Mental Health Billing: 10 Common Questions and Answers
If you are a mental health professional working in private or group practice, you have your work cut out for you. Serving your clients well, and finding the time to handle all of the administrative tasks of your practice can become quite stressful.
Mental health professionals have billing needs that differ from other medical professionals. It is commonplace for many types of medical doctors to have large office staffs, with many administrators handling the billing and claims.
However, many (and perhaps even most) mental health practices run on much thinner financial margins than their “medical” counterparts, and therefore the burden of mental health billing often falls on the counselor, or a small office staff. Perhaps because of this, sadly, many practices collect less than 85% of the money they are owed from insurance companies.
You can do much better than this! With some perseverance, and a strong working knowledge of billing, you can expect to collect 96%, to as high as 99% of your claims. Here are some quick questions and answers that will save you time and money.
1. Is the reimbursement pay from the insurance company worth it?
Being a mental health professional can be difficult, and you want to be rewarded appropriately for your service. Is it worth it to bother with reimbursements from insurance companies? Should counselors just stick to a “cash-only” approach?
Answer:
Some insurance companies pay poorly, but many pay quite well. Usually the larger private insurance companies: Aetna, Blue Cross, Blue Shield, and United Behavioral Health (and many more) pay the best. In general, Medicaid and Medicare reimburse lower than the private insurances.
Regardless of the reimbursement rate, it’s important to stick to the time limit provided in a service’s CPT code. For example, if you are billing for a 45-minute psychotherapy session, any time spent with clients after the 45-minutes is free labor. Those 15-minute overages add up!
2. Can I bill the same client for multiple sessions in one day?
Without special permissions, the rule is normally one session, per patient, per day. However, if you call the insurance company, you may be able to receive authorization for more than one service per day. Special circumstance: if you have a psychiatrist on staff, it is completely acceptable for the psychiatrist to provide one service, and then you (the counselor) to perform one service, totaling two services.
3. How long do insurance payouts normally take?
Typically, it can take 30 business days from the date the insurance company received the claim until the payout is received. But it does not always take that long. For example, Blue Cross in Massachusetts normally pays their claims within 2 weeks, and Aetna normally takes three weeks.
Still, the rule that insurance companies abide by is that all claims must be filled within 30 days. Thus, if you think about it, after the first month of practice, providers don’t usually notice the delay because payments are continuously flowing in.
4. What do you do if a patient changes their insurance information and does not tell you?
This problem happens too often; a client doesn’t let you know they have a change in their policy (or, in really bad cases, no policy at all). Typically, you will send the claim, wait for it to get paid, only to find out that the claim has been rejected.
In this situation, you need to connect with the client/patient, and get their new insurance information. You will probably run into one of two situations:
A. They don’t have any insurance. In this case, you have to try and get payment from the client directly.
B. They have a new policy. In this instance, you need to re-file the claim through the new policy, and hope that the session didn’t need pre-authorization. If it did, call the insurance company to see if they will “back date” the authorization. If the company says that they don’t back date authorizations, ask nicely for an exception to be made for this “one time” unique situation. The insurance company might not care about you and your practice, but they will care about annoying a newly insured member who will be on the hook for your clinical fees if they don’t grant the authorization.
Lastly, if you haven’t seen a client for a while, call the day of their session to see if the client is still active with their insurance plan.
5. How long do I have to submit an insurance claim?
This varies by insurance company, so it is always good to check with the insurance companies that you submit claims to. In some cases, time is of the essence – Aetna normally allows 90 days to file a claim. With other companies, you may have more than a year – Medicare typically allows 1 year to 18 months (but it depends on the state).
You really need to check with the insurance companies that you work with to make sure you get your claims in on time. If you provide the service, forget to submit the claim on time, and then try to submit the claim late, it will probably be denied.
6. Do sessions need to be pre-authorized?
Typically, with most insurance companies, a basic office visit, therapy session, even the initial session, do not need authorization; but it is always best to check to make sure. When in doubt, check it out!
Tufts insurance almost always requires authorization for a claim. Also, in the case of psychological testing, you always need to obtain an authorization. Some insurance companies like Blue Cross of Massachusetts allow up to 12 visits without authorization, and then providers are required to get an authorization for the next 12.
Generally, for the basic stuff, you do not need authorizations, but always check.
7. Can I bill a client for the balance?
If I am a healthcare provider and my service fee is $150 per appointment, but the insurance company only pays $75, can I charge the client/patient the balance?
Answer:
If you are contracted with a particular insurance company, you cannot “balance bill” your clients. You will have to accept the insurances’ rate, and then write off the difference, for that particular service.
Being contracted with an insurance company is a give and take. Being in-network with an insurance company brings in more patients and clientele, and some evidence shows that your clients might even stay longer on average, but your hourly/session rate might be reduced.
