Tips on the Billing Process for Psychological Testing
There is little doubt that many clients seeking care have benefited from psychological testing and the clarity that testing provides for complex diagnostic situations. However, the barriers clinicians must navigate to be successfully reimbursed for their time and expertise are complex. While many clinicians choose to charge their services outside of the realm of third-party payment, there are still a great many who choose to utilize third-party reimbursement for a myriad of reasons.
We believe two critical assumptions are true. First, we believe in the third-party payment system only because it enables broad access to quality care. Second, we believe that systems and clear processes are the key to successfully navigating the third-party payment system in which we exist.
Managing the claim submission and billing process for psychological testing services is crucial for ensuring timely reimbursements and reducing administrative burdens. Here’s a guide on how to streamline this process effectively.
Gather Complete and Accurate Patient Information
Before submitting a claim, ensure you have all the necessary patient details. Without these details, you may chase patients for their information, delaying claim submission and creating more work for you than you would like. A clear system to gather all your patient information and verify the accuracy of the information is the first step in successful reimbursement. This includes:
Full name, address, and contact information
Insurance information (policy number, group number, etc.)
Date of birth and social security number
Referral information, if required
Accurate information from the start prevents delays caused by errors or missing data.
Obtain Pre-authorization
One of the unfortunate realities of the insurance system that healthcare organizations operate in is that each company, public or private, operates with its own set of rules and regulations for reimbursement of services. There are several hundred health insurance companies in the United States, and each operates differently regarding what services they authorize and which they don’t. Because of this accepted reality, you must assume that you or a staff member will be the expert in the prior authorization policies for the insurance you work with for psychological testing.
There are many ways a practice can systematize this process, but to streamline the claim submission process, you must clearly understand when you need prior authorization and when you don’t.
Pre-authorization is often required for psychological testing. To obtain it:
Verify the specific requirements of the patient’s insurance provider
Submit detailed information about the proposed tests and their necessity
Follow up regularly to ensure the authorization is granted before the testing begins
Documenting this process can help in case of disputes or denials later on.
Use Correct Billing Codes for Psychological Testing
Coding for psychological testing changed in 2019, and many clinicians have yet to adopt the new coding systems. We know change is hard, and it requires a tremendous amount of flexibility on your part to make sure you are using the correct codes. We have included the most common CPT codes here so you can reference them.
Using the correct billing codes is critical. Common CPT codes for psychological testing include:
96130: Psychological testing evaluation services by a physician or qualified health care professional, first hour
96131: Psychological testing evaluation services by a physician or qualified health care professional, each additional hour
96136: Psychological or neuropsychological test administration and scoring by a physician or qualified health care professional, first 30 minutes
96137: Psychological or neuropsychological test administration and scoring by a physician or qualified health care professional, each additional 30 minutes
Ensure your staff is trained on correctly using these codes and any updates or changes in coding practices.
Timely Submission
One of the biggest reasons practices lose so much money is through claims denied because of timely filing. We know that psychological testing is time and resource-intensive, but that is all the more reason to ensure that your claims leave the practice on time. All the prep work you have done to ensure you have a clean and well-coded claim is important to ensure your claim lands at the insurance company within the specified timely filing guidelines.
We recommend that you develop a system to ensure claims are submitted within the time frame required by each insurance provider.
For example, you could require that all notes and assessments be appropriately entered in your Electronic Health Record System within a specific time frame, and your biller knows they must submit the claim at least two weeks after the documentation is finished. This would give you time to ensure the clinical documentation is completed and give your billing department an objective against which to measure success.
Regular Follow-ups
Don’t assume that the process is complete once a claim is submitted. You or your biller must regularly follow up with insurance companies to check the status of your claims. This proactive approach can help resolve issues before they become denials. Most of the time, problems in the processing of claims can be caught and resolved with a proactive approach, and because you have already invested weeks (potentially) in an evaluation, you will want to make sure you are paid as quickly as possible for that work.
Train Your Staff
Ensure that all staff involved in the billing process are well-trained in the latest practices and technologies. Regular training sessions can help keep everyone up-to-date and aware of any insurance policy or procedure changes. Maintaining your and your staff’s knowledge of the claim process, the testing process, and any changes with the insurance companies you are in-network with will greatly leverage your ability to streamline your claim submission process for psychological evaluations.
Seek Professional Help
If managing the claim submission process becomes overwhelming, consider partnering with Practice Solutions. Our professional billing services provide expertise and resources that can help ensure your claims are submitted accurately and efficiently, maximizing your reimbursements and allowing you to focus on providing quality patient care.
Conclusion
Streamlining the claim submission process for psychological testing requires attention to detail, timely actions, and ongoing monitoring. By following these best practices, you can enhance the efficiency of your billing operations, reduce errors, and ensure that you receive timely reimbursements for the valuable services you provide. For more support and professional assistance, contact Practice Solutions today.
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