Insurance Billing for Therapists: A Roadmap to Financial Stability

Understanding how to bill insurance to cover therapy can be a complicated and nuanced process. Even seasoned experts who have been practicing for a long time can be overwhelmed. It's also complicated: an estimated 80% of all medical bills contain mistakes.

Therapy billing necessitates a thorough awareness of insurance industry jargon, diagnosis codes, claim rejections, and much more – it's no surprise that many therapists find the process overwhelming.

While one of the most prevalent problems of being a therapist is billable insurance, knowing insurance billing is essential. It's necessary for running a practice and getting paid. Let’s have a deep dive into the insurance billing for therapists, which is a roadmap to financial stability:

Getting Credentialed

Medical credentialing is the procedure by which a therapist becomes a member of an insurer's provider panel. Therapists who are not credentialed with insurance companies cannot bill insurance directly. The client must instead seek reimbursement from the insurance. Reimbursement is not assured, and the client may be required to jump through several hoops. Meanwhile, the client is accountable for the bill, and the financial stress may lead to a client attending therapy less frequently. As a result, joining a provider panel may be a preferable choice for both the therapist and the client.

Here are the four steps to become credentialed:

• Make a list of the companies you want to be credentialed with. With hundreds of insurers in the United States, it's best to go with the largest insurance company in your area. You should also inquire with other therapists about their experiences working with particular insurance companies. Some may provide additional pay or make the credentialing process simpler.
• Apply to join the insurer's provider panel. Most insurers have an application available on their website. Many insurers will then issue you a CAQH number, allowing you to complete a CAQH application.
• Fill out the Council for Affordable Quality Healthcare (CAQH) application. Most large insurers require the CAQH application as part of the credentialing procedure. Only when you have applied to the insurance company for credentialing and received a CAQH number will you be able to finish the CAQH application. CAQH will subsequently forward the application to the insurance company.
• Follow up with each insurer to whom you have applied. It may take many months to be approved, and you may be required to give further information. Following up ensures you are aware of any application issues as soon as feasible.

Following the acceptance of your CAQH application, you will be required to re-attest the information included therein every quarter. Keep an eye out for CAQH alerts in your mail to avoid losing your credentials.

Deadlines And Payment Schedules

The amount of time you've to submit a claim for payment varies by insurer, so consult your provider panel paperwork for details. Medicare and Medicaid usually require claims to be submitted within 365 days of the date of therapy. Private insurers typically have shorter deadlines.

Therapists who work with various insurance companies may be required to meet multiple deadlines. To avoid missing a deadline, determine the shortest filing period and file all claims within that period. Consider filing all claims within 90 days if you deal with private insurance that only offers a 90-day filing period.

Generally, therapists must be reimbursed within 30 days. However, coding errors might cause delays in reimbursement, so keep track of every statement you send out. If you have not received payment within 30 days, approach the insurer.

Outsourcing Insurance Billing for Therapists

Submitting claims can be difficult, especially for providers without a specialized billing staff. However, you may avoid the most typical errors with the right information and implementing the following strategies, such as:

• Reduce errors by ensuring that all patient information in your records is correct and comprehensive.
• Know your service codes and utilize them correctly.
• Maintain copies of insurance cards on file.
• Keep the therapy billing process organized to save time and worry.
• Track claims systematically throughout the process so you know when they are submitted, pending review, approved, denied, or rejected.
• Use digital tools to simplify administrative duties, such as filing electronic claims through secure portals.

Insurance filing might be complicated, but it is critical to the operation of your practice. It is essential to keep structured records and track claims and payments to receive timely reimbursements. If you don't want to deal with insurance billing and need assistance, 24/7 Medical Billing Services is the professional medical billing and coding company that takes the hassle out of billing for mental health practitioners, providing you more time to achieve an optimum work-life balance as a therapist.

See also: Maximizing Revenue: Strategies For Denied Claim Recovery