For example, if $70.00 is your contracted rate with an insurance company, for a 45-minute service, and the patient pays a $20 co-pay, the insurance will pay everything minus the $20 dollar co-pay (that is $50 dollars). So, if your cash-rate is $150.00 – you will get the $20 co-pay from the patient, and the of $50 from the insurance company; and that’s it! You cannot say to the patient, “You owe me an additional $80 bucks.”
If you are out of network and do not have a contract with an insurance company, then you can bill the patient for the remainder. But if you have a contract, you are contractually bound and cannot go over what they allow for that particular service.
8. How does COBRA affect me as a counselor?
A COBRA plan gives people, who may have just lost their job, time to find a new job with new insurance, without losing insurance coverage.
If a patient has a COBRA plan, and they had a previous plan that you had billed, then you would continue to bill them as normal. If a client has just lost his or her job, it may take a little while for the coverage to kick in, and the patient may show as inactive when you call the insurance company. However, the client still has insurance, and the insurance company will backdate the COBRA, as long at the client makes his/her COBRA payments.
9. What happens if a patient stops paying his or her COBRA dues?
If a patient fails to pay their COBRA (and some do, because it’s expensive), then they will lose their insurance coverage and your insurance claims will not get paid. COBRA gets renewed on a monthly basis, so you may want to call and check to see if your client is presently active under COBRA.
10. What is the hardest part of mental health billing?
The hardest part for providers conducting mental health billing is the variety of hoops that each insurance company makes the biller jump through. For counselors and other healthcare providers, time management becomes a major issue when one is trying to see patients and simultaneously file insurance claims. It takes time to learn what diagnosis codes work, and even where and how to submit each claim.
It gets complicated. Mental health billers find that insurance companies often have multiple addresses for each department, and it is sometimes hard to know what department to send claims to. If you happen to send the claim to the wrong department, it will reject. If you submit a paper claim for a company who only accepts electronic claims, it will be rejected. If you submit a claim to an insurance company that has decided to outsource its handling of behavioral health services to another company, the claim will be rejected. Billing is a detailed process to say the least.
To Bill, or Not to Bill
Mental health billing is not always an easy or straightforward process. However, with patience, perseverance, and maybe even a little training from someone who has done it before, you can tackle your practice’s medical billing.
Alternatively, mental health billing can be outsourced to a professional billing company. Some counselors find that they are better off delegating billing tasks, and offsetting the costs by spending the time that they would have spent billing insurance claims seeing a few more clients. The choice is yours! If you do decide to hire a credentialing or billing team, consider our friends at East Meadow Management Group. They’re available to offer a timely quote, or help you find a solution. You can reach them at 516-277-8291 or by filling out this quick and easy form here.
If you see a patient for 60 minutes and bill then it is denied for no pre auth can you bill for 45 minutes that does not need the pre-auth even though you spent 60 minutes with the patient?
Hello,
I have a question regarding billing. A client paid private rate fees for an assessment.The client did NOT provide insurance. The client was provided with a “superbill” so she could submit her own claim. The client is now requesting an overpayment reimbursement since the claim only paid the client the providers contract rate. Is this legal?? Any feedback would be greatly appreviated.
Thank you,
Sylvia
I have a question regarding billing for a P-LPC vs a LPC. My supervisor is advising me to only bill out of pocket for the co-pay since I am a P-LPC and therefore most insurance companies don’t accept services from P-LPCs, but my new boss is adamant that Medicaid only requires a Master’s level degree in therapeutic/counseling/psychology related fields. What do I do?
I see that no one has responded to your question, and that may be because the question is a tad confusing. It’s not clear if you are contracted with Medicaid. In order to bill Medicaid in your state, it is my understanding that you must be licensed in the state that you are practicing.
I don’t know what a P-LPC is (I assume you are accumulating hours towards a license and have a limited permit perhaps?). In New York state, no insurance company will reimburse for a therapist with a master’s degree but no license. They will not accept you on their panel until you have a license (you must have a contract with them to be on their panel — they’ll ask during that process if you have a license). Even then, they do not accept ALL master’s level licensed mental health professionals.
If you don’t have a contact, you’d only be able to get reimbursement if you bill as a provider outside of their network, and even then, they’ll insist you be licensed. Medicaid does not pay out of network so I think your supervisor is misinformed.
When in doubt, just call the insurance company and simply ask if they will reimburse you. Medicaid, in New York State, has high requirements and will only reimburse those who have licenses; it used to be that they would reimburse for master’s level clinicians without a license but only in certain institutional settings. That was the case a few years ago, but I think that exemption was eliminated years ago.
In those settings, a clinician would not be doing her own billing anyway and so the question is moot. Usually you’d be employed by those institutions and supervised by their supervisors.
I hope this helps. Every state is different but I wouldn’t ask your supervisor, I’d ask the insurance companies what their requirements are. They’re not likely to pay anyone not licensed.