Avoiding insurance fraud and misrepresentation in psychotherapy, counseling, and social work is an important part of protecting the integrity of your profession. Below are some key tips to help you make sure that you’re billing honestly about the mental health services you provide.
Understand Your Client’s Insurance Policy
Make sure to read through the client’s insurance policy so that you understand what services are covered and what aren’t. Keep accurate records of all paperwork related to insurance claims.
Balance Billing
As patients, we put a lot of trust in our providers to understand and abide by their insurance contracts. However, sometimes providers engage in a practice known as balance billing, which can put patients in a tough spot. Balance billing occurs when a provider charges a patient for the difference between their full fee and the reduced negotiated rate agreed upon in their insurance contract.
It’s important to note that this violates the provider’s agreement with the insurance company, which means patients shouldn’t be responsible for this extra cost. If you find yourself in this situation, don’t panic. Simply remind your provider of their in-network agreement and the relative cost of services. As always, knowledge is power, and understanding the ins and outs of insurance can help you navigate these tricky situations with confidence.
Incorrect CPT Codes
Be sure to use the right CPT codes when filing insurance claims. it’s important to understand how this can amount to insurance fraud. Take for example 9083, which is used for family psychotherapy. To bill this code, the therapist must be present in the same room with all members of the family at once. If that’s not the case, another CPT Code should be used to accurately reflect your services provided.
Do Not Record CPT Codes for Sessions That Do Not Take Place
It is important to never record CPT Codes for sessions that did not take place. If you decide to include your client’s missed sessions, your records must show that the services were not provided due to a cancellation or now show.
By following these tips, you can help protect yourself from insurance fraud while still providing quality services to your clients. Make sure to stay up-to-date with the latest laws and regulations related to insurance billing, so that you can always remain in compliance with applicable policies. With a little bit of effort, you can help ensure that your practice remains honest and ethical.
Need Help with Your Mental Health Billing to Insurance?
Billing for mental health insurance is no easy task. If you are a psychotherapist, counselor, or social worker and need help with insurance billing for mental health treatment, you can always turn to an expert for assistance. At Anchor Point Billing Solutions our team of trained professionals is available to help you navigate through the billing headaches. Reach out today for a free consultation.