Protecting Your Practice: Why Behavioral Health Therapists Should Verify Insurance
As a behavioral health therapist, your priority is to help your clients improve their mental health and overall well-being. However, you also need to protect your practice by verifying your clients’ healthcare insurance benefits before providing any services. In this article, we will discuss the importance of verifying insurance coverage for behavioral health therapists, along with key terms and concepts to keep in mind.
Protect Your Practice from Financial Loss
Verifying insurance coverage is one of the most important things you can do to safeguard your practice from financial loss. If you offer services to a client without verifying their insurance, you could end up with denied coverage or unpaid claims. This can lead to significant financial losses and even put your practice at risk. By verifying insurance coverage before providing services, you can ensure that you will be paid for your services and avoid any surprises down the line.
With many insurance companies passing along more of the financial responsibility to the patient, it is important to know how much each responsible party pays. The insurance pays as reimbursement, however, the patient has an out-of-pocket payment, in the form of a co-payment, coinsurance, or full payment when they have a deductible.
Understand Important Insurance Terms
As you start to verify healthcare insurance coverage for your clients, it’s essential to understand some of the critical insurance terms. Some of these terms include copay, coinsurance, deductible, out-of-pocket maximum, allowed rate, bill rate, and more. Understanding these terms can help you navigate insurance claims and billing codes. Additionally, you can make sure your clients receive the care they need without any additional financial burden.
Deductible meaning: The amount of money a patient must pay out of pocket for medical expenses before their insurance coverage kicks in.
Medical expenses tax deductible: Certain medical expenses, including mental health services, may be tax deductible for patients.
Billing codes: CPT Codes or service codes are used to identify medical procedures and services for billing purposes.
Out-of-pocket maximum meaning: The maximum amount of money a patient is responsible for paying out of pocket for medical expenses during a given period.
Copayment meaning: A fixed amount that a patient pays for a covered medical service. Example $25.00.
The allowed rate meaning: The maximum amount that an insurance company will pay for a particular medical service code.
The billed rate meaning: refers to the amount of money that a provider charges for their services per each service code.
Patient healthcare benefits: The specific services and treatments that are covered by a patient’s insurance plan.
Tips for Insurance Verification
Here are some tips for verifying insurance coverage for your behavioral health practice:
Know which insurance companies you work with Different insurance companies have different billing processes and requirements. Make sure you understand how to submit claims for the insurance companies you work with.
Understand billing codes: Familiarize yourself with the billing codes used for behavioral health services. Some common codes include ICD-10 codes for diagnoses and CPT codes for procedures.
Verify benefits: Always verify a patient’s insurance coverage and benefits before providing services. This can help avoid any surprises when it comes to payment.
Keep up with changes: Stay up-to-date with any changes to insurance plans, deductibles, copays, and out-of-pocket maximums. This can help you provide accurate information to your clients.
Consider outsourcing: If medical billing and coding isn’t your area of expertise, consider outsourcing to a third-party billing company. This can help ensure accurate and timely billing.
Credentialing and Patient Benefits
When a provider is credentialed with an insurance company, it means that they have met certain qualifications and have been approved to provide services to patients with that insurance. In contrast, a non-paneled provider does not have a contract with the insurance company and may not be eligible to receive payments directly from the insurance company.
Credentialed Providers
Patients who see a credentialed provider can often receive benefits such as reduced copays or lower out-of-pocket costs. Additionally, some insurance plans may cover a higher percentage of the cost of services provided by a credentialed provider compared to a non-paneled provider. This is because the insurance company has negotiated rates with the provider and has agreed to cover a certain amount of the cost of services provided.
Non-Panelled Providers
Patients who see a non-paneled provider may have higher out-of-pocket costs, as the provider is not contracted with the insurance company to receive direct payment. In some cases, insurance plans may not cover services provided by non-paneled providers at all. This means that the patient would be responsible for paying the full cost of the service out of pocket.
In summary, patients may receive different benefits depending on whether they see a credentialed or non-paneled provider. It is important for patients to understand their insurance coverage and the benefits available to them when choosing a provider. Providers should also be aware of their credentialing status and how it may impact their patients’ benefits.
Improve Your Billing Processes
Verifying insurance coverage can help you streamline your billing processes. By having accurate information about your clients’ insurance coverage, you can submit claims more quickly and efficiently. This can lead to faster payments and a more streamlined billing process overall. Additionally, verifying coverage can help you avoid any issues or delays with insurance companies that could lead to delayed payments or denied claims. With the proper in-take process, and scheduling of patient appointments with an EHR software, such as SimplePractice, TherapyNest, or TherapyNotes office operations can become efficient.
