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HCFA-1500 Form for Mental Health Billing

Few things in this world are as frustrating as claim rejections and denials. Sure, there’s the loss of revenue, but also they’re an incredible waste of time and energy. Many mental health professionals loathe the idea of handling their billing, mainly because of all of the rules and regulations. The vast majority of claim rejections occur due to improperly filling out the HCFA 1500 Form.

This short guide will help you better understand the pitfalls and obstacles so you can successfully file your Medicare billing claims correctly.

The 5 Most Common mistakes made on HCFA 1500 forms

  1. Using an outdated form or using the incorrect form, such as the CMS 1450 (UB04 form).
  2. Using a non-specific diagnosis code. The ICD-10 diagnosis code you identify on the claim form must be highly specific. Here is a wonderful reference for common ICD-10 codes for Mental & Behavioral Health diagnoses.
  3. Entering Inaccurate CPT Codes for the Services You Provided. Click here’s a comprehensive reference for proper CPT codes.
  4. Misusing CPT Codes. This can unintended consequences because it can look as if you are trying to commit insurance fraud. Codes can be misused in three ways: unbundling, upcoding, and using modifiers incorrectly. You’re unbundling when you use multiple CPT codes for a single service (which translates into greater reimbursement) when there’s a single code that accurately reflects the services provided. Upcoding happens when you use a code with a higher reimbursement rate when it doesn’t truly apply — again, this is especially common with timed codes. Misusing modifiers (the two-digit codes that are appended to a CPT code to communicate additional information) can be interpreted as trying to receive higher reimbursement than is warranted. To avoid getting claim flagged, be sure that you’re using the most applicable CPT codes and modifiers for the services you provided.
  5. Missing Information or Using Inaccurate Information. With so many fields and subfields, it can be easy to overlook one of them. The most common fields missing information or using inaccurate information are the patient name, patient sex, insured’s name, patient’s address, patient’s relationship, insured’s address, dates of service, and ICD-10 code.

In conclusion, filling out your claims forms properly and understanding how to interpret the information that your payers send with denials will improve your billing. You’ll increase your claims acceptance rate and boost the success of your appeals. And since the health of your practice depends on cash flow, you’ll also be making your practice more sustainable for the long-term, allowing you to better serve clients.

For more information, please consider reading the following article: