2022 Benefit Guidance for Mental Health Providers

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: 

  1. 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. 
  2. 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.
  3. 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?)
  4. 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. 
  5. 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!
csears2022 Benefit Guidance for Mental Health Providers
read more

How COVID Has Transformed Mental Healthcare

Much has changed since March of 2020, when COVID-19 swept through our lives and changed everything we know and do. One of the biggest changes was the fast & furious migration to mental health care delivered through telehealth platforms. This change has led to a revolution in the way care is delivered, and mental healthcare is better for it. 

There are four major ways in which the pandemic has transformed the mental health field for the good, and for good: 

Patients now have easy access to care from the comfort of their home

Previously, each time a patient was going to your office for a session; now all they need to do is get on their computer. Additionally, you are also able to perform this service from your ideal location, and deliver care to a broader array of patients than you might have previously. This includes patients within your city & surrounding areas, or your state, or perhaps even in another state. This ease of delivery greatly benefits the patient and the provider. 

Insurance companies know this. Just recently a senior executive at a Blue Cross Blue Shield plan in a large state made a remark to a group of behavioral health providers that, “We are committed to telehealth as a mode of health care delivery both during the pandemic and beyond.” At another BCBS plan, this one for Tennessee, the insurer has already announced that they have instituted a policy change making telehealth expansion permanent. There is support at all levels of Government, State & Federal, as well as in Congress, to make telehealth expansion permanent. 

Behavioral Healthcare delivered in an effective way via telehealth can lead to cost-savings over time for insurers

When people are chronically ill, have pre-existing conditions, or are in a state where medical attention is required along with behavioral health, data shows that spending on behavioral health care can lead to cost-savings in the future. Think of all your patients requiring standard medical attention, whether it is for an illness, condition, or something worse. More often than not, their mental health is a major part of their treatment. 

At an investors conference (pre-COVID), I listened to a panel of leading healthcare investors and executives speak about the benefits of behavioral health. One panelist, from an insurance company, remarked that $1 spent on mental healthcare can save potentially $3-$5 down the road on medical care. The healthcare industry in our country is a trillion dollar industry, so if we extrapolate these estimated numbers, the cost-savings from the services you offer can be in the billions. 

Telehealth was already being used in certain circumstances but the pandemic has accelerated the transition

Prior to COVID, certain insurers were allowing telehealth services. Cigna & Aetna are two companies in particular that had telehealth-friendly policies for mental health. Even Medicare allowed the service, though it paid less than an office visit. 

Now, seven months later, telehealth has become the norm. For practices we work with, billing  volume has increased and practices/providers are busier. There are some practices and providers that have transitioned to telehealth entirely, offering 100% of their services over friendly platforms like Zoom or Doxy.me. I would estimate that the average practice is doing around 50% of their visits via a telehealth medium. 

Providers are eager to get credentialed and breakaway from group practices; insurers are offering the contracts for participation

The pandemic has motivated many people who were thinking of starting their own practice to take the leap. This entrepreneurial spirit, which is within all of us, has been activated now more than ever. The ability to work from home and manage your caseload presents an attractive alternative for providers looking to start their own practices. 

Insurers have not stood in the way. Over the last 5 months, I have seen more opportunities for credentialing than in the last 3-4 years. Some insurers, like Medicare, have completely accelerated their credentialing process to the point where approvals can be obtained in a week! This was unheard of just one year ago! Other insurers like Cigna & Optum have shown the ability to move quickly if your CAQH profile is perfect, so keep that profile updated if you are looking to credential! 

A quick comment on addresses: many people ask what kind of address is needed for credentialing and if a home/virtual address is acceptable. The answer is yes. However, when you start the credentialing process, stick to the address that you started the process with. If you need to make changes, wait until you have an approved contract. Doing this can avoid lengthy delays!

There is no guarantee that telehealth will remain a covered mental health service when the public health emergency ends. Now is a great time to make sure that your voice is heard, and help ensure telehealth is here to stay. You can get involved with national organizations like NASW or the APA, or work within your communities. A unified voice can go a long way! 

