The holiday season and new year are here! It’s very exciting as the calendar resets and new opportunities are presented for an even more successful 2022 than the year just ended!
The new year is also a stressful time for healthcare providers and mental health providers specifically. Insurance plans and deductibles reset; patients change their insurances; and many other insurance related issues arise. The goal of GreenpointMed’s 2022 Benefit Guidance for Mental Health Providers is to provide you with a blueprint for navigating the waters with a minimum of issues, and for mitigating any issues that do arise before they become serious.
Before getting to best practices, questions to ask your patients, and things to look out for, let’s review quickly what GreenpointMed does and does not do:
First, GPMD is not reverifying schedules ahead of when patients come in. Unfortunately, the logistics of completing this effort for each practice are too complex. We will however verify insurance benefits when they are requested through our intake portal, and return those benefits as we normally do. In addition, we will proactively review remittances, ERAs, and EOBs to update patient responsibility. If you are a TherapyNotes user (as most of you are), we will update the Copay amount directly in the system. Our team plans to be aggressive in updating patient responsibility to catch as many changes as we can.
And though we intend to be as proactive as possible, there will be instances where a patient responsibility (PR) is not updated. It’s important in these cases for the practice to manage the communication with its patients to avoid unpleasant encounters. (This will be discussed in more depth below.)
During the month of January (and possibly through February) some special projects may be delayed due to an expected influx of verification and reverification requests. However, standard billing activities, including claims submission, payment posting and denial follow-ups will continue normally without disruption. This includes claim submission to secondary insurances. It’s expected that certain benefits may take as long as 5 or more business days to return, but we’ll be working hard and as expeditiously as possible to reduce these timeframes.
For mental health, benefits are never easy. I wrote a blog post earlier in 2021 and published on TherapyNotes’ blog describing how mental health benefits are a hybrid–not primary care and not specialist. Given the grey area that MH benefits fall into, providers and practices should already be accustomed to the variation seen between verified benefits and paid claims. In other words, the benefits quoted can be different than how the claims process. This experience actually puts MH providers in a unique position, given the exposure to “bad benefits” and the all-too-common conversations with patients around those benefits. Leverage those experiences as you communicate with your patients in the beginning of the year!
Some MH benefits will have deductibles, while others will not. That is important information to know and can help you estimate patient responsibility. If your patient has the same insurance as last year, and that insurance did not have a deductible that applied to mental health, chances are they will continue to owe their copay only. But if your patient did have a deductible, be prepared to collect your contracted rate for services.
For TherapyNotes users, please look in Billing Settings to see if there is a billing note which indicates if the deductible applies or not. If the deductible does apply, you will need to collect your contracted rate for services. Insurance will not reimburse until that deductible is met, but once the deductible is met you’ll collect your copay or co-insurance.
If your patient has changed insurance, you will want to get it verified. As part of that verification, you’ll need to know if the deductible applies to mental health. That isn’t always the easiest information to obtain, but once you have the answer you’ll know exactly what to connect. Calling an insurer and waiting on hold for an hour to get an answer to that question isn’t always an option, and some provider portals (such as Availity) aren’t always reliable. The true answer will come from the remittances, which is why paying attention to those is key. If you see on your remittances for a date of service in 2022 that there is a copay only, collect your copay going forward. If you see on that same remittance a 2022 claim at your contracted rate, begin collecting that dollar amount.
If you are unsure what to do, these are your options:
- Don’t collect anything and wait until the remittances come back. The benefit to this option is you’ll know exactly what is owed to you, if anything. The downside is that it might take a few weeks from until after your claim is submitted.
- Collect what you have been collecting from your patient and when the remittances come back you’ll know if your patient has a balance that is owed. I personally think this is a good approach.
- Collect the copay amount for SPECIALIST on the patient’s insurance card, if it’s printed on the card. MH is not technically a specialist as defined by most insurers, but the copay amount listed for a specialist will be closest to a copay for MH. (Did we say that working with insurance is easy?)
