Knowing how to bill insurance for therapy can be a confusing process filled with complexities and nuances. It can overwhelm even seasoned professionals who’ve been practicing for a long time. It’s complicated, too — anestimated 80%of all medical bills contain errors.Therapy billing requires a good understanding of insurance industry jargon, claim rejections, diagnosis codes, and much more — it’s no wonder many therapists find the process daunting.While billing insurance is one of the most commonchallenges of being a therapist, mastering insurance billing is a must. It’s integral to running a practice and receiving compensation.Luckily, there are many options available for you to bill insurance. You can outsource the entire thing, use practice management software designed specifically for therapists, or do it yourself.Be a Talkspace TherapistWork flexible hours as part of a supportive virtual community of care providers. Receive ongoing training and free CE credits.Apply nowIf you’re among the many who feel billing insurance is the worst part of your job, this guide is for you. Learn how to bill insurance for therapy and explore the terminology, differences between in and out-of-network billing, why getting credentialed can help, the importance of verification and authorization, and so much more. We’re sharing everything you need to know about how to bill insurance for counseling services.
Knowing how to bill insurance for therapy can be a confusing process filled with complexities and nuances. It can overwhelm even seasoned professionals who’ve been practicing for a long time. It’s complicated, too — anestimated 80%of all medical bills contain errors.
Therapy billing requires a good understanding of insurance industry jargon, claim rejections, diagnosis codes, and much more — it’s no wonder many therapists find the process daunting.
While billing insurance is one of the most commonchallenges of being a therapist, mastering insurance billing is a must. It’s integral to running a practice and receiving compensation.
Luckily, there are many options available for you to bill insurance. You can outsource the entire thing, use practice management software designed specifically for therapists, or do it yourself.
Be a Talkspace TherapistWork flexible hours as part of a supportive virtual community of care providers. Receive ongoing training and free CE credits.Apply now
Be a Talkspace TherapistWork flexible hours as part of a supportive virtual community of care providers. Receive ongoing training and free CE credits.
Be a Talkspace Therapist
Work flexible hours as part of a supportive virtual community of care providers. Receive ongoing training and free CE credits.
Apply now
If you’re among the many who feel billing insurance is the worst part of your job, this guide is for you. Learn how to bill insurance for therapy and explore the terminology, differences between in and out-of-network billing, why getting credentialed can help, the importance of verification and authorization, and so much more. We’re sharing everything you need to know about how to bill insurance for counseling services.
Understanding Insurance Terminology
Therapy billing in the field of mental health care involves complex terminologies, including:
In-Network vs. Out-of-Network BillingPart of mastering billing and understanding insurance coverage is distinguishing between in-network and out-of-network.In-network providershave agreements with insurance companies that allow them to offer their services to clients at a reduced rate. This helps someone afford therapy, but these contracts can potentially limit the choice of preferred provider if a therapist is not “in the network.”Out-of-network providersdo not have contracts with an insurance company. This means a patient could have greater freedom in choosing a provider, but it will generally lead to higher costs since the insurance plan will not cover as much of the bill (if it covers any at all).“The in-network billing process might seem intimidating at first, but once you are able to engage in the process and start billing insurance companies, it gets easier. The initial process is more time-consuming, but once it is in place, it is pretty smooth. In-network billing allows clients to use their insurance to pay for therapy with little or no copay. This makes therapy more accessible to those who need it the most since many people cannot afford to pay out-of-pocket for therapy.”–Talkspace therapist Bisma Anwar, LPC, LMHC
In-Network vs. Out-of-Network Billing
Part of mastering billing and understanding insurance coverage is distinguishing between in-network and out-of-network.
“The in-network billing process might seem intimidating at first, but once you are able to engage in the process and start billing insurance companies, it gets easier. The initial process is more time-consuming, but once it is in place, it is pretty smooth. In-network billing allows clients to use their insurance to pay for therapy with little or no copay. This makes therapy more accessible to those who need it the most since many people cannot afford to pay out-of-pocket for therapy.”
Getting Credentialed
A big part of understanding how to bill insurance for therapy means learning the ins and outs of credentialing. This process is something mental health professionals can go through before they bill insurance companies.
Credentialing proves that a therapist is qualified and competent to provide mental health services. Filing a claim with an insurance company can be nearly impossible without credentials.
Credentialing is important because it:
The process of getting credentialed involves several steps. First, gather all necessary documents, including:
Once you have everything, you’ll submit the documents to the individual insurance company networks you wish to join. Note that while the process is generally similar for each insurance company, there can be slight differences — be sure to check with each company before you submit to ensure you’re giving them exactly what they require.
