Billing Fees and Procedures

Billing Fees and Procedures

Fees:

  • Intake (all insurances except United Healthcare) CPT 90791: $150
  • Intake United Healthcare (UHC) CPT 90791: $150
  • Intake Discount Rate CPT 90791: $125
  • Counseling session 1 hr. CPT 90837: $125
  • Counseling session 1 hr. (UHC) CPT 90834: $125
  • Counseling session preventative 99404: $125
  • Counseling session Discount Rate CPT 90837: $100
  • Counseling session Family/Couple CPT 90847: $125
  • Crisis/Emergency counseling CPT 90839: $250
  • Crisis/Emergency counseling +30mins CPT 90840: $100
  • Group Therapy 90853: $60
  • Group Therapy Discount Rate CPT 90853: $30
  • Late Cancellation/No Show fee: $50
  • Medical Record surcharge: $10
  • Medical Record copies (up to $100): $1 per page
  • Returned Check fee: $35
  • Documentation Request: $25+
  • Documentation Request same week rush fee: $50
  • Presentations: $250+
  • Psychological Assessment: $150 current clients $300 new clients
  • Career Assessment: $250
  • College/Career Coaching: $150hr
  • Court appearance: $375/hr
  • Resume Writing: $100
  • Resume Editing: $50
  • Special Events: $35

Insurance Accepted:

Please note: Professional counselors may not be credentialed on all panels

  • Aetna-Out of Network
  • AmeriHealth
  • Anthem Blue Cross Blue Shield
  • Beacon
  • Beacon EAP
  • Blue Cross and Blue Shield
  • Cigna
  • Emblem Health
  • Empire Blue Cross Blue Shield
  • GHI
  • Hackensack Meridian-all plans
  • Horizon Blue Cross Blue Shield
  • Magellan Behavioral Health
  • Meritan Health-Toms River & Long Branch Schools
  • Military OneSource
  • Optum
  • Qualcare
  • Tricare
  • UMR
  • United Health Care
  • Value Options

Financial Policy:

  • Office manager will set up invoices daily for appointments.
    • LAC invoices will have the Clinical Supervisor or Director (EAP cases) as pay to provider
  • Government ID and insurance card must be received at the initial session
  • Inform the client that they are solely responsible for understanding their insurance policy/requirements prior to their session including benefits and eligibility, referrals, authorization and other required forms (Office staff will have applied general mental health benefits information in the welcome e-mail they received prior to intake session).
  • Credit card is strongly encouraged to be put on file during initial session for copays and outstanding balances
  • Copays for insured clients and full amount for discounted rate and other services are due prior to the start of each session.  If clients cannot pay, service cannot be rendered and late cancellation fees with apply.
  • Clients without a copay may receive service as long as an outstanding balance is not present or a payment plan is in place.
  • Phone conversations with therapists over 10 minutes will be charged at the hourly session rate, counselor will notify client of this at the 5 minute mark.
  • We require 24 hours notice for canceling any appointment, or a $50.00 missed appointment and/or no show fee will be charged by the counselor to the client’s file with the original billed sessions removed by the counselor.
  • A $35.00 fee will be charged for any checks returned for insufficient funds.
  • Electronic communication including emails and text messaging is for scheduling/billing purposes only.
  • If a counselors deems a situation as a crisis, the session should be re-billed by office staff to reflect the crisis rate and appropriate add on codes prior to any claims being submitted for that date.  The Office Manager will remove the original invoice and bill appropriately while the counselor will inform that client that the session will be billed as a crisis considering circumstances.
  • Any outstanding balances from the previous month will be charged to the credit card on file on or on the closest business day to the 15th of the following month by the Director with the exception of a payment plan on file.
  • Returning clients who have a balance will need to clear their balance with the Office Manager prior to scheduling a new appointment.  The counselor will refer any returning clients with an outstanding balance to the Office Manager to clear their balance and schedule a new appointment.

Client Credits:

  • If client is inactive, Office Manager will alert Director of credit. Credit will be mailed via Chase bank directly via business account and take up to 10 business days to process and mail.
  • If client is active and receives a credit, it will be added to their account by the Office Manager and applied to their next payment.

