Medical Billing for Therapists: A Complete Beginner’s Guide

Introduction

Knowing how therapists get paid is important for getting reimbursed on time, reduction of claim denials, and overall financial well-being of the practice. For those new to therapy billing or even for those who want to improve the processes, this billing guide gives a complete overview of billing, claim submissions, coding, and everything else in between. This is for any therapist, be it mental health therapists, speech therapists, physical therapists, or occupational therapists.

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Why Medical Billing is Important for Therapists

Medical billing is more than just getting a payment—it encompasses a wide range of actions from reconciliation of administrative work to ensuring compliance with legal and insurance frameworks. Effective billing facilitates therapists in the following ways:

• Maintain a steady revenue stream.
• Reduce claim rejections and payment delays.
• Ensure compliance with HIPAA and insurance policies.
• Improve efficiency by automating administrative tasks.
• Enhance patient satisfaction by simplifying the payment process.

Key Terminology in Medical Billing

Before diving into the billing process, it’s essential to understand common terms:

• CPT Codes (Current Procedural Terminology): Standardized codes used to bill insurance companies for services provided.
• ICD-10 Codes: Diagnostic codes used to justify the necessity of treatment.
• EOB (Explanation of Benefits): A statement from the insurance provider explaining claim approvals or denials.
• Co-pay: The amount a patient pays out-of-pocket for a session.
• Deductible: The amount a patient must pay before their insurance starts covering services.
• Modifiers: Additional codes that provide extra information about a procedure.

Common CPT Codes for Therapists

Each therapy discipline has specific CPT codes used for billing. Below are commonly used codes:

Mental Health Therapy

• 90791: Initial psychiatric diagnostic evaluation.
• 90837: 60-minute psychotherapy session.
• 90834: 45-minute psychotherapy session.
• 90832: 30-minute psychotherapy session.
• 90847: Family therapy with the patient present.
• 90846: Family therapy without the patient present.

Speech Therapy

• 92507: Individual speech therapy session.
• 92508: Group speech therapy session.
• 92610: Evaluation of swallowing function.
• 92526: Treatment of swallowing dysfunction.
• 92521: Evaluation of speech fluency (e.g., stuttering).

Physical Therapy

• 97110: Therapeutic exercises to improve mobility and strength.
• 97112: Neuromuscular re-education.
• 97161-97163: Physical therapy evaluations (low to high complexity).
• 97530: Therapeutic activities for functional performance.
• 97140: Manual therapy techniques.

Occupational Therapy

• 97165-97167: Occupational therapy evaluations (low to high complexity).
• 97535: Self-care and home management training.
• 97530: Therapeutic activities to restore function.
• 97110: Therapeutic exercises.
• 97537: Community reintegration training.

Steps in the Medical Billing Process

Step 1: Verify Client Insurance Coverage

Verifying insurance eligibility for coverage, co-pay, deductibles, and limitations prior to scheduling an appointment goes a long way towards preventing issues related to billing and unexpected out-of-pocket expenses for clients.

Avoid denials and delays! Learn the best practices for filing insurance claims for therapists and maximize reimbursements.

Step 2: Assign Correct CPT and ICD-10 Codes

Claim approval is related to correct coding. A delay or denial in claims is dependent on choosing the correct CPT and ICD-10 codes.

Step 3: Submit Claims to Insurance Providers

Claims can be submitted manually or electronically through medical billing software or clearinghouses. Common methods include:

• Electronic Health Records (EHR) systems
• Third-party billing services
• Direct submission via insurance provider portals

Step 4: Monitor Claim Status and Address Denials

Not all claims are approved on the first attempt. If a claim is denied:

• Review the denial reason on the EOB.
• Correct any coding or documentation errors.
• Resubmit the claim promptly.

Step 5: Collect Payments from Clients

Once insurance payments are received, ensure clients pay any remaining balance, such as co-pays or deductibles. Offering online payment options can make this process easier.

Learn about the most frequent errors in medical billing and how to prevent them. Read our expert tips on Common Billing Mistakes Therapists Make.

Common Billing Mistakes Therapists Should Avoid

1. Inaccurate Coding

Using incorrect CPT or ICD-10 codes can result in claim denials or reduced reimbursements. Regular training and coding updates help avoid errors.

2. Missing Documentation

Incomplete session notes or treatment plans can lead to rejected claims. Maintain detailed records to justify billed services.

3. Delayed Claim Submission

Insurance companies have strict deadlines for claim submission. Late submissions may result in denied claims and lost revenue.

4. Not Following Up on Denied Claims

Many practices lose money by failing to appeal denied claims. Always review and resubmit claims with proper corrections.

5. Lack of Compliance with Insurance Requirements

Each insurance provider has specific billing rules. Staying updated with insurance policies ensures smoother transactions and fewer rejected claims. Explore top-rated billing solutions to enhance efficiency and accuracy in your therapy practice. See our latest review of Best Medical Billing Software for Therapists.

Best Practices for Efficient Medical Billing

• Use a Reliable Billing System: Electronic billing software streamlines claims submission and tracking.
• Verify Insurance Details Before Sessions: Avoid surprises by confirming client coverage beforehand.
• Submit Claims on Time: Establish a workflow for timely submissions.
• Train Staff on Billing Processes: Ensure administrative staff understands medical billing procedures.
• Consider Outsourcing Billing: Companies like Global Tech Billing LLC specialize in handling billing for therapists, reducing administrative workload.

Should You Use a Medical Billing Service?

Billings services can be contracted out which can have many positive benefits to busy therapists. Global Tech Billing LLC offers expert billing solutions with guaranteed timely payments, lowered claim denials, and full compliance within the industry.

Discover how to optimize your billing system and grow your practice successfully. Read our detailed guide on Scaling a Therapy Practice with Medical Billing now!

Benefits of Outsourcing Billing:

• Saves time and reduces administrative burden.
• Improves claim approval rates.
• Keeps up with regulatory changes and compliance requirements.
• Maximizes revenue by minimizing claim errors.

Conclusion

Billing is an important aspect of running a successful medical practice, especially for therapists. Efficient billing translates to financial profitability for speech, physical, occupational, and mental healthcare specialists. An accurate understanding of billing concepts and strategic management of common pitfalls can help medical professionals streamline their finances, which allows for more focus on providing quality patient care. Global Tech Billing LLC is one of the many businesses offering professional billing services and confirms that seamless billing guarantees profitability for companies in the healthcare sector.

Discover strategies to improve claim approval rates and ensure timely payments. Read our guide on Medical Billing for Therapists: Insurance Reimbursements today!

FAQs

1. How can I reduce claim denials?

Verify insurance details, use correct CPT and ICD-10 codes, and follow up on denied claims promptly.

2. What is the best billing software for therapists?

Popular options include SimplePractice, TherapyNotes, TheraNest, and WebPT, all designed for therapy billing needs.

3. Can I handle billing myself, or should I outsource?

While therapists can handle billing, outsourcing to a company like Global Tech Billing LLC can save time and improve claim accuracy.

4. How long does it take to get reimbursed by insurance?

Reimbursement times vary but typically range from 14 to 45 days, depending on the insurance provider and claim accuracy.

5. What should I do if my claim is denied?

Review the Explanation of Benefits (EOB), correct errors, and resubmit the claim with proper documentation.