Billing Codes and Claim Submission
When it comes to billing codes and claim submissions, there are many details to keep in mind. You need to understand CMS 1500, ICD-10 billing codes, revenue codes, medical service codes, preventive care CPT codes, inpatient billing codes, insurance diagnosis codes, and more. Additionally, you need to know how to submit claims for different insurance companies like Aetna, Blue Cross Blue Shield, Cigna, Humana, and United Healthcare, or Optum. Mental health insurance will sometimes have a third-party insurance company, such as Beach Health Strategies, Healthgram, Health Plans, or Magellan. By mastering these details, you can ensure your claims are paid correctly and quickly. In this case, a mental health specialist from a mental health billing service will have expertise in navigating these insurance payers.
Mental Health insurance claims
Mental health claims are typically submitted to insurance companies or third-party payers that provide coverage for mental health services. Mental health services may include counseling, psychotherapy, medication management, and other types of mental health treatments. Insurance companies and third-party payers are responsible for processing and paying mental health claims submitted by healthcare providers and issuing reimbursement based on the patient’s healthcare policy.
Private healthcare insurance companies
- UnitedHealth Group: UnitedHealth Group is one of the largest healthcare insurance companies in the world, providing health insurance, dental insurance, and other healthcare-related products and services.
- Anthem, Inc.: Anthem, Inc. is a healthcare insurance company that provides health insurance plans, dental insurance, vision insurance, and other healthcare-related products and services. Operates the in the below states:
- Blue Cross Blue Shield of California
- Blue Cross Blue Shield of Colorado
- Blue Cross Blue Shield of Connecticut
- Blue Cross Blue Shield of Georgia
- Blue Cross Blue Shield of Indiana
- Blue Cross Blue Shield of Kentucky
- Blue Cross Blue Shield of Maine
- Blue Cross Blue Shield of Missouri
- Blue Cross Blue Shield of Nevada
- Blue Cross Blue Shield of New Hampshire
- Blue Cross Blue Shield of New York
- Blue Cross Blue Shield of Ohio
- Blue Cross Blue Shield of Virginia
- Blue Cross Blue Shield of Wisconsin
- Aetna, Inc.: Aetna, Inc. is a healthcare insurance company that provides health insurance plans, dental insurance, vision insurance, and other healthcare-related products and services.
- Humana, Inc.: Humana, Inc. is a healthcare insurance company that provides health insurance plans, dental insurance, vision insurance, and other healthcare-related products and services.
- Cigna Corporation: Cigna Corporation is a healthcare insurance company that provides health insurance plans, dental insurance, vision insurance, and other healthcare-related products and services.
- Blue Cross Blue Shield: Blue Cross Blue Shield is a federation of 36 separate health insurance companies that provide health insurance plans, dental insurance, vision insurance, and other healthcare-related products and services.
- Kaiser Permanente: Kaiser Permanente is an integrated healthcare delivery system that provides health insurance plans, healthcare services, and other healthcare-related products and services.
Utilize Best Practices
To make the most of insurance billing, it’s essential to utilize best practices. This includes waiving copays, verifying benefits, understanding mental health billing, submitting claims correctly, and using telehealth. Additionally, you may want to consider outsourcing your billing to a company like MCM South Medical Billing Service, LLC. They offer billing services for mental health providers and can help you navigate insurance billing complexities more efficiently.
Take Advantage of Health Savings Accounts
As a behavioral health therapist, you may be eligible for a health savings account (HSA) or flexible spending account (FSA). These accounts allow you to set aside pre-tax dollars for medical expenses, including mental health services. Additionally, you can use these accounts to pay for deductible and copay expenses. By taking advantage of these accounts, you can save money and reduce your out-of-pocket expenses.
In conclusion, verifying insurance coverage is a crucial aspect of running a successful behavioral health therapy practice. It can help protect your practice from financial loss, ensure your clients receive the care they need, and streamline your billing processes. By understanding important insurance terms, mastering billing codes and claim submission, utilizing best practices, and taking advantage of health savings accounts, you can maximize your revenue and reduce your stress.
Medical Billing Service services for Mental Health providers
At MCM South Medical Billing Service, LLC, we are a billing service for mental health providers. We understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, MD., Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines. Our therapists are in solo or group practice.
Services
– Comprehensive medical billing service
– Patient insurance benefits verification (offered as a standalone service)
Our therapists specialize in a range of areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
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