The credentialing process looks something like this:
Verificationof client coverage lets you confirm that a client’s insurance provider will cover the therapy sessions you’re offering. Verification is a detailed and essential step that protects you so you’re paid for your services.
Pre-authorizationmight be required before initiating care, especially for intensive outpatient programs or residential treatment. In short, pre-authorization simply means securing approval from an insurer before starting therapeutic interventions.
Pre-authorization can seem complex, but it serves two critical purposes:
Common Billing Codes in TherapyCurrent procedural terminology (CPT) codes denote and identify specific types of therapy sessions and modalities as well as diagnostic information. The codes function as a way to describe interventions used in sessions or reasons for treatment. Filing claims with an insurance provider using a standardized code simplifies therapy billing. It ensures you’re paid what you should be.Some standard CPT codes in therapy include:90834: Individual psychotherapy for a 45-minute session90837: A 60-minute psychotherapy session90791: Initial diagnostic interview or assessment, with no medical services added on
Common Billing Codes in Therapy
Current procedural terminology (CPT) codes denote and identify specific types of therapy sessions and modalities as well as diagnostic information. The codes function as a way to describe interventions used in sessions or reasons for treatment. Filing claims with an insurance provider using a standardized code simplifies therapy billing. It ensures you’re paid what you should be.
Some standard CPT codes in therapy include:
Submitting ClaimsSubmitting claims to insurance companies is a crucial step in mental health billing. The process must be done correctly and includes filling out insurance claim forms that share detailed and specific information.You only have a certain amount of time to submit claims, and the deadlines vary from insurer to insurer.To fill out a claim form, you must have:Provider’s namePractice tax IDClient information, including full name and date of birthDetails about each therapy session, like the date and corresponding service codeEven minor errors could result in a rejection from an insurance company. Make sure that you take the time to fill out claims forms correctly using the following tips:Cross-check every detailDouble-check that a patient’s identifiers match the information on their insurance cardLook at the insurance requirements before submitting the formMake sure the codes you use accurately reflect the services provided
Submitting Claims
Submitting claims to insurance companies is a crucial step in mental health billing. The process must be done correctly and includes filling out insurance claim forms that share detailed and specific information.
You only have a certain amount of time to submit claims, and the deadlines vary from insurer to insurer.
To fill out a claim form, you must have:
Even minor errors could result in a rejection from an insurance company. Make sure that you take the time to fill out claims forms correctly using the following tips:
Handling Rejections and DenialsErrors in the billing process or discrepancies between service codes and providers can lead to a claim being rejected or denied.Rejections: Often, rejections stem from simple errors in a submission. For example, an incorrect practice tax ID number or a mix-up with patient identifiers could slow things down.Denied claims: A claim denial can be a big issue for therapists. A denied claim was processed but rejected. Denials can result from a keystroke error or simple mistake, or they could be due to services provided that weren’t a covered benefit.You can appeal a rejection or denial status, but for a decision to be reversed, you must have supporting documents like session notes and treatment plans readily available to support your case. Documents like this will help you establish the necessity of services, which can improve the likelihood of payment.
Handling Rejections and Denials
Errors in the billing process or discrepancies between service codes and providers can lead to a claim being rejected or denied.
You can appeal a rejection or denial status, but for a decision to be reversed, you must have supporting documents like session notes and treatment plans readily available to support your case. Documents like this will help you establish the necessity of services, which can improve the likelihood of payment.
Navigating Client Payments
Clients will sometimes need to pay a portion of their care services cost.
Costs might include:
Best Practices for Successful Billing
Best practices include:
Avoid the Headaches of Submitting Claims
Submitting claims can be a daunting process, especially for providers who don’t have a dedicated billing department. With the proper knowledge and some organization, though, you can avoid the common pitfalls.
Insurance filing can be complicated, but it’s vital to running your practice. Maintaining organized records and tracking claims and payments are essential for timely payment. If you don’t want to deal with billing and are looking for help, Talkspace is an online therapy platform that takes the headache out of the billing process for mental health professionals, giving you more time back to achieve an idealwork-life balance as a therapist.
“Talkspace takes over the process of billing insurance so that I can just focus on helping my clients. I do not have to worry about filing the paperwork, doing submissions, or following up on claims. This really makes my life easier!”
If you’re looking to untangle the confusing web of insurance billing for therapists, learn more about how Talkspace can do it for you, soyoucan focus on doing what you love — helping people.Become a Talkspace therapisttoday to make running a practice easier.
Sources:
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