APA PRACTICE ORGANIZATION | apapracticecentral.org
Claims Submission Pointers, continued
• Consistently document patient encounters
in the record to substantiate service delivery.
Thorough documentation includes noting start
and stop times for timed services such as psychotherapy as well as H & B services, and charting
patient progress in light of the treatment plan.
• Check the entire claim form to ensure accuracy.
For example, look for missing or inaccurate
codes. And be sure the patient’s name matches
the way it appears on his or her insurance card.
• File claims promptly after delivering services.
This step is particularly important for your
practice finances if your claim is rejected and
must be refiled, thereby affecting your revenue
stream. And preparing a claim while details of
the patient encounter are fresh in mind can
help ensure accuracy.
Claims Denial Pointers
• Thoroughly review all notifications regarding
the claim, such as an Explanation of Benefits.
The notification should indicate whether the
claim was paid in full or in part, delayed or denied
– and the reason(s) why a claim was rejected.
• Make sure you understand what is being
denied. Do not assume that a claim is being
denied because the insurer considers the service
“not medically necessary.” The insurer may
simply want more information related to the
claim. Contact the company if the notification
of denial is unclear; you might discover that
the claim was processed incorrectly because
of an administrative error.
• Whether communicating electronically or
by phone, use a cordial approach at the outset,
and become more assertive over time if necessary.
If you deal with a company regularly, find out
who can help you with problem resolution
and build rapport with that person.
• Before filing an appeal, learn about the
company’s process. Procedures vary by
insurer and state law. Be sure you know what
information you need to submit if you decide
to file an appeal and the deadline for filing.
• Be persistent. You may need to resubmit a
claim or file an appeal more than once. Your
persistence can demonstrate to an insurer
that you are serious about getting paid.
• Maintain good records on disputed claims.
Thoroughly document and maintain records
of communications you have with company
representatives, including all actions you have
taken and their outcome. These records can
be especially important when taking your
appeal to higher levels.
• Take advantage of available help. Your state
insurance commissioner, state attorney general
and legislators’ offices are potential sources of
assistance with issues involving private insurers.
Further, psychologists in states with prompt
payment laws can use these laws to press
private insurers to pay “clean claims” within
the required time – often 30 days.
The APA Practice Organization’s Practice Central
website contains information about the health
and behavior codes, along with additional guidance
on coding and billing for services. Visit the “Billing
and Coding” section under Reimbursement at
apapracticecentral.org. Secure documents
(accompanied by a lock icon) are accessible to
APA Practice Organization members who log in
APAPO SUPPLEMENT TO THE MONITOR ON PSYCHOLOGY