No matter what, telehealth is the new norm for mental health. As time goes by, the amount we will learn from the past seven months will only help to benefit all aspects of mental health and insurance, including billing, credentialing, and so many other things. After seven months of the pandemic, we can confidently say that the transition to telehealth has been overwhelmingly positive for mental health providers. 

Justin Gaines 
GreenpointMed, Inc. | President
GreenpointMed is a medical billing & credentialing company that works with mental health providers to deliver simple & efficient solutions to insurance needs. A proud partner of TherapyNotes, GreenpointMed serves providers & practices in over 30 states. Learn more about how GreenpointMed can help you by visiting www.greenpointmed.com

Justin GainesHow COVID Has Transformed Mental Healthcare
read more

How Is Mental Health Billing Different From Medical Billing?

How Is Mental Health Billing Different From Medical Billing?

For any typical practice, medical billing is almost assuredly a time-consuming, labyrinthian, and frustrating process with plenty of room for errors. Often, the paperwork required to run a sustainable practice can quickly become overwhelming without the proper help. Medical specialists either build themselves a full team to handle billing concerns or outsource the work to medical billing companies.  While these issues hold true for both standard medical practices as well as mental health practices, the bureaucratic needs are often more severe and harder to manage for the latter.

Why is Mental Health Billing so Different From General Medical Billing?

Insurance companies dictate much of how mental health services are provided as well as how often.  The limit on therapy sessions, for example, creates a financial ceiling that doctors performing ear exams or x-rays don’t experience. These burdens can severely limit a practice. To use a case-study: It was found some years ago that pediatricians were typically able to bill up to 10 different billing codes for medical visits, but only 1 code for behavioral health visits.

 

Mental health practitioners are also operating with smaller staff and leave quite a bit more money on the table due to their inability to properly manage all of their billing needs. Some estimate that as much as over 80% of the money owed to mental health practitioners by insurance companies goes uncollected. Looking at those numbers, It makes sense that mental health billing and behavioral health billing needs are beings outsourced more often than ever these days.

The Value of a Simpler Billing Process
There are a lot of ways that simplifying the billing process with medical billing companies benefit medical and mental health practices. Most understand that less time spent dealing with billing means more time spent with patients and growing a practice, but a more straightforward billing process also avoids insurance companies rejecting a medical claim.. Some estimates claim that around 80% of medical bills contain some error. Even small mistakes can lead to a rejected billing claim.

http://www.healthcarebusinesstech.com/medical-billing/

Insurance Companies Look at Mental Health Differently

The way in which insurance companies, as well as patients, look at mental health is dramatically different than the way they look at more traditional medical practices. Expectations and costs are much different between the two. These differences go back decades and are likely inherent in the current culture. The result is that specialized psychiatry billing services entirely separate from the standard medical industry have arisen to handle the issues unique to the growing mental health sector.

 

In private practices, psychiatrists generally handle their own billing since their ability to hire multiple staff is less common. These days, however, a single practicing professional is often overwhelmed by the need to keep up to date on billing codes, unique requirements of insurance companies, and changing regulations. This, in turn, leads to missed billing opportunities, paperwork mistakes, and lost work hours. When you add in need to check up on unpaid claims and refiling needs, it is near impossible for a single person to operate at full efficiency. In the end, it’s usually much more cost effective to outsource this process from the beginning.

 

The unique rules and financial demands make billing for mental health providers a much different beast than general medical billing systems.

Acute Billing Concerns for Mental Health Providers

Mental and behavioral healthcare claims are only approved; roughly 85% of the time. This is caused for a myriad for reasons, but the majority fall into only a few groups.

 

While we have been able to maintain a 97% claim approval rate for the practices we are managing billing for.

 

As stated before, mishandling these issues can cost a practice considerable amounts in reimbursements.

●    Constantly Changing Rules and Billing Methods

Insurance policies are always changing, and they all eventually lapse. If a practice doesn’t make an effort to be proactive on checking up on these issues, they can quickly find themselves trying to handle an overload of paperwork -plus, medical and mental health practitioners are often notified last of insurance changes or problems.

To add to the confusion, the rules dictating how all of this must operate are often shifting. Compliance regulations, coding systems, and more need to be followed to the letter. Not keeping up with these changes quickly adds up when problems arise.

