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English invoice example for Healthcare

if you mention the word billing to any mental health professional they'll shudder if they don't it's likely because they're new to the industry although the billing rules within the mental health space seem archaic the practice sends shivers down the spine across the entire medical world regardless of specialty you see the average initial claim denial rate in q3 of 2020 alone hit over 11 at the time that was an all-time high and the survey that that statistic came from suggested that denial rates weren't slowing down anytime soon what i'm trying to convey is that you're not the only healthcare professional who's faced the challenge of getting paid by client insurance provider that's not to dismiss what you're going through misery loves company but how are you actually going to solve this problem after all there are differences between the types of claims that hospitals submit compared to those coming from mental health facilities fair warning i'm about to bring in another general statistic to help paint the healthcare billing landscape for you a more recent survey from 2021 determined that 85 of all denials are preventable in other words if you're wondering if there are ways to improve your billing processes and increase the revenue for your mental health organization there is hope you just have to know where to start getting an understanding of mental health billing terms is actually the best place to start hi everyone i'm matt from etacticus and today i'm going to explain and define 10 of the most important terms to know in the mental health billing world before we get started though make sure you subscribe to our youtube channel by clicking the button below while you're down there hit that alert bell icon next to it as well so when we post new awful content you get notified [Music] the first mental health billing term you need to know is an appeal although troubling receiving a denial from a payer for a claim you submitted isn't the end of the world however if you think that the claim is correct as it is you can write a letter to fill out a specific payer form however if you think that the claim is correct as it is you can write a letter or fill out a specific payer form and resubmit it whether you send this to the payer by mail or upload it to their portal this process of disputing a denial is called an appeal next let's talk about ansi 837s my favorite the acronym ansi stands for the american national standards institute ansi 837 is the accepted hippa compliant electronic format for submitting mental health claims there are two main types of ansi files ansi a37i and ansi 837p ansi 837i is the accepted electronic format for facilities that have to use ub04 claim submission forms the i stands for institutional ansi 837p is the accepted electronic format for practices that have to submit under the cms 1500 form the p stands for professional do you remember a little bit ago when i defined what an appeal was the definition i included and provided to you had the word denial within it it's probably pretty helpful if i explain what a denial was too huh well every insurance payer has a series of requirements required to receive reimbursement for claims if you submit a claim and it doesn't meet all the requirements the payer won't accept it and deny it usually you receive a notification of the claim denial through practice management or pm system and your clearinghouse there i go mentioning important terms that you might not know in the definitions of others well it's because this is alphabetical a clearinghouse is usually a service offered by a third party organization that acts as a central repository and middleman to your claim submission process essentially you submit your claims to your clearinghouse it runs your submission through a series of automated tests and alerts you to any errors it also usually has a series of pre-established connections to insurance organizations to streamline submission clearinghouses usually provide you with a helpful service called clearinghouse level rejections before submitting your claim to a payer you may submit it to your clearinghouse for a review instead if your clearinghouse finds an error it will reject it on a clearinghouse level and notify you of the same a clearinghouse rejection happens on a preliminary level in other words it's like a second set of eyes reviewing your claims before you submit them so that you don't receive a denial rejections are better to receive than denials because they happen sooner and don't affect your bottom line nearly as much let's talk more about claims we'll start with claim submission to make it easy claim submission is the process of submitting your client claims to your clearinghouse and or insurance payer there are two industry standard forms that payers accept in the mental health world if you print and mail a claim or upload that claim to the payer website cms 1500 and ub04 if you submit electronically claims can be in an 837p or 837i ansi format the type of form you're required to submit to the payers you work with depends on what type of behavioral health organization you work for your clearinghouse should be able to help you with claim scrubbing as well claim scrubbing is the process your clearinghouse runs your submitted claim through before sending it to a payer this is for claim rejection this process is usually automated it involves checking for and correcting spelling and formatting errors once submitted your claim is ready for submission to a payer for reimbursement now i've mentioned this before as well but let's talk about everyone's favorite form within the mental health billing space the cms 1500 form the center of medicaid and medicare services or cms 1500 form is the standard paper form that mental health practices must use to submit claims all professional claims sent by paper ucms 1500 forms they're also sometimes called the hcfa1500 so far everything i've given you has been in alphabetical order but since we're on the topic of forms this is an appropriate place to mention the ub04 form you see ub04 is the standard paper form for claim submissions that mental health institutions have to use this type of form replaced ub 92 forms in 2007 and it's also sometimes referred to as a cms 1450. the tenth and final mental health billing term that i'm going to define for you in this video is current procedural terminology or cpt cpt codes communicate services and tasks performed by mental health professionals during sessions there are five digit code that the department of health and human services or hhs created to instill uniformity insurance organizations refer to this code for billing purposes now the moral of this video is that mental health billing is complex and can be downright confusing although it's difficult it isn't impossible to learn and starting with common terms within the industry is a good starting point for you but i'm only just scratching the surface here if you'd like to learn more about mental health billing and revenue cycle management reach out to etactics and you already made this far into the video so you might as well like it share it and comment below