Psychology

Practice Alerts & Guidelines

Insurance Billing and Pitfalls

Insurance billing, though seemingly uncomplicated and straightforward, may easily lead to disputes and/or allegations of misconduct. To avoid this, billing statements, insurance claims, and treatment reports should be simple, clear, direct, and accurate representations of the services provided, the fees charged for each service, and the nature of the patient's/client's evaluation and treatment.

• Psychologists would be wise to have the patient's written authorization to release the information necessary to process an insurance claim or to complete a treatment report for pre-certification, although the patient could give a verbal consent. Verbal consents are difficult to prove when charged by a client with releasing confidential information.
• Psychologists should be aware of precisely what they are stating when signing any insurance form or report. They should be aware that what they are asked to state could and does vary dependent upon the insurance form or report. For example, a signature as provider on the insurance form may be a claim that the signatory directly provided the services him or herself.
• When billing for services provided by employees, psychologists should identify the provider by name and title or degree, if it is required on the form. The same is true when insurance forms ask who personally, or directly, provided the service.
• Discussing payment arrangements and insurance issues (including pre-certification) at the first meeting with the patient or client, or soon afterward, could help to avoid any possible misunderstandings and subsequent disputes: for example, co-payments, contract differences, among others.
• Attention to details and making certain that all information is provided when completing insurance forms and reports can help to avoid delays in payment and subsequent misunderstandings and disputes between the psychologist and the patient/client
• When a patient cancels or does not appear for a session, it is usually considered fraudulent to bill an insurance company for that session unless the insurer has provided for cancellations within the contract.