Introduction:
I am a licensed professional counselor, currently licensed in Texas. Having transitioned from working independently in an office setting, I now offer counseling services through virtual platforms. I operate under my private practice, Blissed Being, PLLC, and have contracts with insurance companies to ensure maximum reimbursement. In addition, I use third-party billing and referral services to make the payment process more efficient.
Explanation of chart information:
I will provide you with a chart that showcases the information regarding the billing and reimbursement processes. I use a third-party billing (TPB) company to submit claims to insurance companies, with the goal of maximizing reimbursements. When I can’t submit a claim for a client, I request reimbursement through my EHR platform. The TPB I work with reimbursement rate is 46.47% of the total amount billed. I usually submit claims for CPT codes 90791, 90837, and 90845.
In Figure 1, you can see examples of AHCCCS 15-minute units, the billing entity, and the final reimbursement amounts from United Healthcare and Aetna. Figure 1 provides a visual representation of this information. My reimbursement rates have increased over time, as shown by this data. When I observe these rates, it becomes clear to me what insurance companies are willing to pay for services, taking into account the premiums clients pay.
Ideas for Services and Add-ons
In order to improve the level of care and appeal to potential patients or increase revenue from current patients, my workplace could explore the option of introducing service add-ons. I think it would be beneficial to provide shorter counseling sessions to better accommodate individuals who have limited time or specific requirements. In addition, I believe that incorporating group therapy sessions can create a nurturing atmosphere for multiple individuals, all while making the most efficient use of the therapist’s time and resources.
The Value of a DBH:
The information presented in this context highlights the value of a Doctor of DBH. With advanced qualifications as a DBH professional, I possess the knowledge and skills necessary to navigate complex insurance systems effectively. I can utilize technological tools like EHR platforms and billing services to ensure efficient reimbursement processes. Moreover, DBH professionals can analyze reimbursement rates, identify trends, and adapt their services accordingly to optimize care delivery and financial outcomes.
Figure 1:
| CPT CODE | DESCRIPTION | AHCCCS Unit (per 15 minute increments) | TPB Submits a claim to UNITED HEALTHCARE | UNITED HEALTHCARE/ TPB Reimbursement is 46.47% | TPB Submits a claim to AETNA | AETNA/ TPB Reimbursement is 46.47% |
| 90791 | Initial Eval / First Session | $22.68 | $264.00 | $123.00 | $284.05 | $132.28 |
| 90832 | Psychotherapy, 30 minutes (16-37 minutes) | $32.51 | $129.11 | $60.00 | $97.71 | $45.41 |
| 90834 | Psychotherapy, 45 minutes (38-52 minutes) | $32.51 | $172.15 | $80.00 | $221.64 | $103.00 |
| 90837 | Psychotherapy, 60 minutes (53 minutes and over) | $32.51 | $241.00 | $112.00 | $279.19 | $129.74 |
| 90839 | Psychotherapy for crisis, 60 minutes (30-74 minutes) | $16.58 | 269.00 | $125.00 | $223.95 | $104.07 |
| 90846 | Family or couples psychotherapy, without patient present | 208.73 | $97.00 | $178.58 | $82.99 | |
| 90847 | Family or couples psychotherapy, with patient present | 215.19 | $100.00 | $219.00 | $101.77 | |
| 90853 | Group Psychotherapy (not family) | 86.07 | $40.00 | $74.37 | $34.56 |
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