How to Bill Insurance Companies for Counseling

How to Bill Insurance Companies for Counseling

Jan, 31 2020
Emotional Intelligence /

Billing is probably one of the worst parts of a private practice or being in business. For some, it requires a lot of effort and patience. It could mean you will need to deal with the paperwork and communicate with different individuals. But insurance billing is not as bad as you think. It can be a breeze if you will establish a specific guideline as you do your private practice and follow it accordingly.

As counselors, you may not always be covered by health insurance or your client's insurance plan. Some companies require more paperwork for mental health billing compared to consultations with doctors or other medical professionals. But since a therapy session can be charged to mental health billing, mental health professionals running a private practice have every right to submit a health insurance claim.

Here are some tips to help establish an efficient billing service for counselors running a private practice. This will help make the delivery of health services more pleasant for mental health professionals.

Establish a Clear Responsibility from Your Client

The first thing that you must do is to set a financial obligation to your client. As a professional doing health practice, you have to present everything clearly on your client intake form. As early as this stage, they will have an overview of their payment responsibilities, and both parties can talk if there is a need to modify things regarding their mental health billing. The bill will be sent to their insurance provider, and is still part of their health coverage. Some companies include counseling or therapy as part of their health benefits. They are allowed to go to a counselor or health practice provider of choice. The bill is just sent to the health insurance company afterward.

Create a Policy for Standard Payment

One of the essential parts of your health insurance billing process is setting a standard policy for the payment. You need to inform your client about this policy and make them understand as soon as they sign up for your service. One of the most effective ways to let them know is through posting it on your reception desk or anywhere near it. Another way is displaying it on your website so that every visitor will have a clear vision of your payment policy without visiting your office.

It is recommended that you create a policy that can be understood easily to avoid confusion for both parties. A practical payment policy should meet the following concerns:

  • Payment Due - generally, payments are given during the service is being rendered. But as private health practice, you have the freedom to alter this depending on the structure of your company billing.
  • Person Who Will Settle the Payment - your payment policy should tell who the person responsible for settling the bill for your counseling service is. If it's an insurance company, determine who is the company representative that you can talk to.
    Payment Type - aside from accepting cash payments, what are the additional payment types that your practice accepts? What are the different credit cards and debit cards that you acknowledge? Do you also accept checks as payment? Make sure to be clear about your payment type.
  • Missed Payment from a Client - this is the last thing that you would want to happen with your practice, but this specific situation occurs in a real-world scenario. That's why you have to be ready whenever an insurance company fails to settle the charged amount for their client. How long are you willing to wait for the 100% of the payment? What is the insurance company failed to settle the debt after giving them an extension? Is it time to talk to a collecting agency and let them do the work for your company? These are just some of the questions that you will need to answer as you begin accepting clients for your service.
  • Missed or Late Appointments - your time is as precious as the time of your client's. This is the reason why you have to include the consequences of missed or late appointments within your policy. Explain this to your client to avoid confusion.

Submitting a Claim

These are the things that you should keep in mind as you submit a claim to your client's insurance provider:
Be sure who to bill. It is not a surprise if your client has two or more insurance providers. With this, you have to be particular about the right insurance that you are about to bill. Ask your client and confirm their primary provider. You can also add their secondary and so-on provider in case the first choice doesn't work.

Deliver an on-time claim. Never be too confident that you still have the time to submit a claim. Though most of the insurance companies' deadline is within 90 days after the service had been rendered, it may not work the same way with the other insurance provider. Always check their deadlines and settle the claim as early as possible.

Always follow up the unpaid claims. Regularly check the status of your insurance claim and make sure to follow up on those overdue payments. If necessary, call the insurance provider's representative and remind them about the claim. This is your business, and you have to be responsible enough to settle the payments that are due to you.

Common Billing Errors to Avoid

No company is safe from committing errors as they request claims to different insurance providers. But, knowing what the possible mistakes that you might encounter are can help you in avoiding it as much as possible. Right here, we will give you the most common billing errors as a counseling service provider.
Duplicate billing - this is one of the most common errors in insurance billing. Duplicate billing happens when the billing process is not adequately discussed or assigned within your office. For example, a processing officer filed a claim to the insurance company. The next day, another processing officer submitted the same request to the insurance provider because he or she was not informed that another person had processed it. When duplicate billing happens, both claims will be rejected, and it could mean another work for your office.

Error with information

you have to be very accurate when it comes to encoding your client's information into your insurance claims. Any misspelled letters or numbers will result in claim rejection. Always check the information of your client, it's insurance provider, your company's data, and the numbers that can be found in your claim. As much as possible, let another person check the document to make sure that everything is correct.
Incorrect Codes - with the hundreds of codes that you might need in formulating an insurance claim and bill, you have to be extra cautious with the one that you will use. Someone can quickly make this error, and it can be costly as well.

Insufficient Documentation

you have to include every information needed within your claims, such as the different services that you did, the medication history of your client, the symptoms and diagnoses, and many more. If you don't want a denied claim, complete your paperwork, and do the billing properly.
Unbundling - instead of billing the insurance company with the package code of your service, you chose to advertise them with each service that rendered to your client. This setup could result in a higher claim, and the insurance provider can deny or reject it.

Under coding

this error happens if you reflect a CPT code that represents a treatment that has a lesser price or severe diagnosis. It can happen by mistake, but some of this error is intentional. One possible reason behind doing this on purpose is when you want your patient to save money. Another goal is your company wants to skip the auditing process of the insurance provider. But whatever the reason is, under coding is considered illegal.
Upcoding - contrary to under coding, upcoding happens if you utilize a CPT code that counterparts a treatment with a higher price or a higher sever diagnosis. This kind of error is often commonly done intentionally. But that is not the situation all the time. Sometimes, it can be a product of office staff who was poorly trained.

As a service provider who submits claims to an insurance company, you have to make sure that you minimize the occurrence of these mistakes.

Best Practices to Avoid Billing Mistakes

As part of every company, there are various practices that you can use to become a service provider. These are some of the ways that you can improve your billing process and avoid possible mistakes.

  • Be careful. Be responsible for the things that are happening within your business, especially with the billing area. As much as possible, create and implement a payment policy for your service/s. Let your staff know about this policy and always be on top of everything.
  • Always train your staff. It will never be safe to assume that your team knows what they do. If you recently hired someone who is doing the billing process with her previous company, disregard the idea that you can trust her, and she can go on with her responsibility for your company. Make sure that every staff inside your office knows the necessary information about billing. This kind of practice will not only keep your business growing, but it can also reduce the troubles of ethical and legal problems due to negligence.
  • Stay updated on the billing and coding policies. It's still a great idea to keep updated with the things related to your business, such as the billing and coding policies. You can subscribe to the newsletters from your own state's accreditation board, industry leaders, and insurance companies. You will be surprised by how many news and updates you will receive from them. You will also appreciate the other ideas and information that they can deliver right through your email.
  • Follow up on your billing claims. Every claim is your business's hard-earned money, so never let it slip and end up falling through the cracks. Check your applications every month and see which among them have been left unnoticed or unsettled. When dealing with an insurance claim, be responsible enough to file it as soon as you can. Don't wait for the last three days of the 90 days before you deliver the claim to the insurance company. If you file your claim on time or earlier than expected, you will have a big chance of getting paid earlier as well.

Billing insurance providers could mean a lot of paperwork for you and your staff. But you don't have to feel bad about it. Keep in mind that your service deserves to get paid. You and your team have worked hard for every service that you provided to your client; thus, you must perform this process vigilantly.

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