- Collect your contracted rate for services. This might be a good option for new patients if you are waiting on your verification. Sometimes it’s easier to collect at the time of service than to bill for balances later.
- Ask your patient to get their benefits! This might be the most underused method, but it is one of the most effective. Ultimately, the patients are responsible for their own benefits.
We’ve covered a lot of ground so far, but there’s more you can do to be prepared. One of the most important things you can do–possibly the most important–is to ask your patients a simple question at the beginning of each service of 2022:
Have there been any changes in your insurance for 2022?
People change insurances all the time, so this is a question that can be asked throughout the year. However, it is most important to ask this when the calendar turns.The decision to change insurance is made weeks in advance of the new year during open enrollment, and there’s a lot going on this time of year–the time gap causes many people to forget.
If they have changed insurance, you should make a copy of their insurance card (front & back). Update your EHR, verify the benefit, and your claims will pay. You don’t want to have to figure this out in March after you’ve performed 10 sessions! (The new year is also a good time to collect a copy of the insurance card of any patients you don’t currently have it for.)
When you are communicating with your patients about insurance, you also have an opportunity to let patients know about possible balances owed. One thing you can say to your patients is the following:
It’s the beginning of the year and your deductible may apply to your mental health treatment. If the deductible applies, you will owe my contracted rate with your insurance company.
This statement, or a variation of it, made at the beginning of the year goes a long way to ensuring smoother conversations with your patients around balances owed. And wouldn’t you rather know that you might owe a balance as early as possible, versus a bill being sprung on you a few weeks later? Unfortunately, the health insurance system is designed in a way that causes this to happen far too often. If you can communicate effectively with your patients, you (and they) will be prepared. These conversations also go a long way toward maintaining continuity of care while making sure you get paid for your services. Transparent communication is always appreciated, often rewarded.
Medicare & Medicaid
All Medicare Part B (straight Medicare, traditional Medicare) plans reset at the beginning of the year, and Medicare’s 2022 annual deductible is $233. Most Medicare patients have secondary or supplemental insurance. This supplemental should pick up the deductible, unless there is a specific provision that the supplemental doesn’t cover the deductible or the supplemental has its own deductible. The EOB from your supplemental will tell you if they pick it up or not.
Remember, Medicare claims will typically “crossover” to the supplemental insurance, if the secondary policy is on file with Medicare. The crossover will cause the secondary to process the remaining 20% that Medicare doesn’t cover, and an EOB will be mailed. For the bigger supplemental policies, such as AARP Med Supplement, the deductible almost always is covered. For the smaller and more obscure supplementals, it may not. (For United American, all I can say is godspeed.)
If a patient is a QMB, there is a chance that Medicaid will pick up the secondary portion. What is a QMB? A QMB is a Qualified Medicare beneficiary, a person who has Medicare primary and Medicaid secondary. The Medicaid secondary in this case will only pay up to the Medicaid allowable rate, and no more. If you are in Ohio, and a Medicare patient has Caresource as secondary, you may get a payment from Caresource after crossover but only up to Caresource’s rate. This will leave the rest of the rate as uncollectible.
Medicare patients without a supplemental can be collected from directly. They will pay $233 out of pocket and then 20%. Medicare patients always owe 20%.
When a patient has Medicaid, there usually is no deductible. Medicaid should pay normally. However, you’ll want to make sure there is no change in the patient’s Medicaid or Managed Care Plan. Make sure to ask your patient or verify through your state’s Medicaid provider portal.
Most Medicare Part C replacement/Advantage plans do not have deductibles. The payouts should be as normal, as will the copays.
Best Practices for Mental Health providers
- Communicate, communicate, communicate! If you are able to practice this effectively with your patients for 2-3 weeks, it will create a stable environment over the following 2-3 months.
- Bill your claims. The faster remittances & EOBs can come back from insurers, the better.
- Patients with HSA/HRA accounts often have funds that can pay their deductibles. The beginning of the year is an ideal time for those HSA/HRA dollars to be used.
- There will be issues–we are dealing with health insurers.
- Be patient.
- Be proactive.
- Work with a billing company!