Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller

Are you intimidated by out-of-network billing? Is being uncertain of what to do interfering with your income or worse, keeping you from accepting clients who would benefit from your expertise?

It’s important to remember that your client may be confused too. Take control of the situation by making clients aware that they may qualify for out-of-network benefits as early in your interaction as possible. Simply addressing payment options during the initial phone screen will give you an opportunity to address potential benefits they hadn’t considered.

The point is that you and your clients don’t have to fret over the phrase “out-of-network” anymore. Not being contracted with certain providers is not an automatic anxiety-inducing problem. With a bit of knowledge, your confidence will be boosted and your reimbursement secure. All you need is some key terminology defined and a clear path to navigate.  Below, you can find both. In addition, you’ll feel supported and less afraid to make a costly mistake.

So let’s get familiar with the basics: generally, there are two ways to bill out-of-network clients:

 

1. Submit a “Superbill” to the Client

What is a superbill exactly? How does it differ from the CMS-1500 form used to bill insurance companies?

Generally, that CMS-1500 form centers on the client’s providers who are in-network on insurance panels. Superbills are typically used when you are not contracted with your client’s insurance plan. Your client can simply pay their therapy costs out-of-pocket upfront as noted on the superbill and follow their payment with a submitted request for reimbursement to their insurance company. This affords them proof of their session with you and the specifics regarding your treatment.

What does a superbill look like?

Typically, you will generate a superbill that looks like an itemized invoice. A superbill form is easily generated through most EHR platforms. On it, the following information is clearly outlined for your client and their insurance company:

Simply put, the client will receive this bill from you, pay your full rate, and submit the superbill to the insurance company for their own reimbursement according to their benefits.

 

How often should you offer clients superbills?

It’s really up to you. Many therapists provide superbills at the end of every month. Some therapists provide a superbill every session.  Still, others generate a yearly bill.

Essentially, the beauty of the superbill is that once you provide it to your client and receive payment, your part is complete.  The client assumes responsibility for coordinating and negotiating benefits with their insurance company. Also, once you’re comfortable, you’ll likely find the method is worth your time and consideration as you can quickly and easily provide more comprehensive care options and still obtain your full fee.

Not interested in superbilling?

2. Courtesy Billing is Another Out-of-Network Option

What is courtesy billing?

This billing option meshes direct billing methods and the superbill process. Basically, your out-of-network client still pays your full fee upfront, but you will assume responsibility for submitting the reimbursement forms for them. In this case, your client isn’t burdened with the required paperwork or coordination of funds. When the bill is processed, your client receives the determined reimbursement funds from their insurance company.

Also, when submitting a courtesy bill, do note that there is a difference in how benefits are assigned that you should pay special attention to.

The term “assignment of benefits” refers to a legally binding agreement between the client and their insurance company. When you submit the form for them, it is vital that you are clear about what selecting or not selecting ” Accept Assignment” on the insurance claim means.

Courtesy Billing – Do Not Accept Assignment 

Selecting “no” on the form where it asks whether you accept assignment of benefits means that the insurance company understands you do not want anything from them. Thus, your money is still paid upfront. All insurance funds go to the client.

 

Courtesy Billing – Accept Assignment

Selecting “yes”  on the form means you will not receive upfront pay and must wait for and accept the determined insurance reimbursement. Obviously, not the right option in helping you accomplish your goal for prompt and efficient billing.

 

Check out this video tutorial: 

I walk you through Out Of Network Billing in Simple Practice Here (https://youtu.be/FpNL1YIlvD0)

 

Take the Next Step

Finally, you have the information and a way forward. Do you still need a bit of support?  You aren’t alone. I’m here to help. Please reach out now. Moreover, get started, get guidance, and get your full fee by billing Out Of Network.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller

Your practice deserves the right care and attention.

Compared to other types of practices, mental and/or behavioral health practices, in general, are special. Your everyday needs are special too. Therefore, to build a successful, thriving therapy practice, you’ll benefit greatly from the use of software that helps you manage the necessary tasks for growth and proper maintenance.

In addition to the basics, you’ll need to consider the type of guidance, support, and ongoing updates required to use your software optimally. Your specialized needs as a mental healthcare professional will likely cover anything from patient scheduling to insurance billing.

