How to Read Your Month End Report from Help Therapy

 

Help Therapy works hard to submit your billing in a timely manner so that claims are processed quickly and efficiently.  As you know, at the end of each month you will receive an invoice based on the receivables that have come through that month.  In addition to the invoice, you will receive a month end report which details the billings that have been submitted for you and those that have been paid out.

 

It is important to remember that different insurances pay claims in a different time frame.  Some take 3 weeks, and some can be backed up for 6 weeks.  Therefore, there are times that you will see your monthly report reflect payments from previous months.  These are payments that have been received that month (or EOBs that you have sent in that month).

 

In order to ensure that your invoices properly reflect the amount that you were paid and to make sure that we can fight denials in a timely manner, it is important to send those EOBs into billing @ [email protected] so that we can reconcile your account.

 

You are an independent practitioner, so that information is coming to YOU and not to Help.  You can set up EOBs to be sent directly to billing (in which case, you would not have to send these in weekly).  If you are interested in this, please reach out to us.

 

Here is how to read that month report



  • Patient ID: All patients will have a unique ID reflected here.  

  • Patient Name: Patients Last, First Name

  • Insurance Company: Patient’s insurance company billed out to

  • DOS: The date of service for that patient encounter

  • Code: CPT Code billed for that encounter.  If you bill multiple CPT Codes for patients, they will be reflected as different line items

  • Unit Charge: There is typically a templated unit charge for each CPT Code

  • Total Charges: Same as the Unit Charge unless there were additional charges added on by the biller.  This is what is billed to insurance.  Please note, insurance does not pay this total amount.  That is why you will see an “Adjustment” which is explained below

  • Total Payments: The amount you were paid out by the insurance company.  This is usually based on your current contract with the insurance company (which is largely based on license).

  • Adjustment: The amount that was billed to the insurance company minus what you were paid out.** (see note on adjustments below)

  • Total Balance: The amount that has NOT been paid out by insurance companies.

Understanding Insurance Adjustments:

 

You are all independent practitioners - therefore you are independently contracted with different insurance carriers.  When you are contracted with a carrier, you agree on a fee schedule for the services that you are going to provide for patients.  MOST insurance companies use the Medicare Fee Schedule (how much they will pay for each service) to determine their own fee schedules, but all of them have a different fee schedule.  I will not go into the details of fee schedules as insurance companies like to keep them very close to the vest.

 

That said, when you sign up with an insurance company you agree to a percentage of the fee schedule for your services.

 

Your percentage can be determined by your:

  1. Location, paying more for under-served locales and less for over-served locations.

  2. License, education, and specialization.

  3. Specialization. (or your taxonomy code)*

  4. Consumer demand at the time of signing your contract.

*Psychiatry Taxonomy Codes

  • Addiction Psychiatry – 2084P0802X

  • Child & Adolescent Psychiatry – 2084P0804X

  • Geriatric Psychiatry – 2084P0805X

  • Psychiatry – 2084P0800X

Behavioral Health & Social Service Provider Taxonomy Codes

  • Counselor – 101Y00000X

  • Addiction (Substance Use Disorder) – 101YA0400X

  • Marriage & Family Therapist – 106H00000X

  • Psychoanalyst – 102L00000X

  • Psychologist – 103T00000X

  • Addiction (Substance Use Disorder) – 103TA0400X

  • Adult Development & Aging – 103TA0700X

  • Clinical Child & Adolescent – 103TC2200X

  • Cognitive & Behavioral – 103TB0200X

  • Counseling – 103TC1900X

  • Group Psychotherapy – 103TP2701X

  • Developmental Disabilities – 103TM1800X

  • Psychoanalysis – 103TP0814X

  • Psychotherapy – 103TP2700X

  • Social Worker – 104100000X

Depending on the above factors, you would be paid out a percentage of this fee schedule. 

Typical Percentage rates for various licenses include:

 

Psychologists/Psychiatrist - 100% of the allowable charge for Medicare

LCSWs - 75-85% of the allowable charge for Medicare

LMFTs - at this time Medicare does not allow for services by LMFTs

**As you can see the allowable charge for Medicare is blank in the sheet above.  If you want to see the Medicare allowables for the year, you can reference this Help Desk.

 

For other insurance companies, your reimbursement rate is determined in your contract.  You are bound by this contracted rate.  We will always bill out MORE than what is expected in reimbursements, which is why you will see an adjustment amount on your monthly statement.

 

**If you are waiting on co-pay this may be reflected in the “balance” on the billing sheet even though you have already been paid by the insurance companies.  It is always best practice to collect this from patients up front.  You will be notified by our schedulers/billing team if the patient has a co-pay that will be owed at the appointment date.  Insurance co-pays will be higher for patients that have not yet met their deductible. This is why we offer to hold Medicare billings for you at the beginning of the year if a patient has not met this co-pay.