Outstanding Balances:

  • Once insurance payment is received, the Office Manager will post the payment and adjust amount the client owes per their Explanation of Benefits received.  Once adjusted, the Office Manager will e-mail the invoice to the client.
  • Counselors are required to check the client’s ledger prior to collecting copays at the start of each session.  If clients have an outstanding balance, meaning there is a balance owed by the client after insurance processing (the Office Manager will post payments as received) the counselor is to inform the client of their balance and attempt to clear it at the start of the session or refer them to speak to the Office Manager to clear before next session or  to set up payment plan.  Counselor will inform client that they cannot schedule an upcoming appointment until their balance has been cleared.  Counselor may block out a placeholder (not appointment) on their calendar for the client as a courtesy, however this placeholder is not guaranteed should a client with a clear balance requests the same time slot.
  • An outstanding balance may include, but is not limited to any missing co-pay/deductible/co-insurance, late cancel/no show appointment fees, etc.; excluding balances due from insurance payments.
  • Any clients who have an outstanding balance will have future appointments canceled until balance is cleared.
  • Any special circumstances between client and counselor concerning an outstanding balance needs to be communicated to the Office Manager.
  • Once accounts have been cleared, the Office Manager will inform counseling staff to ensure limited lapse in treatment.
  • If accounts are not cleared and there is no payment plan on file by the 15th of the following month, accounts will be considered delinquent and sent to profit recovery following collections.

Payment Plans:

  • Clients who have an outstanding balance of $200+ are eligible to set up 1 payment plan only if:
    • there are special circumstances
    • the Office Manager and Director approve of the plan
    • the plan is signed with understanding that future session outstanding balances must be paid in full or future sessions will be canceled until balance is cleared.
    • $200 minimum outstanding balance with $500 max
  • Credit card must be placed on file for any clients who wish to participate in the payment plan, regardless if they are paying via cash or check as a back-up.
  • Office Manager will distribute, monitor, track and collect money for monthly payment plans on the 15th of each month as well as ensuring future sessions are cancelled if plan is not followed by client.
  • All clients on discounted rates are not eligible for payment plans, payment is due in full at time of session

Billing Process:

Part 1:

  • Office Manager creates invoice for client appointment
  • Counselor collects copay or payment for appointment
  • Office Manager submits claims for insurance processing

Part 2:

  • Office Manager receives explanation of benefits from insurance for claim and adjusts invoice
  • Office Manager e-mails client invoice
  • Counselor:
    1. Checks client ledger and informs client if balance owed at start of session
    2. Informs client copy of invoice was e-mailed to them, prints if client requests
    3. Client payment:
      • Counselor collects payment from client – can schedule next session
      • Refers client to Office Manager with any questions – sets placeholder for next appointment until payment is received

Part 3:

  • Office Manager calls client:
    • Asks if they have any questions regarding invoice
    • Collects payment via phone and changes placeholder to appointment
    • Sets up temporary payment plan if client meets criteria

Part 4:

  • Office Assistant creates report for outstanding balances to be charged on the 15th or closest business day of the following month.
    • Director charges client credit card of the 15th of the following month or closest business day
    • Director updates charge report in Evernote, Office Manager does the following on the 16th or closest business day:
      • Clients who were charged successfully:
        • Office Manager calls clients to schedule next appointment
      • Clients who could not be charged:
        • Office Manager mails client final request letter for payment by the 1st of the next month with attached invoices and credit card authorization form

Part 5:

  • Payment is received: account restored and Office Manager schedules next appointment with client
  • Payment is not received:  Office Manager initiates collections process by registering client in profit recovery program

Flow process from Part 2:

Example Scenarios:

  • Scenario 1: Client has discounted rate, but cannot pay at session start.  They will need to reschedule and session cannot be conducted.  All discounted rate payments are due at time of session.  We do not set up payment plans for anyone on a discounted rate.
  • Scenario 2: Client has a copay, but does not have it at the time of session.  If they have a credit card on file, we can charge the credit card.  If not, they will need to reschedule.
  • Scenario 3: Client has an outstanding balance at start of session and offers to pay part of it plus their copay, but not entire balance.  Session can be conducted, however a future appointment cannot be scheduled, only placeholder until balance is cleared.  Client must be referred to Office Manager to clear account for future appointment to be restored from placeholder.