Billing Specialist for Private Practice
Billing is not in your job description. Off load it to someone with a proven track record
Let me handle your insurance billing so you can focus on your practice
Billing Specialist with multiple years of claim adjudication (the action or processing) helping private practice therapist get their feet off the ground or help them grow their business.
Are you tired of trying to manage the claims of your practice and feel like your getting no where?
Tried of the clients calls related to "why haven't you billed my insurance" "this can't be my co-pay" (hopefully you are collecting those upfront)
Savvy to what ever EHR system you have in house.
Telehealth
Today Telehealth is being utilized more than ever. Are you providing this service? I hope you are checking benefits prior to the session. This is something I can do.
I will work your old claims
CPT Code 90791
This procedure code is used for diagnostic evaluation of new behavioral health concerns and or illnesses, or upon treatment of a new client.
CPT Code 90791 is typically billed for the initial intake appointment a client will have. Subsequent sessions will be billed with procedure codes 90834 and 90837, depending on the appointment duration.
Does 90791 Require Authorization?
90791 is considered a routine outpatient appointment, so typically no authorization is required. But like any procedure code, exceptions do exist depending on the plan and insurance company.
Some insurance companies like United Health Care (UHC) will grant one authorization for 90791 and a separate one for 90834 or 90837 EAP sessions. If authorization is required, when you call and get authorization, make sure that 90791 is covered under it!
To find out if authorization is required, you’ll need to perform an eligibility and benefits verification on the client’s insurance plan.
It can be billed by Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Mental Counselors (LMHC), Licensed Marriage Family Therapists (LMFT), clinical psychologists, and psychiatrists.
CPT Code 90792
is a very similar code to 90791 but there are some differences.
Like 90791, it is defined as a psychiatric diagnostic evaluation. The only distinction is that 90792 includes medical services done by a physician.
This means that only medically licensed professionals, such as a psychiatrist, can bill 90792
Who can bill
Billing for CPT Code 90791 can be performed by the following licensed mental health professionals:
Licensed Clinical Social Workers (LCSW)
Licensed Professional Counselors (LPC)
Licensed Mental Counselors (LMHC)
Licensed Marriage Family Therapists (LMFT)
Clinical Psychologists (PhD or PsyD)
Psychiatrists (MD)
If you have a different license, odds are high you are not eligible to perform a diagnostic evaluation, and as such you are not able to specify a mental health diagnosis for that client.
CPT Code 90791 Coding Requirements
The following services are required, according to Medicare, to complete an initial mental health evaluation for a new client seeking mental health services:
Elicitation of a complete medical and psychiatric history
Mental status examination
Evaluation of the patient’s ability and capacity to respond to treatment
Initial plan of treatment
Reported once per day
Not reported same day as E/M service performed by the same provider
Covered at the onset
Telehealth Billing Checklist
Verify benefits first- Ask the insurance comapny which CPT Code and modifier to use
Authorization may be required for the telehealth sessions. Ask while you have them on the phone
Insuance companies utilize place of service 02 for telehealth. This will also need to be verified while on the phone.
By following these steps this is the only guarantee of payment.
Small or new practice
Companies to get you started
Aetna
CIGNA
Medicaid
Optium/UHC