Unlock the Secrets to Mastering Psychiatry Billing: The Ultimate Guide for PAs & NPs to Boost Reimbursements and Streamline Your Practice

Are you a Physician Assistant (PA) or Nurse Practitioner (NP) struggling with the complexities of psychiatric billing? You’re not alone! In a rapidly evolving healthcare landscape, mastering billing practices is key to ensuring smooth operations and maximizing your reimbursements. Whether you’re new to billing or a seasoned practitioner looking to streamline your process, our Ultimate Guide to Psychiatry Billing is your go-to resource.

Rosemary Ingado, PA is a dedicated and experienced clinician with over 20 years of practice in both primary care and mental health. She specializes in an integrated healthcare approach, combining physical and mental health services to provide holistic care. Rosemary’s work extends beyond the clinic, as she is known for her compassionate housecalls, bringing essential care directly to her patients.

Please note, the views and opinions expressed by Rosemary are based on her extensive experience but are not a guarantee of success in managing a virtual mental health practice or mastering psychiatry billing. Each practice and billing situation is unique, and outcomes may vary.

Why You Need This Book

Billing for psychiatric services is notably different from other medical billing due to the unique variables in mental health care. The guide demystifies psychiatric billing and provides actionable insights on everything from ICD codes and CPT modifiers to telehealth billing. With easy-to-understand explanations and step-by-step instructions, this guide will help you:

• Increase reimbursements by ensuring accurate coding and billing.
• Avoid costly mistakes that lead to denied claims.
• Save time with streamlined billing workflows designed for PAs and NPs.
• Stay updated with the latest billing codes, telehealth rules, and regulations.

This is more than just a book—it’s a powerful tool to take control of your billing processes and avoid costly errors!

Pros of Mastering Psychiatry Billing

• Higher Reimbursements: Get paid what you deserve for your services by accurately coding and billing each procedure.
• Full Control: By understanding the billing process, you no longer have to rely entirely on billing departments or third parties.
• Up-to-Date Knowledge: The guide is packed with the latest updates in psychiatric billing, from CPT codes to mental health add-on codes.

Cons & Limitations of Doing Your Own Billing

• Time-Consuming: Billing requires time and attention to detail. As a PA or NP, this can take away from patient care.
• Risk of Errors: Without thorough knowledge, errors in coding can lead to claim rejections or underpayments, impacting your practice’s revenue.
• Constant Updates: The medical billing field is always evolving. Keeping up with frequent changes in regulations and codes can be challenging.

Is This Guide Right for You?

While it’s possible for PAs and NPs to handle their own billing, it requires a solid understanding of billing processes and codes. The Ultimate Guide to Psychiatry Billing gives you the tools you need, but remember: successful billing also requires staying updated on industry changes and dedicating time to accurately complete claims.

For a complete guide to Psychiatry Billing Course, click here and unlock the secrets to mastering psychiatric billing.

Psychiatry Billing Claim Calculator

Disclaimer: The reimbursement amounts shown in this Psychiatric Billing Calculator are based on the average fees provided by CMS (Center for Medicare and Medicaid Services) for physician billing. Please note that PAs (Physician Assistants) and NPs (Nurse Practitioners) are typically reimbursed at 80% of the physician fee schedule. Actual reimbursement rates may vary depending on your location, the specific payer, and other factors. This calculator is intended for educational purposes only and should not be used as a sole resource for financial decisions related to billing.

Here are some Frequently Asked Questions (FAQs) about Psychiatry Billing:

1. What is Psychiatry Billing?

Psychiatry billing refers to the process of submitting claims to insurance companies for reimbursement of psychiatric services provided to patients. This process involves using specific billing codes (CPT, ICD, and modifiers) that accurately represent the services rendered, such as psychiatric evaluations, therapy sessions, and medication management.

2. What are the common CPT codes used in Psychiatry Billing?

Some common psychiatry CPT codes include:

• 90791 – Psychiatric Diagnostic Evaluation (without medical services)
• 90792 – Psychiatric Diagnostic Evaluation with medical services
• 90832 – Psychotherapy, 30 minutes
• 90834 – Psychotherapy, 45 minutes
• 90837 – Psychotherapy, 60 minutes
• 90846 – Family psychotherapy without the patient
• 90847 – Family psychotherapy with the patient

3. What is the difference between CPT Code 90791 and 90792?

• CPT 90791 is for a psychiatric diagnostic evaluation without medical services, typically used by psychologists or therapists who do not prescribe medication.
• CPT 90792 includes medical services, such as medication management, and is used by psychiatrists, nurse practitioners, or physician assistants who can prescribe medication.

