An effective mental health biller, waiting patiently for customer service | Your Billing Buddy

An effective mental health biller’s day – all before lunch!

I thought it would be fun to show you what effective mental health billers do each day to keep your money flowing in.

Maybe “fun” isn’t the right word. But the back office tasks are vital if you want your behavioral health practice to be profitable.

7:30 am – Monday

I arrive at work, clutching my coffee. There are several voice mails from Friday afternoon.

An offshore vendor wanting my business. Delete.

A patient wanting to pay their bill. YEAH!

The mother of a young adult patient challenging the bill. Sigh.

No return calls from insurance companies!

The client wanting to pay was on the East Coast, so I called him back first. It went to voice mail. Of course. I left a message.

Not wanting to tackle the mother just yet, I got started on my daily routine. First up:

Check the rejected claims queue.

To be an effective mental health biller, or medical biller, you must check rejected claims – how will you know if something went wrong?

Rejection # 1. Invalid client zip code? What the hey, this person has been seen for years!

First step: checked and entered the address I submitted. Yep – all of a sudden it’s a different zip code after 3 years of therapy! I mentally thanked the client for telling the therapist about their “new” address, made the change at the clearinghouse level, and pushed the claim out again. Then changed the address on the client demographic screen in the practice management (PM) system so that the error would not duplicate next visit.

Rejection # 2. Policy cancelled. Sigh.

If I had a dollar for every time a client forgot to give their therapist new insurance information, I’d be sitting here!

Checked eligibility – it wouldn’t be the first time a claim denied for no coverage when there really was coverage. But no – it was cancelled. I inactivated the policy, posted the zero pay. This drops the charges to patient responsibility. No credit card on file. A bill to the client will go out in the next batch. Maybe if the therapist really wants to get paid, she’ll start keeping credit cards on file.

Review the $0 remits.

$0 remit # 1. Deductible. Posted. No credit card on file. A bill will go out next statement cycle.

$0 remit # 2. Coordination of Benefits. Typed out an email to the therapist and added my COB client information letter template. Posted as a denial so a bill will go out also. In case the therapist doesn’t follow up. Or in case the client doesn’t.

$0 remit # 3. Billed wrong payer. Well, with no card what else can you expect? The original eligibility inquiry didn’t indicate a mental health carve-out or other special payer. Nope…that would be too easy. I’ll need to call to find out who the correct payer is.

$0 remit # 4. Another deductible. Ah-ha! There’s a credit card on file! CHARGED!

$0 remit # 5. Provider forgot telehealth modifier. Easy fix. Added modifier, sent the claim back out.

I’ll need more coffee before tackling Irate Mom.

8:45 am – Monday

Need. More. Coffee!


While fixing my coffee, I heard the phone ring. Upstairs. Why does the phone ONLY ring when I can’t get to it?

Back upstairs, I checked the inbound number. It was the East Coast client who wanted to pay, so I returned the call, and took care of that. One thing done!

Taking a deep breath, I dialed Irate Mom, while checking the PM system to see if there’s a release on file to share information with her. This is always a gray area; HIPAA allows for “routine” disclosures due to “treatment, payment, and healthcare operations.” Billing & payment – that would be me. BUT…this is mental health. You do have to be careful. Typically, I take my lead from the caller – I don’t share, unless they already know of the treatment relationship. If they do, then my shares are limited to money, insurance, and only that. If they don’t – nothing.

While dialing Mom, I reviewed her account and noticed that she gave the practice a card for a Health Sharing Ministry. Uh oh. Health sharing arrangements aren’t legally obligated to furnish the benefits deemed “essential” by the Affordable Care Act. Which means they don’t have to cover mental health. And many outright exclude it.

Mom answered the call, and after identifying myself and verifying her identity, I asked how I could help. Sure enough: “You didn’t submit the claim to our insurance!”

Patient-submitted health insurance reimbursement form with stethoscope

I reminded Mom that the practice is out of network with the rent-a-network used by the Health Sharing Ministry. And according to the practice’s policy that she signed at intake, payment is due at the time of services. Yeah…so why didn’t the practice actually, um, collect?

“Can’t you just submit the claims and see what happens?”

