Billing for mental health services can be frustrating work.  Unless you have special arrangement contracts that allow you to just use an invoice of sorts, knowing the ins and outs of specific payor requirements can significantly slow the time from patient visit to correct reimbursement.  Here are a few tips for successful billing that can make a big difference.

Touch the claim as few times as possible.

Every time your billing team touches a claim, it costs you money and time.  Efficient billing starts with clean claims, which means accurate, complete patient and guarantor demographics and charge capture.  Depending on your EDI tools, claim errors may not be detected until the claim is adjudicated by the payor, which as we all know can be a while.  Shoot for a clean claims rate, the percentage of claims correctly adjudicated on the first filing, of >95%.

Think about everything that happens before you file a claim – marketing costs, setting the appointment, possibly rescheduling the appointment, collecting patient demographics and insurance information, obtaining the prior authorization, not to mention actually seeing your patient.  That’s a lot of time and effort invested only to sideline reimbursement with a faulty claim.

Make obtaining prior authorizations a top priority.

Nobody likes calling insurance companies – for any reason, but not getting prior authorizations and including the correct PA information with the claim is a luxury we can’t afford.  If your staff is not habitually getting prior auths, they need to do better, unless you want to do it for them.

Know your modifiers and when to use them.

Always ask if and which modifiers are required for billing when verifying eligibility and benefits.
Here are the basics:

• 95 Modifier – Synchronous Telehealth Services
• GT Modifier – Synchronous Telehealth Services [Medicare]
• AJ Modifier – Licensed Clinical Social Worker (LCSW)
• HJ Modifier – EAP or Employee Assistance Program Visits (EAP)
• HE Modifier – Mental Health Program (MHP)
• HP Modifier – Psychologist or Doctorate Level (PsyD or PhD)
• AH Modifier – Doctorate Level or Clinical Psychologist (PhD or PsyD)
• AF Modifier – Psychiatrist (MD)
• HN Modifier – Bachelor’s Degree Level (BA, BS)

At Cvikota Medical Business Services, our mission is to preserve healthcare choice by helping independent providers thrive.  If you think we may be able to help, call us at 800-657-5175.

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