4. What are the common ICD-10 codes used in Psychiatry Billing?

Psychiatric ICD-10 codes categorize various mental health diagnoses. Some common codes include:

• F32.9 – Major Depressive Disorder, unspecified
• F41.1 – Generalized Anxiety Disorder
• F31.9 – Bipolar Disorder, unspecified
• F43.1 – Post-Traumatic Stress Disorder (PTSD)

5. How does telehealth billing work for psychiatry?

Telehealth billing for psychiatry allows providers to bill for services delivered via video or phone calls. To bill for telehealth services, you need to use telehealth-specific CPT codes or modifiers such as 95 or GT. For example:

• CPT 90791-95 – Psychiatric Diagnostic Evaluation via telehealth.
• CPT 90837-95 – 60-minute psychotherapy session via telehealth.

6. What are the common psychiatry billing modifiers?

Modifiers are used in psychiatry billing to provide additional information about the service performed. Common modifiers include:

• GT – Telehealth service (via interactive audio and video telecommunications systems).
• 95 – Synchronous telemedicine service rendered via real-time interactive audio and video.
• AF – Psychiatrist.
• AH – Clinical psychologist.
• AJ – Clinical social worker.

7. Can PAs and NPs do their own billing in psychiatry?

Yes, Physician Assistants (PAs) and Nurse Practitioners (NPs) can do their own billing in psychiatry if they are authorized providers and appropriately trained in billing codes. They must use the correct CPT codes and modifiers specific to their licensure, such as SA for a nurse practitioner or PA for a physician assistant.

8. What are the common challenges in Psychiatry Billing?

Common challenges in psychiatry billing include:

• Coding errors: Mistakes in using the correct CPT or ICD-10 codes can lead to denied claims.
• Insurance coverage: Some insurance companies may not cover all psychiatric services.
• Telehealth billing: Adapting to new telehealth billing codes and regulations can be complex.
• Reimbursement delays: Incorrect billing or missing documentation can delay payments.

9. What is “claim scrubbing” in psychiatry billing?

Claim scrubbing is the process of reviewing and correcting claims before submission to ensure there are no errors, such as incorrect codes, missing patient information, or incomplete documentation. Claim scrubbers are often built into billing software and can help reduce the number of denied or rejected claims.

10. What is the reimbursement process for psychiatry services?

The reimbursement process involves submitting a claim to the insurance company for the services rendered. After review, the insurance company either pays the claim or rejects it, often citing errors in coding or documentation. Providers must ensure that the codes used are accurate and that services are medically necessary to receive timely reimbursements.

11. How can I reduce denied claims in psychiatry billing?

To reduce denied claims, follow these best practices:

• Use accurate CPT and ICD-10 codes.
• Ensure medical necessity is clearly documented.
• Verify patient insurance eligibility before the appointment.
• Use billing software to automate the process and reduce errors.

12. How do I handle rejected or denied claims in psychiatry billing?

When a claim is rejected or denied, it’s important to:

• Review the reason for denial (usually provided by the insurance company).
• Correct any errors (e.g., incorrect codes, missing information).
• Resubmit the claim within the specified timeframe. Using a claims management system can help you track and quickly resolve denied claims.

13. What is the difference between a rejected and a denied claim?

• Rejected claims are those that contain errors or missing information and are never processed by the insurance company. Once corrected, they can be resubmitted.
• Denied claims are processed by the insurance company but are not paid due to reasons such as non-covered services or lack of medical necessity.

14. Can I bill for both therapy and medication management on the same day?

Yes, you can bill for both therapy and medication management on the same day, but you need to use the correct codes. For example:

• CPT 99213 for medication management (Evaluation & Management).
• CPT 90833 for 30 minutes of psychotherapy as an add-on.

15. What is a CPT add-on code, and when should I use it?

A CPT add-on code is used when a service is provided in addition to the primary service. In psychiatry billing, add-on codes are commonly used for extended therapy sessions or additional procedures. For example:

• CPT 99354 – Add-on code for prolonged service after a 60-minute therapy session.

16. What should I look for when choosing a psychiatry billing software?

When selecting billing software for psychiatry, look for these features:

• ICD-10 and CPT code integration specific to mental health.
• Telehealth billing capabilities.
• Claim scrubbing to minimize errors.
• Automation for insurance eligibility checks and claims submission.
• Easy-to-use interface for staff and practitioners.

17. Are there special billing considerations for telehealth services?

Yes, telehealth services require specific modifiers and sometimes unique CPT codes. You need to:

• Use telehealth modifiers like 95 or GT for virtual sessions.
• Confirm insurance coverage for telehealth services, as not all payers reimburse telehealth at the same rates as in-person services.

