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Benefit checks
Outpatient therapy visit limits, deductible, and out-of-network rules vary by plan, and some have a max number of outpatient therapy visits.
Session-based billing doesn’t leave much room for error and one wrong time band or missing diagnosis can slow down payment. Mental Health Billing takes claims, denials and posting off your plate, so you can stay with your caseload.
A therapist sees 25 clients a week. That means they send about 25 claims a week. Every claim needs the correct code, diagnosis and payer information. Add in benefit checks, remittances and unpaid claims and billing becomes a second job.
Mental Health Billing includes the sections you give us: eligibility checks, psychotherapy coding and charge entry, claim submission, denials, payment posting and A/R follow-up. We agree on the list before we start work and clinical notes stay with you.
On this page, we apply our broader medical billing services to therapy and counseling practices. medical billing company
Most delays begin with a small gap early in the process. The four are the most common in therapy practice.
Outpatient therapy visit limits, deductible, and out-of-network rules vary by plan, and some have a max number of outpatient therapy visits.
Codes are minutes of psychotherapy. If there is no start time or a code is not correct, then a claim can be pulled for review.
A rejection needs a quick fix, a denial needs a reason, an appeal needs paperwork. Before anyone resubmits, they all get sorted.
Copays, adjustments and late payments make it hard to know which claims are still open and balances age quietly.
Choose individual tasks or bypass the entire cycle. “The scope is dependent upon what services we agree to for your practice.
We review active coverage, copays, deductibles, out-of-network benefits, visit limits, and authorization rules per what the payer reports that day. A check is no guarantee of payment.
Each session is matched to a CPT code by documented minutes. 90791 is used for intakes. Add-ons or family codes are used when the record supports them. Diagnoses are linked to the rendering clinician. You still own your clinical notes.
We review demographics, subscriber information, diagnosis, place of service and rendering provider prior to a claim going out. Next we track payer acknowledgments and status.
We read the remark and reason codes, separate fixable errors from true coverage denials, correct and resubmit and prepare appeals the record supports. Not all reversals are denials.
We post insurance payments, adjustments and client balances to the appropriate session and flag any payment that is different than the plan should have paid.
We track unpaid claims by payer and age, contact payers, answer records requests and log the next step. No guarantee of collection on follow up.
Where it’s in scope, we prepare client statements post-payer and superbills for out-of-network clients to send on to their own plans.
Who can bill what depends on license type, state rules, payer contracts, and credentialing. One clinician’s claim can pay, the next can fail.
Get rid of claim tasks that compete with session time and notes.
Maintain coding consistency across clinicians, licenses and payer panels.
Each state and plan has different enrollment rules, and Medicare pays these licenses at 75% of the psychologist rate.
Check out our psychology billing for PhD and PsyD practices.
Place of service, modifiers and eligible provider rules vary by payer, so we check these plan by plan.
Note: Psychotherapy billing is different from medication management visits. Practices with prescribers can also read about our psychiatry billing.
Medical billing for psychiatry →Each claim is subject to the rules of the individual payer and requires a complete record.
The three separate codes bifurcate at 37 and 52 minutes, and payers are looking closely at 90837. The code is supported by start and stop times in the note.
ICD-10-CM codes are from the clinical record. Sessions coded only to a relationship problem are often out of coverage.
Family sessions (90846, 90847) and group sessions (90853) are billed under a client’s diagnosis. Group claims are sent out per client.
Medicare gives 12 months from date of service, some commercial plans only 90 days.
Payers determine their own place of service codes (e.g., 02 or 10), modifiers (e.g., 95), and covered provider types.
Track copays, deductibles and coinsurance per claim. Late cancel and no-show fees benefit the client and do not go to the plan.
This is the general flow. What we run for you is based on the agreed scope.
We’ll look at your payer mix, your current process and where claims get stuck.
We compare the session details, codes and diagnoses to the record before it is submitted.
We send out claims and monitor acknowledgments, rejections and payer status.
We post payments, work denials and chase unpaid claims as agreed.
Outsourcing doesn’t work for all practices. If you’re a clinician who is short on admin time, a billing partner can set up a steady routine for the tasks you hand over.
Move just the tasks you want to.
There is a next step recorded for each open claim.
Details are checked before submission.
Payments, adjustments and balances are tied to sessions.
We do not guarantee results or refunds. Coverage, payer policy, documentation, and agreed scope are dependent on results. Check out our medical billing service medical billing company
Intake assessments are done with 90791. Individual sessions are billed using code 90832 which covers 16 to 37 minutes. Another code is 90834 which covers 38 to 52 minutes. The third code is 90837 which is used for 53 minutes or more. Family sessions are billed using code 90846 or 90847. Group sessions are billed using code 90853. Check each code against the CPT guidance. Check each code against the note. Check each code against the payer policy.
There is no rule that you have to do this, but it is a good idea to check on reported coverage, copays, visit limits and authorizations needed before a client agrees to care. It doesn't guarantee payment.
Here are some possible reasons. They can include coverage that's not active. They can include information about the subscriber or the provider. They can include codes that do not match the note. They can include missing authorization. They can include going over the visit limits. They can include being out of network. They can include filing. They can include filing duplicates. They can include problems with the setup.
Frequently. Payers set up their place of service codes, modifiers, eligible provider types and rules, about where the client sits during the visit. Payers provide the guidance that we check before we bill.
Sure. We check the status of the claim. We find reasons why payment did not happen. We fix mistakes. We answer questions, from the payer. We write appeals if the record shows that an appeal is possible. No one can say for sure that payment will happen.
Decide which tasks to outsource, decide how client information and system access will be secured, decide what reports you will receive, decide how fees work and decide who will oversee credentialing and payer enrollment. If applicable, request a business associate agreement.
Utilize the contact page to explain your practice, payers and billing pain points. We will tell you which services fit your work flow.
Let us know where you spend time on claims, denials, posting payments or A/R and we will tell you if our services are a fit.