Billing for mental health services can be complex. You have to remember to include all applicable diagnoses codes, provide adequate documentation, and use accurate CPT codes for the mental health services you’re providing. There are rules and regulations surrounding documentation and when and how to use various codes. And you’re expected to manage billing in the midst of a full schedule providing quality services to your clients!
But getting a firm grasp on billing is important for maintaining a healthy therapy practice. In this post, we look at just why accurate billing is so essential and cover common mistakes that therapists often make when billing (and how to fix them).
Why Accurate Mental Health Billing is Essential
Using the right CPT codes in the right way should be a priority for your practice for two primary reasons.
- Reliable Cash Flow — In order to operate your business, you need cash available on a predictable basis. That cash comes from a streamlined claims submission process that ensures you’re reimbursed for your services in a timely manner. Claims rejections or denials due to inaccurate or incomplete CPT coding can cause bottlenecks in your cash flow — or worse, prevent you from being reimbursed at all.
- Avoid Being Flagged for Abuse or Fraud — While few therapists intend to commit abuse or fraud, the law doesn’t look kindly on coding errors that result in insurers paying more than they should be for services their customers receive. Some coding mistakes are obviously innocent, but others could be interpreted as intentional, even if they weren’t. Accurate coding will prevent your practice from being flagged for abuse or fraud, and if you are audited, proper coding will keep you from facing fines as a result of coding errors.
Common Mental Health Billing Errors
While regularly making mistakes can wreak havoc on your practice financially, rest assured that you’re not the only one who struggles with mental health billing. Private practice healthcare providers of all types are faced with the challenge of handling this complex task with a limited staff. Let’s look at the common errors that you’re likely to make if you’re new to billing.
1. Using the Wrong CPT Code
Procedure codes are quite specific, especially when it comes to the time spent in a session. If you’re operating on auto-pilot, it’s easy to use the same code you always use, even if a session was shorter than normal (causing you to over-bill) or if you provided additional billable services in a session (causing you to under-bill). Additionally, if you’re providing a new service, it can be difficult to know what code to use without digging into each potential code’s description (which you should always do).
Why It’s Problematic: Using the wrong CPT code is problematic because it’s likely that you’re either leaving money on the table or over-billing.
How to Fix It: Become familiar with the mental health CPT codes, and be sure you have a thorough understanding of the most common codes.
2. Using Outdated Codes
The CPT code set and the ICD are continually being updated, so it’s important to keep up with the most recent set of codes. There’s always a grace period after a change, but payers will expect you to use the most recent codes past a certain date.
Why It’s Problematic: Using old codes can cause a reimbursement to be delayed, crimping your cash flow.
How to Fix It: Be sure you’re not using an old code that you found online.
3. Unbundling Codes
“Unbundling codes” means using multiple CPT codes for a service when a single code is available that accurately reflects what you provided.
Why It’s Problematic: Unbundling is often used in order to increase payment, so it’s a big red flag for those who are looking for abuse or fraud.
How to Fix It: Understand what exactly is included in the code descriptions and be sure that if a single code is available, you use it.
Upcoding refers to the practice of using a code with a higher reimbursement rate when you shouldn’t. For example, if you spend 30 minutes doing a psychotherapy session but use code 90837 (Psychotherapy, 60 minutes), you’re engaging in upcoding.
Why It’s Problematic: Upcoding is another red flag that can trigger an investigation of abuse or fraud if done regularly.
How to Fix It: Track your time, and be sure that you’re using timed codes accurately. Also, understand what is included in codes you’re unfamiliar with so you don’t inadvertently bill for a service you didn’t provide.
5. Using Modifiers Incorrectly
Modifiers are the two-digit codes that are appended to a CPT code to communicate additional information for the payer (such as how or where a service was provided). There are rules governing the use of modifiers, so it’s important to know and follow them.
Why It’s Problematic: Using modifiers incorrectly can cause a claim to be rejected or denied. Misuse of modifiers can also be flagged as abuse or fraud if it’s done on a regular basis.
How to Fix It: Don’t use a modifier unless you understand the rules around its use.
Using an EMR to Reduce Billing Errors
A good EMR software can help by serving as a resource for coding, reducing your rate of errors. With an EMR, you can go paperless by uploading files directly to client records, stay organized by electronically attaching intake forms and insurance cards to client files, and make session comments and collection notes directly in digital client records. You can also set up automatic appointment reminders for clients, give clients access to their accounts online, and accept credit card payments from clients. Also highly beneficial is the ability to continuously monitor your practice health with comprehensive reports.