A clinical social worker (CSW) is someone who is trained, educated, and licensed at the graduate level to provide mental health services. As a CSW or an LCSW, you may be able to bill insurance companies for reimbursement, depending on the services you offer. This is exciting because being able to bill insurance means being able to access your payments faster than with your self-pay clients.
The issue is that insurance billing is rather complicated for those in the mental health profession. Whether a provider is working with a private payer or Medicare, there are dozens of billing requirements, CPT codes, and processes that need to be mastered in order to get the most out of the experience. So what are some of the basics of billing for social work services?
Billing for Social Work Services:
Will You Accept Insurance?
It is not required that you accept insurance in order to offer mental health services to clients. In fact, up until recently, many mental health providers chose not to. In this scenario, providers rely on their patients to pay their bills 100% of the time. When it comes to billing for social work services, this is not the most trustworthy system, and accepting insurance is the more stable and efficient route to take.
Most providers will accept insurance from popular private payers in their area or participate in the Medicare reimbursement program if they are eligible. Either route is a great option to take, as long as you have tools that help you optimize billing for social worker services. Since you are not experts in the field of billing and reimbursements, it is best to use software or services that help you navigate the unfamiliar territory.
If you have decided to accept insurance, then you will need to get credentialed with each company you hope to work with. This should include 2-3 of the most popular private insurance companies in your geographical area. This is essentially applying to join their provider panel and be recognized as an “in-network” provider in their system. You do not need to be in-network to file a claim to a patient’s insurance, but more financial responsibility will fall into the lap of the client and delay your in-full payment.
How to Bill a Payer
When billing for social work services, there are a few important steps to take. First, providers will need to familiarize themselves with CPT codes. CPT codes are billing markers that help payers identify the type of service you offered to your client. After a visit, you will file a claim for reimbursement to the client’s insurance. On this claim, there are details like patient information, diagnostic codes, and CPT codes.
The information on each claim must be 100% accurate if a provider wants to be fully reimbursed by the payer. This is where quality software plays a huge role. A good billing tool can make sure each claim is optimized for approval.
Once a claim is approved, the provider receives reimbursement for the services they provided. A claim that is approved after its first submission is called a “clean claim” and is the ideal route for providers billing for social work services.
The Complications of Billing Payers
- Denials
When there is even a small error on a claim, a payer will find cause to deny it. Now, there is often a chance for providers to correct mistakes and resubmit, but this delays their payment date. Good software will automatically scrub claims before their initial submission to make sure they are free from errors from the start, preventing denials and increasing clean claims when billing for social work services.
- Inefficient Workflow
For providers that do not use the right software or try to do the majority of the work on their own, inefficiencies and errors take place. This increase in administrative burden can increase provider burnout and distract from patient care. Providers need to make sure they are using software that streamlines their social work billing workflow.
- Lack of Coverage
Sometimes patients think they are covered for services and they are not. This can happen if a patient does not realize their coverage has lapsed or they have a mental health carve-out plan. Regardless of the reason, it is best to know beforehand what a patient’s coverage is to maximize reimbursements. Software that is designed for billing social work services can automatically verify a patient’s coverage before services are rendered.
Billing for social work services is complicated but exciting. For clinicians just starting out on their journey to insurance billing, there will definitely be bumps along the road. The best thing that you or your practice can do to streamline its billing workflow, improve clean claims, and boost its bottom line is to implement high-quality software that is designed for billing for social work services.
To learn more about an EHR that can help you streamline and organize your practice management, click here.