18. What are psychiatry billing “place of service” codes?

Place of service (POS) codes describe the location where services are provided. Common POS codes for psychiatry include:

• POS 11 – Office
• POS 12 – Patient’s home (telehealth)
• POS 02 – Telehealth provided from a distant site

19. What is the typical turnaround time for psychiatric claims reimbursement?

The typical turnaround time for psychiatric claim reimbursement varies but is usually between 2-4 weeks for electronic claims. Paper claims can take up to 6 weeks or longer. The process is faster if the claim is correctly filled out and submitted through electronic billing systems.

20. Do I need to comply with HIPAA in psychiatry billing?

Yes, HIPAA compliance is crucial in psychiatry billing to protect patient data. Billing systems and software must ensure that all protected health information (PHI) is securely handled, stored, and transmitted in line with HIPAA regulations.

Glossary of Psychiatric Billing Terms

1. CPT Code (Current Procedural Terminology Code)
A five-digit numeric code used by healthcare providers to describe medical, surgical, and diagnostic procedures. Each psychiatric service has a specific CPT code, such as 90792 (Psychiatric Diagnostic Evaluation with Medical Services) or 90837 (60-minute Psychotherapy).

2. ICD-10 Code (International Classification of Diseases, 10th Edition)
A system of codes used to classify diagnoses and conditions. In psychiatry, ICD-10 codes are used to document mental health diagnoses like F32.9 (Major Depressive Disorder, unspecified) or F41.1 (Generalized Anxiety Disorder).

3. CMS (Center for Medicare and Medicaid Services)
The federal agency that administers Medicare, Medicaid, and CHIP. CMS sets the fee schedules and reimbursement rates for healthcare providers, including psychiatrists, PAs, and NPs.

4. Modifier
A two-character code that provides additional information about a procedure without changing the meaning of the CPT code. For example, Modifier 95 indicates a service provided via telehealth, and Modifier AJ identifies services provided by a licensed clinical social worker.

5. Telehealth/Telemedicine
The use of digital communication technology to provide healthcare services remotely. In psychiatric billing, telehealth requires specific CPT codes and modifiers (e.g., GT or 95) for virtual consultations.

6. Reimbursement
The process by which healthcare providers are paid for services rendered. In psychiatric billing, the reimbursement is typically based on a fee schedule determined by the insurance payer (e.g., Medicare or private insurance). PAs and NPs are generally reimbursed at 80% of the rate for physicians.

7. Place of Service (POS) Code
A two-digit code used on medical claims to indicate where a service was provided. Common psychiatry-related POS codes include:

• POS 11 – Office
• POS 02 – Telehealth
• POS 12 – Patient’s home

8. Claim
A formal request submitted to an insurance company for payment for services rendered. Claims can be submitted manually or through automated billing software, and they must include accurate CPT codes, ICD-10 codes, and other required information.

9. Claim Scrubbing
The process of reviewing and correcting claims before they are submitted to insurance payers. Claim scrubbing helps reduce errors and increases the likelihood of claim acceptance.

10. EHR (Electronic Health Record)
A digital version of a patient’s medical history that includes diagnoses, treatments, and billing information. EHR systems often integrate with billing software to automate coding and claims submission.

11. Add-On Code
A supplemental CPT code used when a service is provided in addition to a primary service. For example, CPT 99354 is an add-on code for prolonged services in addition to psychotherapy sessions.

12. Mental Health Add-On Codes
These are codes used to bill for additional psychiatric services, such as interactive complexity (90785) or pharmacologic management after therapy (90863).

13. Denied Claim
A claim that has been processed by the insurance company but not paid due to various reasons, such as coding errors or lack of coverage. Denied claims can be appealed or corrected and resubmitted.

14. Rejected Claim
A claim that was not processed due to errors or missing information. Rejected claims must be corrected and resubmitted before they can be processed for payment.

15. Transitional Care Management (TCM)
CPT codes that refer to the management of a patient’s transition from a hospital setting to a community setting. For example:

• CPT 99495 – Transitional care management with moderate complexity.
• CPT 99496 – Transitional care management with high complexity.

16. E/M (Evaluation and Management) Codes
A category of CPT codes used for billing visits and consultations. These codes cover services like psychiatric evaluations and medication management and range from CPT 99201 to CPT 99499.

17. Global Period
A set period (usually 10 or 90 days) during which services related to a procedure are covered under a single payment, rather than being billed separately. Some psychiatric services may be subject to a global period if performed in conjunction with medical procedures.

18. Medicare Fee Schedule
The official list of fees Medicare pays to healthcare providers for services. This schedule determines the reimbursement rate for various procedures, including psychiatric services.

19. Behavioral Health
A broad term that encompasses the diagnosis and treatment of mental health and substance use disorders. In billing, it includes services like therapy, psychiatric evaluations, and medication management.

