Insurance Billing 101 for Therapists

Introduction

Insurance billing is one of the most challenging aspects of running a therapy practice. Between credentialing, claim submission, and denial management, it's easy to feel overwhelmed.

This guide breaks down everything you need to know about insurance billing, whether you're just starting out or looking to optimize your current process.

Should You Accept Insurance?

Before diving into the mechanics, let's address the fundamental question: should you accept insurance at all?

Pros of Accepting Insurance

Larger client pool: Many people can only afford therapy with insurance coverage

Steady referrals: Insurance directories drive new client inquiries

Credibility: Being in-network can build trust with potential clients

Consistent payments: Insurance payments are predictable

Cons of Accepting Insurance

Lower reimbursement rates: Insurance typically pays less than private pay

Administrative burden: Credentialing, claims, and denials take time

Delayed payment: Insurance payments can take 30-90 days

Restrictions: Some insurers limit session frequency or length

Getting Credentialed

Credentialing is the process of becoming an approved provider with an insurance company.

The Credentialing Process

1. Choose your panels: Decide which insurance companies to pursue
2. Gather documents: License, NPI, malpractice insurance, etc.
3. Submit applications: Each insurer has their own application
4. Wait: Processing takes 60-120 days on average
5. Follow up: Check status regularly and respond to requests

Tips for Faster Credentialing

Keep all documents current and organized

Use CAQH to store provider information

Follow up every 2 weeks

Consider a credentialing service if time is limited

Understanding CPT Codes

CPT codes tell insurers what service you provided. Common therapy codes include:

Individual Therapy

90834: 45-minute session (most common)

90837: 60-minute session

90832: 30-minute session

Intake/Assessment

90791: Psychiatric diagnostic evaluation

90792: Psychiatric diagnostic evaluation with medical services

Group Therapy

90853: Group psychotherapy

Family Therapy

90847: Family therapy with patient present

90846: Family therapy without patient present

Submitting Claims

Electronic vs. Paper Claims

Always submit electronically when possible:

Faster processing (days vs. weeks)

Fewer errors

Better tracking

Required by most payers

Required Information

Every claim needs:

Patient demographics

Insurance information

Provider NPI

Date of service

CPT code and diagnosis

Place of service code

Using Therapal for Claims

Therapal automates much of the claims process:
1. Complete your session note
2. Verify the diagnosis and CPT code
3. Click "Submit Claim"
4. Track status in your dashboard

Managing Denials

Denials happen. Here's how to handle them:

Common Denial Reasons

Coding errors: Wrong CPT or diagnosis code

Eligibility issues: Patient not covered on date of service

Prior authorization: Required authorization not obtained

Timely filing: Claim submitted too late

The Appeals Process

1. Identify the reason: Read the denial carefully
2. Gather documentation: Collect relevant records
3. Write the appeal: Address the specific denial reason
4. Submit promptly: Appeals have deadlines
5. Follow up: Don't assume silence means success

Superbills for Out-of-Network

If you're out-of-network, superbills allow clients to seek reimbursement directly.

What to Include

Your name, credentials, and NPI

Your tax ID

Patient name and date of birth

Date of service

CPT codes and fees

Diagnosis codes

Best Practices for Billing Success

1. Verify eligibility before every session
2. Submit claims within 24-48 hours
3. Check claim status weekly
4. Appeal all wrongful denials
5. Keep detailed records
6. Use technology to automate

Conclusion

Insurance billing doesn't have to be overwhelming. With the right systems and knowledge, you can get paid what you deserve while focusing on client care.

Therapal's built-in billing features automate much of this process, from eligibility verification to claim submission. Start your free trial to see how we can help.