General Features of Mental Health Software

Firstly, it’s important to know that, mental health software is actually a network of software systems. Combined, the idea is that these individual systems will cover all of your business bases. To be most effective, therapists usually need software platforms systems that address the following:

Electronic health records (EHRs)

Accounting & Billing

Patient scheduling

Patient portal

Telemedicine

Overall Management

Essentially, it comes down to this: you want software systems for improved efficiency, accuracy, and effectiveness of patient care. Simultaneously, you also want to support the effectiveness of administrative jobs, especially account management and insurance billing.

So…where do you start to find the best options for billing software?

You definitely aren’t alone if finding the best platforms for coding and billing seems like a big ask, especially when you’ve already got so much going on.

It’s true too, that there are lots of options on the market. But they aren’t all equal when it comes to features and ease of use. Wouldn’t it be helpful to have a clear comparison of the best programs?

Look no further. Below you’ll find a features breakdown of three major software platforms:

Mental Health Billing: Comparing the Features of Three Major Software Platforms (EHR’s) 

Simple Practice

When it comes to ease of use, popularity among therapists, and customer support. Simple Practice is well regarded and highly rated. 

Features

Grab your free trial with $50 off here

Therapy Notes

This platform is intuitive and user-friendly with features that allow you to get up and running quickly.

Features

iTherapy

This platform permits you to put together all the tools you need, with the option to add services as needed.

Features

Code:  Kym 

Use the code above when enrolling and you will receive 50% off the first two months!

Need Some More Help?

Now, just because these platforms offer so many features, support, and options doesn’t mean you know what to do when and how to tackle billing tasks optimally right out of the gate! Still, it’s good to know that you won’t be poring over a calculator, the DSM, and a pile of undecipherable forms, pulling your hair out.

With good information, a therapist with the know-how to help you along, and electronic tools you can ease the way. Soon bolstering your practice’s income will seem entirely possible. I’m here to help. Let’s get together and get billing firmly added to your skill set.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller 

So, you want to take insurance payments? Or do you think you might possibly want to take insurance payments at some point down the road? 

Whether you’re sure right now or not, you’ll do yourself a favor by learning about credentialing in the clearest and least intimidating way possible. 

Not sure what that credentialing really is? Or does what you do know sound like a hassle you don’t want to take on?

To be sure, insurance panel credentialing and Medicare credentialing have their challenges. However, don’t assume that. With a little education and expert support, you will have what it takes to get the job done.

Now, to start, it’s always good to answer some basic questions first:

What is Credentialing Exactly? 

Simply put, credentialing is a process by which you establish your qualifications as a legitimate, licensed professional and submit them for assessment to health plan networks.

Why bother? Insurance plan credentialing is essential if you want to provide care for patients who are insured as an in-network provider.. In other words, if you want in-network  benefits to pay for your work, credentialing with local insurance companies matters. It is vital to generate a bill-pay process that will support your aim to create a lasting and profitable healthcare revenue cycle for your practice.

Is Credentialing Hard to Do?

It doesn’t have to be the chore it’s purported to be! Still, you need a wealth of user-friendly information and experienced guidance. Fortunately, you’ll find those here.

With an open mind and commitment, you’ll soon organize and obtain the credentials necessary. Moreover, you’ll have the skills required to build a revenue cycle that brings you peace of mind and the profits you deserve.

You should know: 

 1) Just as license requirements vary from state to state, so do credentialing requirements from one health plan to another. Some have paper forms to return some have an online process to adhere to. 

2) Attention to health plan constraints and guidelines is paramount. Knowing your client base well is vital. This will help you accurately pair your own services and the health plan’s reimbursement offerings. Also, being clear about which local insurance companies cover mental healthcare and are most popular is crucial.

Is There Anything I Can Do to Make Insurance Plan Credentialing Less Overwhelming?

Yes! The best course of early action is to get your documentation ducks in a row. You want to be ready and able to provide whatever the company requests. A quick-start guide can make things so much easier and insurance panel requirements much less intimidating. Fortunately, we have such a guide. Our list of actions suggests the following

Insurance panel credentialing can take quite a while. Even if you do it all correctly, an initial application’s road to acceptance is often 50-180 business days!  You’ll need to be mentally prepared and patient as you may find you need to appeal or reapply depending on your situation.

