Mental health billing

Mental health billing is when social workers, psychologists and psychiatrists use codes to file health insurance claims with carriers and governmental entities. Mental health billing is also one of the most difficult tasks for therapists in private practice. In order to bill, you need to be credentialed, understand diagnosis and treatment codes, verify eligibility and benefits, and then there’s invoicing, payment and follow-up. (There’s also your day job of treating clients, right?)

Best case scenario: Everything works well and you get paid. In the case of denied or rejected claims, however, you may find yourself in the stressful role of bill collector. Now you’re chasing down payments, following up with clients and payers while re-reviewing forms and submitting appeal letters. Fun.

The key to avoiding unnecessary administrative tasks around billing is developing a mental health billing process or strategy. The process involves several steps but can be simplified through preparation as well tools like practice management software.

Mental health credentialing

Credentialing is the first step in mental health billing and involves becoming an insurance panel member. Ultimately, you’ll be listed by an insurance company as an in-network therapist and gain access to new sources of clients. Additionally, your credentials follow you even if you change jobs – a nice bonus.

Credentialing requires high-level organization and you’ll need to have plenty of documents on hand to start including:

• A current CV and work history for the past five years
• Any certifications
• References
• Graduate school transcripts

Additional documentation requirements can be found at Mental health credentialing with insurance companies

Once credentialed, you’ll need to become proficient at what’s known in the biz as a clean claim, or a complete and accurate claim that is properly formatted. One good thing about mental health billing is that the CMS-1500 form is the industry standard used by most billing software platforms, clearinghouses and portals.

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Mental health billing

Client data

Correct client data is crucial for mental health billing and you’ll need an accurate version of the following client data when ready to bill:

• Full name
• Date of birth
• Address
• Gender
• Plan member ID
• Insured person’s information if client is a dependent on a plan

Practice data

In terms of the diagnosis and care, as a therapist or mental health practitioner, you’ll need to provide:

• Full address of the practice location
• Dates and place of service
• Diagnostic/ICD-10 Code(s) (more on those below)
• Service code and modifiers for each date of service
• Service provider’s National Provider Identifier or NPI
• Practice NPI (may be different from service provider if billing under a group)
• Service provider’s taxonomy code
• Practice tax ID (may be different from service provider if billing under a group)

If you use software, you likely won’t need to enter this information each time, but will have it automatically completed each time you bill.

Mental health billing ICD-10 codes

ICD-10 refers to a system designed by the World Health Organization to catalog health conditions by categories of similar diseases under which more specific conditions are listed. The listings are referred to as the International Classification of Diseases and in this case, the tenth edition. While each specialty has its own codes, common codes for mental health billing are below.

Common anxiety ICD codes

Common depression ICD codes include:

While these codes tend to be used by mental health providers frequently, try to be as accurate as possible with your patient’s diagnosis if possible even if it means using a lesser known code.

Mental health billing using CPT codes

As a therapist, you’re likely familiar with mental health CPT codes which were created by the American Medical Association as a uniform language for describing diagnostic services. Mental health professionals including social workers, psychologists and psychiatrists use the same codes when filing health insurance claims with private health insurance carriers as well as Medicare and Medicaid. CPT codes help health insurance companies know what services were provided to the clients. You can see a list of commonly used codes in the table below.

Some mental health CPT codes have a gray area and it’s good to understand coding complexities and how to bill based on specific situations.

Verifying eligibility and benefits

Verifying a client’s eligibility and benefits is where you’ll put your data gathering skills to the test. To check whether a patient’s eligibility, you’ll need to:

• Call the customer service phone number on the back of the client’s insurance card
• Request to verify mental health outpatient provider benefits and eligibility
• Share your TAX ID and NPI (remember those from above?) to determine whether you are in-network or out
• Share the patient’s info including name, date of birth, and subscriber ID
• Request the patient’s deductible, copay and coinsurance and ask for claims addresses.

Mental health claims submissions

Errors during the claims submission process can result in non-payment. Insurance companies are now requiring providers to use clearing houses to file their claims. Going through a clearing house can provide a safeguard against incomplete information as they scan for missing data and catch common human errors before the claims are submitted. While clearing houses can help you streamline mental health billing, for your benefit and the benefit of your clients, you’ll want to consider whether the clearing house is HIPAA-compliant, has the ability to track claims in real-time, its customer service reputation, usability and cost. Additionally, an EMR integrated with a clearing house can help you streamline all billing processes in a single tool, which can be a major time saver when it comes to mental health billing.