“I’m sorry, the practice’s policy is not to submit out of network claims. Once the account is paid, I’ll be happy to print you a superbill you can use to request reimbursement. Hopefully you’ll be able to get something back.”

Not the part of billing I enjoy. I’ll never understand why, if the policy of the practice is to collect at the time of service, they don’t! so much for effectiveness!

9:10 am – Monday

As I’m documenting the call with Irate Mom, the phone rings.

“Hello, Billing Office, how can I help you?”

(foreign accent) “Hello, this is (garbled name) calling from Multiplan on behalf of Cigna to discuss negotiation of a claim for patient J, date of birth 01/01/2000.”

“We don’t negotiate. Please send the claim back to Cigna.” I began the usual notes in J’s record, making no effort to type quietly.

“But if you don’t negotiate, the plan only pays 110% of Medicare and you’ll lose money,” the voice wheedles.


“No, we won’t.” [seriously? Like you care about us losing money?] “J paid us in full when he was seen. Did you look at the claim? There’s no assignment of benefits. Cigna will be sending J whatever his plan allows. We will not agree to decrease J’s reimbursement. Cigna needs to pay the claim according to the plan provisions.”


“Please spell your name and provide me with a reference number.”

“U N I Q U E, reference # 90782w4984d13000003367845.” I have to ask “Unique” to repeat since she speaks so fast. I want to finish noting the account so I can get on with my day.

Facepalm, OMG | Your Billing Buddy

Hanging up, I hear, “Thank you for calling Multiplan.”

9:40 am – Monday

What a fun way to spend 30 minutes. And it’s already almost 1 pm on the East Coast! I have a doozy of a project next.

Anthem BCBS is still sending paper checks to an old address. Knowing they’ll do nothing unless I do this first, I access Availity. Which nags me to “attest” to directory correctness even though Availity knows I’m a mental health biller, not a provider. Ignore.

I checked the provider’s data. It’s correct. Of course it is. I updated it two months ago. And CAQH. And sent paper letters to Anthem by both fax and US Mail.

Deep breath. And then another.

I got all the information ready: NPI, tax ID, policy ID, date of birth, dates of service, claim numbers, amounts. After about 4 levels the voice mail maze lets me ask for a representative.

When the representative answers, I can barely understand him.

Is his telephone a tin can? Then there’s the noise from his neighbor.

I explained the numerous attempts made to update the psychologist’s address. The rep apologizes for the “inconvenience,” puts me on hold 15 minutes, featuring repetitive music interspersed with assurances that my call is valued.

While waiting, I reviewed and interpreted benefit verification profiles. If you can’t multi-task, you’ll never be an effective mental health biller.

The rep returned, thanking me for patiently waiting. Really? How does he know if I was patient?

He stated, “Upon checking, I am sorry but this is not my department.”

It took 20 minutes to determine that?

He offered to transfer me, and does so just as I began to ask him to void the checks sent to outdated addresses. Sigh. Instead of getting something done, or even reaching another representative, I am sent all the way back to the automated voice response system. I trudged back through a second time.

After a second 20-minute wait, I get another offshore representative. This one told me to contact my network provider representative to make the necessary changes to the address. I asked for the contact information of this person. (I am well aware that they do not exist…or if they do, I’m not allowed to contact them).

20 more minutes. In that time, I finished with interpretation of benefits, registered new clients in the PM system, answered emails, and posted a few electronic remittances.

I’ve now been at this one task for over an hour, if you include the preparation time…

The second rep finally returned to the line. Sheepish-sounding, apologizing profusely for the “inconvenience,” he states there is no contact information for a network rep in the provider’s state.

biller as psychic fortune teller | Your Billing Buddy

After a while, effective mental health billers can moonlight as psychics.

Knowing it’s probably futile, I requested a US-based representative. I’m told “there is nothing the onshore representatives can do that I cannot do.”

Are there even any US reps, anymore?

Then I requested a supervisor or at least a team lead. I pointed out that I’ve called every 30 days for the past for the past 4 months to get these checks reissued to the correct address. I gave all the reference numbers, and pointed out all the updates I’ve made to Availity, CAQH, and the faxes/letters sent.

