Health Assets
The Answer for Mental Health Practices in New York State


Health assets Mental Health Billing Forms and Resources

FAQs

Common Insurance Terms

What is a "deductible"?

  • A deductible is an amount the patient is responsible to pay before the insurance begins to pay.

What is a "coinsurance" and how is it different from a copayment?

  • A copayment is a fixed amount that the patient must pay the provider at the time of treatment
  • Coinsurance is a percentage you share with the insurance company after the deductible has been met.
    • If there are two insurance companies, the primary insurance will pay first (after the deductible has been met), and then the secondary pays the balance.
  • Coinsurance can act like a copayment.
    • If there is no secondary insurance, the patient pays the coinsurance percentage of the allowed amount the insurance pays. Unlike a copayment however, a coinsurance is a percentage as opposed to a fixed amount and is not necessarily due at the time of treatment.

What is the difference between a "prescriber" and a "non-prescriber"?

  • A prescriber can write prescriptions, an MD, PA or NPP, and a non prescriber, Psychologist or LCSW, cannot write prescriptions for patients.

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Claims Submission

How quickly do you submit my claims after I send them (fax or email or mail) to you?

  • Claims are usually submitted within 3 business days from the day you submit them to us, unless we are waiting for further patient information preventing a claim from being submitted.

How long does it take for me to get paid?

  • Medicare pays in 2.5 weeks after claims are submitted
  • Most other commercial companies pay in 3-4 weeks after claims are submitted
  • Medicaid will hold the check for 2 weeks after it is written, and then mail it, if you don’t have direct deposit set up, about 5-6 weeks

How will I know if I have gotten paid on a claim that Health Assets submits for me?

  • We supply ERA’s (Electronic Remittance Advices) with the details of each payment.
  • We can also run reports, if needed, to show claims that have been paid.

Does Health Assets follow up to be sure my claims are paid?

  • Yes, this service is included in the claim submission price. Claims that are not paid in 20 days fall into a safety net program and follow up begins.
  • Health Assets will follow up on any claim for as long as it takes to be properly processed including, but not limited to, going though the appeals process for you.

Why do I need to write the first date of service on my new patient information sheet?

  • When we verify the patient’s benefits, it allows us to see if the first date of service is covered by the insurance and falls after the insurance’s effective date.
  • It also allows us to obtain authorization for the patient’s visits if necessary.

What is the basic patient information I need to send in order for a claim to be submitted?

  • Basic patient information needed in order to submit a claim includes:
    • Patient’s full name
    • Patient’s date of birth
    • Patient’s address
    • Patient’s Insurance and ID number
    • Policy holder’s name and date of birth if it is different than the patient
    • Patient’s diagnosis code
    • Patient’s gender
    • CPT codes you expect to use for this patient

Why should I report to you what my patient pays me directly?

  • Heath Assets keeps records of everything you send us, including this information. We can give you a full income accounting if, and when, you need it. In addition we can send out a bill to the patient for you on your request.

Do you charge extra if my patient’s claim has to go to 2 or more insurance payers?

  • No, there is no extra fee for submission to additional insurances that a patient may have. Health Assets will send your claims to all payers for one price.

Is there an extra charge if the payer requires the claim to be submitted on paper?

  • No, there is no extra charge for insurances that require paper submissions. We will do whatever is needed for the proper submission of any claim for the same claim submission price.

Are phone sessions covered by a patient’s insurance plan or Medicare?

  • No, phone sessions are not covered by a patient’s insurance plan or Medicare. If a patient wishes to do a phone session, it must be self pay and not go through the insurance.

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CPT Codes

What CPT code should a non-prescriber use for an individual psychotherapy session?

  • For an initial individual psychotherapy session, you should use the CPT code 90791
  • Typically, for follow up individual psychotherapy visits, you would use CPT code:
    • 90834 for sessions lasting 38-52 minutes
    • 90837* for sessions lasting 53 or more minutes
  • *Note: Not all insurance companies are accepting the CPT code 90837 or they are requiring authorizations for the use of this code.

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Medicare and Medicaid

How long does it take to get set up with Medicare or Medicaid if I am not a participating provider now?

  • Medicare can take between 45 and 90 days and the effective date is the day Medicare receives the application
  • Medicaid: Once you have been approved by Medicare you can be credentialed with Medicaid which can take up to 90 days.

In NY, Can an LCSW be paid by Medicaid for psychotherapy services?

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  • No, Medicaid alone will not pay. For instance: if you see a patient that just has Medicaid you will not get reimbursed and there is no patient responsibility.
    • We still do a Medicaid application for Medicaid Managed Plans because in order to be INN (in network) with those plans, providers must have a Medicaid number. You will however, receive no direct payments for your services from Medicaid.
  • Your Medicaid provider number does allow you to get paid by some of the Medicaid Managed Care plans.
    • By accepting Medicaid Managed Care Plans you can get paid for your services.
    • We recommend that if a Medicaid recipient wants to see you that they ask Social Services if they are eligible to switch from Medicaid to a Medicaid Managed Care plan which will enable you to be paid for services.
    • *This will also most likely help your practice, since many LCSWs turn down Medicaid patients without informing them of this option.
  • Patients with Medicare and Medicaid:
    • If you see a patient that has Medicare and Medicaid, Medicare will process the claim in the way they normally do and then the balance will be forwarded to Medicaid, but Medicaid will not reimburse you for this balance.
  • Patients with a commercial insurance and Medicaid:
    • If the patient has a commercial insurance (i.e. Empire, UBH, BCBS, CDPHP, etc.) and Medicaid, the commercial insurance will pay their normal amount and then the claim will be sent to Medicaid. Medicaid will not pay their portion.
  • *Important: you cannot bill a person that has Medicaid for the remaining balance

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Health Assets Services and Policies

How often can I submit billing? You can submit billing as often as you like.

  • We recommend weekly for most practices

How long does it take to become a provider with a commercial insurance or HMO panel?

  • The process generally takes 90-120 days.

How long do I have to wait before Health Assets can start submitting my claims once I sign on?

  • Once you sign on as a provider, you will be set up to bill within 2-3 weeks.

Why doesn’t Health Assets charge a percentage?

  • It is illegal and is considered fee splitting in New York State.
  • Instead we charge a flat rate for all services we provide

Am I tied into a contract? Is there any minimum number of claims I must submit per month?

  • There is no time-based contract nor a stipulation saying how many claims you must submit per month or year

If I don’t submit any claims during a month, will I still be charged a fee?

  • In addition to the fee per claim each month we charge a $9 clearing house fee; if you submit no claims during a month, you will not be charged that fee.

Do you charge extra to send me reports?

  • No, we do not charge extra to send reports.

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Health Assets Contacts

If I have a question, who can I email?

  • You can email info@healthassets.com and our provider relations department will direct you to the appropriate department or staff member.

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Health Assets Mental Health Billing News

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