So, you just joined a mental health practice and have no idea how to bill your patients. Don't panic. Billing can be complicated, but we're here to walk you through the basics and get you on your feet. By the end of this guide, you'll feel like a pro. First, decide whether you want to bill patients directly or go through their insurance. Both have pros and cons, so think about what will work best for your practice and patients. If billing insurance, ensure you understand the different types like HMOs, PPOs, and EPOs so you know which plans you accept. You'll also need to determine your rates for additional services. It may seem overwhelming now, but take a deep breath and start with the fundamentals. You've got this! Before you know it, billing will just be another part of your routine.

Psychiatry Billing Basics: An Introduction to Coding and Reimbursement

To get started with psychiatry billing, you first need to understand coding. Psychiatrists use the ICD-10 and CPT code sets to report diagnoses and services. The ICD-10 contains codes for mental and behavioral disorders, while the CPT codes describe psychiatric services like evaluations, therapy, and medication management.

  • ICD-10 codes have between 3 and 7 digits, and CPT codes have 5. You'll need to choose the codes that most accurately reflect the patient's diagnosis and services provided.
  • Codes are the foundation of reimbursement. The codes you choose determine how much the insurance company will pay for each visit. Undercoding or overcoding can lead to claim denials or audits.
  • Codes must be supported by proper documentation in the patient's medical record. Notes should contain symptoms, test results, treatment plans, and patient progress. Thorough notes are crucial to getting paid.
  • Codes change frequently, so stay up-to-date with the latest versions of ICD-10 and CPT. The codes you used last year may not be valid this year.
  • Consider using a certified medical coding specialist. They have the training and expertise to choose the proper codes for maximum, appropriate reimbursement.

With the basics down, you're ready to start submitting claims. Follow each insurance company's billing guidelines carefully to avoid delays or rejections. Provide complete, accurate information and keep records of all claims in case of questions. If you receive a denial, determine the reason and make corrections right away. Staying on top of the latest rules and tools will make psychiatry billing second nature in no time. 

Common Psychiatry Billing Codes and Documentation Requirements

To bill for psychiatry services, you'll need to know the proper codes and what documentation is required.

The two main code types are CPT (Current Procedural Terminology) for services and ICD-10 (International Classification of Diseases) for diagnoses. For therapy, use codes like 90832 for 30 minutes, 90834 for 45 minutes, and 90837 for 60 minutes. Psychiatric diagnostic evaluations are billed with 90791 and 90792.

Medication management

For medication management, use 99211-99215. Code selection depends on the complexity and time of the visit. Document the medications reviewed, any changes made, and the time spent.

Documentation requirements

You'll need thorough documentation for each visit. For therapy, note the start and end time, modalities used, topics discussed, and patient progress. For medication management, document the medications reviewed, changes to dosages or prescriptions, and time spent.

Include diagnoses for conditions treated using ICD-10 codes—also, document symptoms, test results, treatment plans, and any follow-up. Keep records organized and sign each entry.

By knowing the proper codes and documentation, you'll be well on your way to billing for psychiatry services. Double-check with insurance providers for their specific guidelines to ensure accurate reimbursement. Stay up to date with any changes to codes or rules. If done right, psychiatry billing can be a straightforward process.

Finding the Right Psychiatric Billing Services for Your Practice

Finding the right billing service for your psychiatric practice can be challenging. There are a few options to consider:

In-House Billing

Some practices handle billing in-house by hiring dedicated billing staff. While this gives you maximum control, it also requires investing in training, software, and ongoing oversight. For small practices, the costs may outweigh the benefits.

Outsourced Billing Services

Outsourcing to a third-party billing service is a popular option. They have the expertise and resources to handle billing efficiently. Look for a service that specializes in mental/behavioral health billing. Some questions to ask:

  • Do they have experience with psychiatric CPT codes, ICD-10 codes, and insurance eligibility checking?
  • What billing software and processes do they use? Make sure they suit your needs.
  • Do they provide reporting to help you track revenue and make business decisions?
  • What are their fees? Fees are often a percentage of collected revenue. Compare options to find a fair rate.

Billing Management Software

Practice management software can simplify in-house billing or supplement an outsourced service. Popular options like Kareo, TherapyNotes, and SimplePractice offer billing features like:

-Electronic claims submission to insurance companies

-Patient billing and payment processing

-Reporting and analytics to gain insight into your revenue cycle

The right solution for your practice depends on your needs, budget, and preferences. Research the options and talk to colleagues about what has worked well for them. With the proper systems and support in place, psychiatric billing can run smoothly and support the growth of your practice.

Conclusion

So there you have it, a quick guide to get you started with psychiatric billing. While it can seem complicated at first, if you take it step by step and keep good records, you'll get the hang of it quickly. Remember, start with your patient's diagnosis and treatment plan, then determine the right CPT and ICD codes. Ensure you understand their insurance coverage and submit claims accurately and on time. Build strong relationships with insurance companies, and don't be afraid to appeal a denied claim if needed. Psychiatric billing will become second nature with some practice, and you'll be appropriately reimbursed for your essential work. You've got this! Stay updated with changes to codes and regulations, ask questions when unsure, and keep your patient's well-being at the heart of it all.