20. HCPCS Code (Healthcare Common Procedure Coding System)
A set of codes used by Medicare and Medicaid to describe medical procedures, services, and equipment not included in the CPT coding system. For example, H0031 is used for mental health assessments by non-physicians.

21. Prior Authorization
A process required by some insurance payers to approve a service or medication before it is provided to the patient. Without prior authorization, the service may not be covered or reimbursed.

22. Co-pay
The portion of a medical service cost that a patient is required to pay out-of-pocket, typically collected at the time of service. Co-pays vary based on insurance plans and services.

23. Out-of-Network
Refers to healthcare providers or services that are not contracted with a patient’s insurance network. Billing for out-of-network services often leads to higher out-of-pocket costs for the patient and may result in lower reimbursement rates for providers.

24. Revenue Cycle Management (RCM)
The process of managing the financial aspects of a healthcare practice, from patient scheduling and insurance verification to billing, payment collection, and reporting. Automated billing systems often include RCM features.

25. Electronic Remittance Advice (ERA)
A digital version of the Explanation of Benefits (EOB) sent by the insurance company, detailing how claims were processed and any payments or denials. ERAs are often integrated into billing software to streamline payment reconciliation.

PSYCHIATRIC BILLING COURSE; Complete Guide To Psychiatric Billing

Psychiatry Billing Resources

1. CMS (Centers for Medicare & Medicaid Services) Resources

• CMS-1500 Form Guidelines:
• CMS-1500 Form Instructions – Official instructions on how to complete the CMS-1500 form, including field-by-field details.
• CMS Physician Fee Schedule Search – Use this to find reimbursement rates for different CPT codes.

2. American Medical Association (AMA)

• CPT Code Resources:
• Current Procedural Terminology (CPT) Code Lookup – AMA provides up-to-date resources on CPT codes used in medical billing.

3. Medical Billing Software

• Kareo Medical Billing – A comprehensive tool for psychiatric billing, including features like claim management, telehealth billing, and EHR integration.
• TheraNest Billing Software – Software designed for mental health professionals with billing features, including claims, telehealth, and insurance tracking.
• SimplePractice Billing – A platform for therapists and mental health professionals to automate billing, including telehealth claims.

4. Claim Submission Tools and Clearinghouses

• Office Ally Clearinghouse – A free claims submission clearinghouse that helps process and track medical claims electronically.
• Availity – A widely used medical claims clearinghouse with integrated features for eligibility checks, claim scrubbing, and submission.
• Trizetto Clearinghouse – A comprehensive claims processing service that includes automated billing workflows for healthcare practices.

5. Telehealth Billing Guidelines

• American Telemedicine Association (ATA):
• Telehealth CPT Codes & Reimbursement Guide – Detailed resources and updates on telehealth billing regulations, telemedicine CPT codes, and reimbursement guidelines.
• Telehealth Billing for Mental Health Services:
• CMS Telehealth Guide – Learn how to properly bill for psychiatric services provided via telehealth, including necessary modifiers like 95 and GT.

6. Medical Coding and Billing Training

• AAPC Psychiatry Billing & Coding Course – Training and certification courses for psychiatric billing, medical coding, and compliance.
• MLN Billing and Coding Resources – A CMS-hosted resource with free billing and coding training for Medicare claims, including psychiatric services.

7. HIPAA Compliance Resources

• HIPAA Compliance Guide – Learn how to keep your psychiatry billing practices compliant with HIPAA, including handling patient information and electronic claims.
• HIPAA and Billing Practices – Official U.S. government resources and regulations for HIPAA compliance in medical billing and electronic health records.

8. ICD-10 Coding Resources

• ICD-10 Search Tool – A searchable database of ICD-10 codes, which are essential for psychiatry billing to classify mental health diagnoses.
• ICD-10 Coding Guidelines – The U.S. CDC provides up-to-date ICD-10 coding guidelines, including mental and behavioral health codes.

9. Revenue Cycle Management (RCM) Tools

• Revenue Cycle Management Overview – Learn the basics and best practices of RCM, including how to optimize your psychiatry billing cycle for better cash flow.
• Waystar RCM Software – A platform for automating revenue cycle management, including billing, claims, and patient payments.

10. Medical Billing FAQs and Forums

• Aapc.com Forums – Active forums where medical billers, coders, and providers discuss psychiatric billing issues, troubleshooting claims, and industry updates.
• MedicalBilling Subreddit – A community of billing professionals sharing knowledge and tips on billing, including handling psychiatric claims.

Conclusion

By leveraging these resources, you can improve your psychiatric billing workflows, stay compliant with the latest billing standards, and automate repetitive tasks to save time and reduce errors. Whether you’re looking for billing software, telehealth billing guidelines, or educational tools, these links will support your psychiatry practice in managing claims effectively.