What If the Insurance Panel I Apply for is Full?

It’s important to keep trying, particularly if the company is a key provider for the community you serve. In addition to your license and resume, a short bio attached to your application can help make your case. The quick-start guide outlines this approach but most important is to create a succinct, compelling at-a-glance picture of your qualifications including:

Finally, just know that the benefit to your practice and your client community is worth the extra effort. The idea here is to stay the course and remain focused. A clear plan and personal resilience will ensure you can effectively offer your services to a host of insured clients.

You can do this; we’re here to help. Check out this bundle I have for sale on this topic: Credentialing 101. Please reach out soon and we’ll tackle this important step together!If you don’t want to do the credentialing yourself, check out YourVAFinder.com for a qualified credentialing specialist.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller

Do you worry that you only have a tentative handle on the telehealth billing guidelines? You aren’t alone.

All of the changes in billing practices throughout the pandemic have not made it easy to pin things down. Yet, even as billing for telehealth feels somewhat fluid, you can still capitalize on points of clarity that will allow you to bill appropriately and get paid promptly.

Key Things to Know When Billing for Telehealth

There is no shame in not knowing what you don’t know. To get anywhere in billing, you’ll need to be clear about which information gaps exist for you. Undoubtedly, you have questions:

The idea now is to get informed and get help when and where you need it. Here are several crucial topics to grasp when billing for telehealth:

Verify First: be sure that your client’s insurance covers telehealth

The most reliable way to secure payment for telehealth? Verify coverage with the client’s insurance  prior to your initial telehealth session. Specifically, call and ask if telehealth is a covered service. 

When you reach out, document the payer representative’s responses clearly. Include the call reference number, in case you need to dispute a denied claim later.

Just Ask: request the telehealth guidelines for each payer

How to know for sure what each payer wants for telehealth? Call and ask the proper questions! Talk to people who know. The following questions are a good start:

It’s important to realize that  guidelines vary depending on the payer, your state, etc. Talking to the payer directly is very helpful. Getting guidance from people who work with that payer is invaluable as well.

Be aware that telehealth is evolving due to our changing times. So be patient and persistent. Even if your telehealth claims are rejected at first, don’t give up. Do your research and try again.

Stay Current: keep a list of telehealth-eligible CPT codes from each payer

CPT billing codes are key. The simplest way to know which codes are eligible or each payer is to request them periodically. If they say they can’t provide them? Ask about specific codes (see my blog post about CPT codes)  CPT codes with a modifier (learn more below).

Know your Modifiers:  understand when to use GT and 95

Are you billing telehealth to a commercial insurance company? No problem, use a regular CPT code and a 95 modifier on the HCFA 1500 form to indicate telehealth. Also, do verify that with the payer when you’re first starting the process.

Are you billing telehealth to Medicare? The 95 modifier informs your Medicare payer that you provided medical service via telehealth. 

The GT modifier is being requested less and less these days and is use to be the standard. Now, most insurance companies want you to use 95 instead, which is defined as synchronous Telehealth.

Location matters: bill the correct place of service code 

When billing telehealth services, on the HCFA 1500 form, healthcare providers must bill the E&M CPT location code of 02 instead of 11 along with the modifier GT or 95. If you do not use the 02 code, the telehealth services  will not be accepted by the payer. This is the case for both Medicare and other insurance providers.

You Have Telehealth Billing Support Available

Hopefully, you understand enough of the key areas to get going! If you have more telehealth billing questions, that’s perfectly okay! I run a Facebook group for insurance billing for Telehealth to help you in real time. Link here: http://bit.ly/2kKfZXp  and please join us soon. Let’s talk things through together with others looking to master telehealth billing too.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist, Boss Biller 

Does the hassle of billing seem like too much to handle amid the responsibilities of your practice? Are you coping with complicated claims? Do you feel overwhelmed by months of procrastination and uncertainty about your ability to bill insurance correctly?

It sounds like you need some support. And a streamlined process for understanding how to maximize the billing process and reimbursement. Essentially, you need to understand the Current Procedural Terminology (CPT) code system and some other key information. Fortunately, this is the place for both.

Let’s take a look together at what you need to know:

What Are CPT Codes Exactly?

