptoms, abnormal findings, complaints, and external causes of injury or diseases. They are used when submitting to indicate why you provided a patient with your services.
Framework for Coding
When billing, it is also essential to understand the framework for coding, so familiarizing yourself with E/M and psychiatric evaluation codes will be helpful.
E/M codes are used in your billing when evaluating a new patient issue and require the following three elements.
- Determine the type of history – You’ll indicate the patient’s current complaint and history of present illness, body system review, and family and social history here.
- Determine the type of physical exam – You’ll determine the extent of the physical exam needed for each body area and organ system.
- Determine the type of medical decision-making (MDM) – You’ll rate the difficulty of establishing the diagnosis and treatment plan based on straightforward, low complexity, moderate complexity, and high complexity.
Once you have determined the history, exam, and MDM types, you can select your E/M code.
Psychiatric evaluation codes are used if your psychotherapy session includes psychiatric elements and needs to be billed and coded separately.
Get Familiar with the Billing Forms
Knowing which billing form to use and being familiar with it is important to help you avoid mistakes.
The two billing forms used in mental health billing are UB-04, filled out by front-office staff, and CMS-1500, filled out by practitioners.
You should understand the information required for each form, ensure all information is accurate and have your National Provider Identifier (NPI) and tax identification number (TIN) available.
Tips for Improving the Overall Billing Process
Collect Patient’s Data Correctly During Intake
Collecting and inputting accurate patient data is important during intake, as even the slightest mistake is grounds for rejecting the claim. Ask your patient to review the information to spot any mistakes or spelling errors.
Collect Copays Right Away
Collecting the copay up front rather than billing later ensures you receive the money. Tell patients that uninsured amounts must be paid upfront or before they leave their appointment. The sooner you can collect a payment, the better.
Check Insurance Eligibility
Before a new client’s first visit, review the benefits and ensure you and your client know what is covered and what isn’t. Review your client’s eligibility regularly, as insurance can change often.
Make Sure Clients Understand the Billing Agreement
Having an agreement in place can ensure you do not lose money when insurance does not cover the cost of the service. The client should understand this agreement and provide written consent to charge the credit card for any remaining balances. It is best to keep credit card information on file so you can collect payment in the event of that happening.
You also should have credit card info on file so you can still collect payment in case something happens with the insurance or for no-shows if that’s part of your agreement.
Frequently Update Information
Update your client’s information at every appointment to keep records accurate for billing.
Don’t Overlook the Importance of Proper Billing
Billing is necessary for a mental health practice because it is an integral part of your revenue stream and can significantly impact your cash flow if not appropriately handled.
Luckily, some processes and tools can be implemented to help with billing, and Leichter is here to help.
At Leichter, we can make suggestions and help you improve your billing processes to have a steady income stream in your business so contact us today.