Understanding Modifiers for Mental Health Billing

You may even think to yourself, “Why do I need to write mental health notes?” Consider all valuable and relevant information insurance companies may need to confirm your reimbursement. In addition, note writing will help you stay more organized with your patient notes if you see a large number of clients regularly. Every mental health insurance claim will require a large amount of information, but that information needn’t be overly complicated. These rates are for Medicare and do not represent a guarantee of payment from any company, rather this is public data published by CMS.gov annotating a national rate schedule for mental health CPT codes. If you are seeking non-emergency, but “medically necessary” medical care at a New York hospital, and you otherwise qualify for a discount, you must live within that hospital’s “primary service area” to receive a discount.

A lot of what we did at Northwestern that worked really well for us would be too time intensive and costly for a smaller organization or a single practice to implement. The reason they’re not on the telehealth list, because they’re designed to be virtual. So you have Interprofessional Telephone, Internet, EHR Referral Services that may be an area of use. There’s a code for the referral and sort of the referee, if you think of it that way, and then some additional codes that I wanted to highlight, particularly for telephone and virtual visits. Most of these are designed for use with established patients in most situations.

Outpatient Mental Health Therapist Diagnostics, Evaluation, Intake CPT Code:

If their diagnosis changes, you need to update it on your claims forms. Having the customer service phone number isn’t essential for submitting claims, but is necessary to gather eligibility and benefits information and to verify claim status and payment amounts. The Figure indicates relatively parallel trends in total medical cost in the 6 months prior to a patient engaging in CoCM relative to controls. Once engaged in CoCM, patients incurred higher mean total medical costs compared with control patients.

• For mental and behavioral health services, this is not always the case.
• Treated members incurred $34.11 PMPM (95% CI, $31.95-$36.27) higher primary care costs that were directly attributed to CoCM, and $19.91 (95% CI, $4.84-$34.98) higher costs for other mental or behavioral health care.
• The care team uses evidence-based practices and measurement-based care and maintains a registry to track patients.
• Absence of a Bill Type does not guarantee that the
  article does not apply to that Bill Type.
• The most recent change for psychotherapy codes took place in 2019, then 2013, and previously 1998.
• Reach out to find out how we can offload this whole nightmare for you.

Without them, the payer wouldn’t be able to understand what happened during your client’s visit. After this process, you have all of the information required to file claims, what to charge your client when they come in for a visit and how to file their claim via online or otherwise. If you submit a claim to a payer after the timely filing limit lapsed, you’ll receive a denial. If you aren’t enrolled to receive the status of your submitted claims electronically, you’ll receive an explanation of benefits (EOB) via the mail.

The Shift towards Behavioral Healthcare

If you have had issues with incorrect information in the past leading to claims issues, it’s always best to implement double-checking in your practice. Confirming your patient’s insurance is one of these areas where you want to be certain. Before sessions with any new or existing patient, ensure that you know their insurance plan and benefits ahead of time. The CPC Preparation course teaches physician office coding, such as how to assign the proper diagnosis and procedure codes from operative reports and patient charts. This course also helps to prepare you for the CPC certification exam.

That’s not quite the case, but you can see that there are some avenues in terms of being able to interact with patients if you’re in a telemedicine environment in a situation that you can still connect with those patients. I think our last slide I will probably go through has to do with internet, or virtual visits and conducting those visits. And these are some that are from our evaluation and management series, our E/M sections.

Our Mental Health Insurance Billing Services

These study findings add to the evidence that CoCM is an efficient strategy for improving health outcomes. It also should reassure insurers that coverage of the new billing codes affords improved access to mental health care8 mental health billing without increasing overall spending. Out of thousands of possible CPT codes, mental health services only span 24 in total. So use our behavioral health cpt code cheat sheet to pick the ones relevant to your situation.

For complex services like a 70 minute emergency call and then a two hour emergency session at their home, you might have absolutely no idea how to bill that situation. If you aren’t sure how to submit the claim accurately, consider asking a colleague or hiring an expert. Use each platform to add the client’s you’re seeing to your account. Once you have gathered all of this information, save it in a secure location for future processing. We do this for free, but here is a guide and script on how to do eligibility and benefits calls yourself. We have a guide called “How to Check Mental Health Eligibility and Benefits” at this link which contains a script and thorough questions to ask so you gather all necessary information.

Tips for Successful Mental Health Billing

Ensure you refile claims in a prompt manner to make the timely filing window for claims submission. Ask for the claim ID for each date of service that you submitted. You will need the claim ID or claim number for each date of service to refile your claims. You’ll want to do this for each date of service (DOS) that you have submitted to ensure they are processing.