10 more minutes, during which the representative came back 4 times to assure me that he was still there and to thank me for my patience.

At last, he returned to say that he was very sorry but all the supervisors and team leads were in a meeting. Of course. Because I’ve been so patient and had to call so many times, he’s been given special permission to manually key in the new address and reissue all the old checks. Dude, you’re laying it on a bit thick. I gave him the claims and check information for all the payments.

I obtained a reference number, and made my notes, but my effective mental health biller psychic superpower tells me this was a wasted 90 minutes of my life.

Time to change my approach. I’ll request executive escalation if these checks don’t arrive in 30 days.

I pasted my documentation from Word into the PM system. Annoying to have to use Word, but at least this way I’m not stuck useless on the same screen while I wait.

11:10 am – Monday. Is it Tuesday yet?

Since I’m having such a wonderfully productive start to my week, my next task will be something equally infuriating (at least for me), but easier, at least.

I have a stack of virtual credit cards I need to have turned into paper checks. These vendors who issue the virtual cards, and the insurance payers who hire them, must really think doctors are idiots. Why should the psychiatrist redeem these when that means her already inadequate in-network reimbursement will now be cut by 3-something percent as a result of merchant fees? At least half of which might be kicked back to the payer?

After assembling the provider’s NPI, tax ID, address, phone number, and all the virtual cards, I called the payer’s intermediary.

While waiting for a rep, I opened my spreadsheet to see if I’ve called this payment vendor before for this payer/provider combination. That determines how forceful I’ll be on the call. Nope…this is the first time. The rep who will answer my call has no idea they just dodged a bullet.

When a person comes on the line I requested paper checks and gave all the verification info.

Now for the fun part. The rep asked, “Do you work directly with the provider?”

I’m having a yucky Monday morning, so I gave my standard sarcastic answer.

“If I don’t work for the provider, then I must be the world’s best psychic since I was able to give you all the correct verification information.”

Cheap entertainment: the customer service rep NEVER knows how to respond.

The rep finally asked what they really meant to ask all along, but didn’t want to say directly. She asked if I was a billing or RCM service.

Innocently, I asked,“does it matter?”

The customer service drone tried to “explain” HIPAA to me, stating that HIPAA forbids billing services from opting providers out.

Honey…no, it doesn’t. HIPAA was written almost two decades before the invention of the virtual credit card as a reimbursement scam. A business associate who can provide verification as I just did by giving TIN, NPI, address, draft information, etc, has the right under HIPAA to receive PHI and act on behalf of the provider, if the appropriate Business Associate Agreement is in place.

I just LOVE how these third-party payment vendors – who are Business Associates of the payers, just like I am a Business Associate of the provider, think they’re qualified to reinterpret federal law.

Probably because she could see her call talk-time spiraling out of control past acceptable parameters, the rep said, “Never mind.” And launched into the usual spiel about virtual cards being the fastest and most “secure” method of payment.

REALLY? You think that? It would be easy to buy something on Amazon using this. Short of a court order, it would be untraceable.

While she continued the spiel about standard mail delivery times and then the required commercial about the wonderful EFT service her oh-so-helpful middleman employer offers, I checked my text messages and watched my friend’s latest adorable kitten video.

Adorable gray striped Scottish fold kitten

Then she asked if I wanted information about registering for the EFT service. And when I asked if it costs anything, she stated she didn’t know.

“No, because I happen to know your outfit charges 2.5% to receive EFT.

I wonder how long she’ll last in her comfortable denial.

FINALLY, she confirmed opting the provider out. That only took 30 minutes when it could easily have taken 10. I documented the PM system and my spreadsheet with her name/last initial, reference #, date, time, and what I was told about opting out and ETA of paper check.

My standard approach is to turn up the heat if I have to call a second time about the same payer/provider combination. Way up. All the way to the C-suite. It works if you use the correct lingo. And because effective mental health billers don’t have time for this nonsense, I’ve assembled a toolkit just for you – everything you need to know to be rid of virtual credit cards and obtain free EFT.

11:40 am – Monday.

Time for lunch!

Susan Frager | Your Billing Buddy

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