You need to ensure you double and perhaps triple check all of your patient’s insurance info before a visit. Also make sure you stay up to date on preferred filing methods and rules.

●    Staff concerns

Costs are more of an issue for mental and behavioral health offices. This can lead to understaffing, usually in the administrative department (for obvious reasons). Cutting costs in regulatory efforts can overload your other staff and decrease morale. This in turn also increases turnover rates. Behavioral health billing and psychiatry billing services are often used these days in lieu of hiring full-time staff. Outsourcing billing to a specialist dramatically reduces the chances of late payments, rejected claims, and improper coding issues.

Victoria YoungHow Is Mental Health Billing Different From Medical Billing?
read more

Exclusive Partnership with TherapyNotes

GreenpointMed is excited to announce an exclusive partnership with TherapyNotes, a leading EHR for mental health providers. As part of this partnership, GreenpointMed is one of a select group of medical billing companies which TherapyNotes customers have access to. The combined partnership of the leading technology platform for notes, billing, scheduling and other important features, with the service excellence of the GreenpointMed billing team makes this a win-win for providers.

Justin GainesExclusive Partnership with TherapyNotes
read more

Beware of the “Unspecified” Diagnosis Code

ICD-10 was introduced to the medical billing world in October, 2015. ICD-10 codes became key to the success of any medical billing platform, whether you bill yourself or outsource your billing almost immediately. The key difference when billing ICD-10 codes vs ICD-9 is that the ICD-10 codes begin with a letter, such as F or G. ICD-9 codes did not follow this format.

Justin GainesBeware of the “Unspecified” Diagnosis Code
read more

GreenpointMed’s Drive To Be More Efficient

I’m obsessed with efficiency. In my daily life, either personally or for GreenpointMed, it is a never ending quest. Our business’ #1 goal is to make the billing process simple & efficient, and we accomplish that better than nearly all private billing companies on the market. It’s an easy formula for us: pay attention to the details, always communicate and be precise. Almost sounds like a winning strategy for a football team, though never for my Miami Dolphins!

Justin GainesGreenpointMed’s Drive To Be More Efficient
read more

Medicare ID Numbers Are Changing: 5 Things to Know

The long awaited change to Medicare ID numbers is here so now is a good time to take a moment to make sure you are prepared. New ID cards will start shipping and be distributed to Medicare beneficiaries in April 2018 and, fortunately, you have time to prepare. This doesn’t mean you should wait until the very last few weeks before the old ID numbers are no longer active to have a plan in place; no, no. Create a plan now so that way when your patients came to you with their new ID cards you will be able to confidently tell them how seamless the transition will be. Why? Because you have a plan, and because you read this blog.

Justin GainesMedicare ID Numbers Are Changing: 5 Things to Know
read more

Happy 2018! New year; new benefits

Happy New Years to all! Let’s all have a happy & prosperous year. Part of making sure that the year starts off in the right direction is to make sure you know your patients’ benefits. Remember, benefits reset at the beginning of each calendar year, so everyone starts at square one with a deductible to meet. It’s important to know the details so you can A) make sure you are collecting the maximum allowable amount, and B) communicate with your patients about their responsibility until their insurance kicks in.

Justin GainesHappy 2018! New year; new benefits
read more

Why I started GreenpointMed

Often times when I begin a conversation about why GreenpointMed’s services are the right fit for a healthcare provider, I inevitably veer into the story of why I started GreenpointMed. It is not that I am eager to tell the story; I am not. By nature, I am a private person and shy at the opportunity to talk about myself. However, I find it instructive to detail the “why” because it ultimately is what the mission of GreenpointMed is built on – to make the business of healthcare simple & efficient for healthcare providers.

Justin GainesWhy I started GreenpointMed
read more

5 Solid Practice Management Tips

Starting a practice is hard, but keeping a successful practice going is even harder. Much like any business, your “edge” is the key to success. I always like the reference to, “what’s your edge”? If you read any of Mark Cuban’s books or blogs, he always stresses that the differentiator between you and everybody else is your “edge”. Finding it, keeping it and building it is the key to maintaining a successful business.

Justin Gaines5 Solid Practice Management Tips
read more