What’s your gut response to a discussion about billing codes? It’s not unusual for mental health clinicians to feel intimidated or anxious at the thought of tackling insurance billing for your work. Yet, with a bit of guidance, and a bit of information editing, you can sift out what you need to bill appropriately and leave the extraneous advice aside.

CPT codes were devised to standardize medical billing across various disciplines and practices.

Therefore, it’s important for you to know that many of these codes have little or nothing to do with mental health work. To be reimbursed for your services, you’ll likely only need to record a few codes. Memorizing the appropriate CPT codes, in the right circumstances, will make billing much easier and make the most of reimbursements.  Key points when considering billing include the following:

Is There a Cheat Sheet for the Codes Most Pertinent for Mental Health Clinicians?

Thankfully, the answer is yes!

While it’s true that mental health providers wishing to be reimbursed will need to master CPT billing, many of us put it off. Worse, we may never tackle it at all. Why? Because memorizing and applying the correct codes seems daunting and tedious. With all of your other responsibilities, poring over the American Medical Association’s CPT manual to pluck out the right codes is likely not your idea of a good time.

Still, the payoff is too good to let the billing opportunity slip by. Fortunately, in this situation, a “cheat sheet” is a great resource. A resource I am happy to provide. Of course, every practice is unique. However, the most common codes are as follows:

CPT Codes Cheat Sheet

Identifying the codes you use most frequently is an invaluable timesaver. Keeping them close by will maintain your confidence in the system, ensure accurate billing, and keep your practice thriving.

Are There Key Strategies for  Best Use of the CPT Codes

Again, the answer is yes!

You want to do your best not to interrupt the billing pipeline and back up your reimbursement. Thus, it is important that you bypass the most common CPT billing code errors. This isn’t difficult; you just need the right information. Fortunately, you don’t have to go anywhere to find it. Below you’ll see a few strategies to keep in mind:

Okay, Sounds Good, So Where Do My Billing Codes Go?

Good question!

To get things going, you’ll add the codes you use to an HCFA 1500 form. This claim form is used to clearly and accurately document your procedures. Essentially, it is just an insurance claim form specifically meant for medical professionals. You or your office will office complete it and submit it directly to the health insurance company.

Keep in mind that when you call insurance companies to discuss benefits, you can ask them about CPT codes too.

***

Finally, and most importantly, know that you aren’t the first therapist to approach billing with some measure of trepidation. The great thing about you? You realize that help is available. Your time and energy are undoubtedly worth the money. You deserve to bill for it.

I’m on your side. Please reach out now for support to get started and guidance when you need it.

Posted by Kym Tolson, LCSW, CSAC, Traveling Therapist and Boss Biller 

One of the things that frightens therapists the most about billing for more money is the idea that they might make mistakes that could be construed as fraudulent. Or even, unknowingly, use a mental health billing practice they thought was okay but turned out to be illegal!

Anxiety about this can be so worrisome that it keeps therapists, just like you, from collecting fees they rightfully deserve. So how can you avoid illegality and enjoy well-deserved prosperity?

Knowledge is the power you need. Learn below what not to do so that you’ll bill for more money the right way. Essentially, it comes down to avoiding two common, but problematic, practices: balance billing and upcoding.

Please Don’t “Balance Bill”

What is balance billing?

This type of accounting occurs when a therapist bills their in-network client for the difference between the cost of services and the amount that their insurance company pays in benefits. This can occur with some frequency because the funds that insurance companies pay therapists are usually less than the therapist's stated charge. Attempts to make up the difference, or balance, through a bill to the client is thus called “balance billing.”

It should also be noted that it is illegal to balance bill your in-network clients as well. When you contract with insurers, you consent to accept the companies’ payments in full. Outside of any copay, deductible, or coinsurance, billing, the client further is off-limits.

Please Avoid Upcoding

Why is upcoding a problem?

This practice of applying higher codes for more money when they really don’t apply is viewed as dishonest. Essentially, it’s a kind of false claim. At best it is frowned upon; at worst, it’s fraud. More specifically, “upcoding” occurs when a therapist employs billing codes that indicate a more grave or serious disorder or diagnosis than exists. This also occurs when therapists indicate that more complex, and time-consuming, and expensive approaches or therapy were used than was actually afforded to their clients.

