The fact is that almost 35 percent of mental-health insurance claims in the U.S. are turned down at the first instance. More than half of those rejections are due to avoidable billing errors. For therapists, psychologists, counselors, and behavioral-health providers, effective Mental Health Billing is crucial, as errors not only cause revenue loss but also create additional stress and unnecessary paperwork.
It is a free checklist that will help you avoid most pitfalls, reduce declines, optimize processes, and complement your revenue cycle. Regardless of the size of your practice or a growing center, these best practices can help you obtain accurate billing and financial stability in the long run.
Step 1: Check the eligibility for insurance
The initial step in cleaning claims is to verify their eligibility. Before each session, confirm:
- Active insurance.
- Behavioral‑health benefits.
- Coinsurance, deductible, and copay.
- Authorized CPT codes for mental health.
- Authorization rules.
- Session limits.
Such a measure will prevent over 50 percent of rejected claims.
If you want to understand why this step is so important, you can explore a detailed explanation in this guide on how eligibility verification improves billing accuracy.
Checklist:
- Check payer portal (Availity, Optum, Aetna, etc.)
- Check behavioral-health benefits only.
- Document the verification in your EHR.
- Re-check on each policy renewal.
Step 2 : Use Correct CPT Codes
Success actually depends on the accuracy of CPT codes, which are very important for proper claim submission and reimbursement. Before you bill, review:
- session type (family, group, individual)
- Time spent
- Add-ons (complexity, crisis psych)
- Provider credentials
Types of common mental-health CPT codes:
- 90834 – 45‑minute psychotherapy
- 90837 – 60‑minute psychotherapy
- 90847 – family therapy
- 90791/90792 psych diagnostic assessment.
- 90853 – group therapy
Mis-coded results in underpayment or rejection.
For a complete breakdown, you can refer to this helpful resource covering mental health CPT codes and their correct usage.
Step 3: Gather the Correct Patient Data
One incorrect digit may delay payment for weeks. Gather:
- Full legal name
- Date of birth
- Insurance ID and group number
- Subscriber details
- Address and phone number
- Correct ICD-10 diagnosis codes.
Clean demographics translate to clean claims.
If you often work with diagnosis coding, this combined guide on CPT and ICD-10 documentation for mental health billing will be incredibly helpful.
Step 4: Proper Document Services
Payers must have concrete evidence of medical necessity. Use:
- SOAP or DAP notes
- Start–stop times
- Mental status exam (MSE)
- Appropriate diagnosis
- Treatment goals
- Session focus and progress
The CPT code and documentation should be supported and adhere to the billing guidelines. Records are good because they guard during audits and reduce rejection.
Proper documentation not only ensures compliance but also supports the clinical importance of sessions, as highlighted by the NIMH mental health statistics.
Step 5 : Submit Clean Claims
A clean claim does not require corrections and can be processed instantly. Checklist:
- Correct CPT & ICD codes.
- Proper patient demographics.
- Accurate NPI and taxonomy codes.
- Attach notes when required.
- Included through EDI medical billing.
- Follow payer guidelines.
EDI minimises mistakes and accelerates payment.
You can learn how to improve this step by reading a simple explanation on submitting clean medical claims effectively.
Step 6: Track Claim Status
After submitting a claim, it is necessary to track it. Monitor: use therapist billing software or your EHR:
- Payer acceptance
- Rejections
- Adjustments
- Delayed payments
- Underpayments
Each time, real-time monitoring can prevent revenue leakage and make sure that everything does not fall through the cracks.
Step 7: Address Denied Claims
Claims are denied–but never forget them. Most denials come from:
- Incorrect CPT or ICD‑10 codes.
- Expired coverage.
- Missing documentation.
- Duplicate claims.
- Non‑covered services.
In your denial management process, you must have:
- Identify the denial reason
- Correct the error
- Recurrently resubmit payer deadlines.
- Maintain a denial log
High denial management enhances reimbursement, cash flow stability, and decreases administrative workload.
Step 8: Therapist Billing Software
The modern therapist billing software simplifies, speeds up, and improves the accuracy of mental-health billing. A good system should offer:
- Automated claims filing.
- Inherent mental-health CPT codes.
- ERA/EOB posting
- Checks on insurance eligibility.
- Superbills to clients who pay on their own.
- Claims tracking
- Integrated documentation
Popular tools such as SimplePractice, Therapy Notes, Kareo, and TheraNest are available. Software automation generates dirty claims and minimises operating errors.
Step 9: Review Your Billing Process on a regular basis
Regular audits will be important to financial well-being. Review:
- Denial trends
- CPT code patterns
- Documentation accuracy
- ERA/EOB payment patterns
- Underpayments
- Credentialing issues
Regular audits are used to figure out loopholes and streamline operations.
If revenue cycle improvement is a priority, this overview of how healthcare revenue cycle management works will help you optimize your workflow.
Step 10: Staff and Provider Education
Trained staff will make fewer mistakes and quicker disbursement. Offer training on:
- Health billing training (behavioral).
- Mental health billing and coding.
- EDI submissions
- Insurance plan changes
- Documentation standards
- CPT/ICD‑10 updates
- Samples of excellent bills in mental health.
Even professionals are required to have a refresher now and then. Training investment will save income and enhance billing.
Should you require professional assistance, you can use the services of a reputable Medical Billing Company such as Providers Care Billing LLC, which will handle all your revenue cycle, including eligibility verification to the management of your denials.
📞 Call Now: 888-495-3786
📧 Email: Info@providerscarebilling.com
Conclusion
Clean mental health billing not only involves the submission of claims but also accuracy, compliance, and a good revenue cycle. This 10-step checklist from Providers Care Billing LLC will help you lessen denials, enhance cash flow, and generally shorten the whole billing process of your behavioral health practice. Regardless of the type of therapist (solo, group, or behavioral health center), the following steps will make a significant difference in terms of financial viability.
FAQs
What is the method of billing for mental health services?
Record patient demographics, check insurance, record sessions, use appropriate CPT and ICD codes, and electronically file claims.
What is the difference between mental and general medical billing?
It entails mental health behavior CPT code, more rigid documentation, repetition of sessions, and payer-specific mental health policies.
What is the work of a mental health biller?
They handle checking of eligibility, CPT/ICD coding, EDI submission, managing denials, reimbursements, and compliance.
What is going to become of mental claims?
Claim denial or delay could be a result of the use of wrong codes, lapsed insurance, unrelated services, a lack of documentation, or incorrect length of the sessions.
Which are CPT codes for mental health services?
Common codes are as follows:
- 90832
- 90834
- 90837
- 90791
- 90846
- 90847
What are some of the things that therapists can do to ensure clean claims?
Assure proper coding, do not make incomplete or late records, check patient insurance coverage, select the correct length of the session, and check all information thoroughly before placing the claim.
What is the billing software assisting therapists?
Other EHRs that have built-in behavioral health billing and TherapyNotes, SimplePractice, Kareo, and others.
