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After navigating the steps of credentialing with state medicaid and Contracting with desired RAEs, you may find yourself unsure of how to start billing. You are not alone!
It’s a question that comes up frequently when providing consultation to colleagues wishing to take Medicaid in their practice. Let’s take a look at some setup steps as well as explore how to avoid common errors so you can start building your Medicaid caseload with confidence!*
1. Use an Electronic Health Record (EHR). Yes, I’m biased in having used one for 6 of my 7 years of private practice so far. I often wonder how I built a group practice that first year without it! For the purposes of this blog, I’m going to focus on the setup steps for SimplePractice.com, a popular option for therapists in my area. Not sure which EHR is the best fit for you? Google comparisons of features and pricing or talk to colleagues to see what they like about each one.
2. Input your Business Data. Under Settings in SimplePractice (SP), be sure to input your NPI, business address, and Tax ID, which will not only populate on claims but will also autopopulate on superbills for clients who request one.
3. Enter your client demographics. Gender, Address, Phone Number, and Date of Birth are all required to bill a Medicaid claim successfully. Enter each client into your client list in SP and fill out their information as thoroughly as you can. You may also give the client access to their own portal, allowing them sign documents and input a lot of this information themselves which could save you time.
4. A Diagnosis is Required. A mental health diagnosis must be entered into the client record to bill insurance for mental health services, including Medicaid. Be sure to record the diagnosis before generating your first claims, otherwise you’ll receive an error message!
5. Choose the Correct Payor ID. This is the most common mistake I see in Medicaid billing for therapists here in Colorado! For Colorado Access, which manages members in RAES 3 and 5, there are two payor options listed to choose from in the “Billing and Insurance” tab. The correct payor ID for Medicaid mental health services with Colorado Access RAES 3/5 is COACC Access Behavioral Care. Choosing the other option will send your claims to the medical department which will either delay payment or get kicked back to you.
6. Enter the Modifier. Required for the past two years, the HE modifier must be included in your claims for any and all mental health services rendered with Medicaid insurance. Claims that are missing the HE modifier, which basically indicates outpatient mental health services, will be rejected and sent back for correction.
So there you have it, six steps to getting your Medicaid claims submitted for processing through an EHR. Be sure to collect your Explanation of Benefits (EOB) for any claims that are paid out by Medicaid, in order to confirm what clients and sessions have been paid out successfully. Thank you for all you do for our community in serving Medicaid members. Still have questions? Book a professional consultation with me to be one step closer to Medicaid Mastery in Private Practice!
*Khara does not work for Medicaid and the information shared is based on her own experience. Be sure to connect with your Medicaid Liaison for further support and clarification on contracts, billing, systems and process