Upcoding happens for a couple of reasons, though neither legitimates doing it:

1. Therapists do it to obtain inflated reimbursements. Misleading “current procedural technology” (CPT) codes can be profitable in the short term, but make no mistake that it is an illegal violation of the False Claims Act (FCA)

All therapists are aware and agree to certain ethical standards in this regard.  Ensuring accuracy in billing and payments so that you are totally compliant with the law is the safest course. Any other isn’t worth the headache or paranoia.

Avoid trouble by using the correct codes and billing with integrity.

2. Some therapists do it thinking they are doing their clients a favor. Upcoding could definitely afford some patients who could afford care services without harming their income. Unfortunately, this doesn’t count the cost to the therapist-client relationship, which is built on trust.  In addition to jeopardizing your practice, your willing dishonesty may inadvertently harm or corrupt the connection you’ve built.

When it comes to billing codes, it’s always best to be as accurate as possible. Maintain your personal and professional standards; there are plenty of tools you can use legally to support your bottom line. The key is to find and follow the guidance of experts who can help you.

Speaking of Billing Guidance and Support…

With the billing “don’ts” explained, you can see that your billing “dos” are rooted in knowing the correct information and letting your good character lead you. In addition, some support from a billing expert who will champion your efforts to build your profits can hurt either. That’s exactly why I’m here. Even better,  I offer a product that thoroughly explains upcoding correctly to use the right codes.  (https://insurance-billers-online-therapy.teachable.com/p/billing-for-more-money/?preview=logged_out) It can help honestly boost your billing IQ as well as your confidence.

Your experience and success as a therapist rests on your ability to communicate with your clients. Yet, sometimes the connection you want to make with a hurting or troubled person is hindered or difficult for any number of reasons. It often takes time to parse out what to do and how to do it. Helping them is built on the cornerstone of communication.

Have you ever wondered how you would charge for such an interaction? As you work through situations like these, you don’t want to be worried or distracted. Thoughts about whether your income will be affected by clients with whom you are slow to connect aren’t helpful to your process or for themselves.

Fortunately, there is a billing code that covers conversations that don’t happen easily. Nearly a decade ago, The American Medical Association (AMA) created the interactive complexity code (90785).

Exchanges that are tense or stilted, or interactions that require more people in the room for support, safety, and care, may benefit from this code. Therefore, let’s explore the ins and outs of using this code below:

So, What Exactly Defines Interactive Complexity for Insurance Companies

Good question! First, understand that the interactive complexity code is a code used in conjunction with primary service codes on the same date of the session. Thus, code 90785 cannot stand alone and is referred to as an “add-on” code. 

 Appropriate use of the interactive complexity code involves circumstances where your services are complicated by communication barriers with a client, during your session. Also, it’s important to note that billing code 90785 reflects the elevated intensity of the interaction, not how much time it takes you to interact with the client.

To be clear, here are the billing code do’s and don’ts of the interactive complexity code:

 

Do use code 90785 with these CPT codes:

Do Not use code 90785 with these CPT codes:

Okay…So What Does A Code 90785 Situation Look Like?

Another great question! To apply the code correctly, ask yourself several key questions:

“Yes” to one or more of these questions means the code applies. Your situation is compliant with the interactive complexity assessment as outlined in the Current Procedural Terminology manual.

To be clear, here are the billing code do’s and don’ts of the interactive complexity code:

 

Do use code 90785 with these CPT codes:

Do Not use code 90785 with these CPT codes:

Okay…So What Does A Code 90785 Situation Look Like?

Another great question! To apply the code correctly, ask yourself several key questions:

“Yes” to one or more of these questions means the code applies. Your situation is compliant with the interactive complexity assessment as outlined in the Current Procedural Terminology manual.

Great! Now, How Do I Bill for Interactive Complexity When Necessary?

Now that you know the do’s and don’ts, how to bill likely won’t seem so hard. Here are a few pointers to keep in mind for your billing form:

That’s all there is to it! Still if you feel unsure or need someone to walk you through the process before you go solo, there’s no shame in that.  Moreover, the point is to help you recognize interactive complexity when it happens. And feel that you can appropriately bill for it. 

Finally, please know we’re here to help! Don’t be afraid to reach out for support and guidance. We’ve got tools and resources to build your billing confidence in no time.

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