Billing & Reimbursement for Psychologists
Discover essential strategies and insights to effectively manage insurance reimbursement challenges in your practice.
Enrolling as Covered Provider
Medicare
Looking to enroll as a Medicare provider? National Government Services (NGS) is the Medicare contractor for Vermont. Recent federal legislation allows master’s level clinicians, such as psychologist-masters, LCMHCs, and LMFTs, to enroll as Medicare providers, but psychologist-masters may need to show that post-degree supervised practice conforms with the relevant regulations. NGS provides several online manuals to assist providers, which you can see here.
Medicaid
Medicaid in the State of Vermont is administered by the Department of Vermont Health Access (DVHA, commonly pronounced “diva”). DVHA includes an array of resources for providers on its website, which you can find here. The DVHA Medicaid Portal also includes instructions for enrolling as a provider and news about changes and updates to its rules and regulations.
Commercial Insurance
In Vermont, the private insurance market is dominated by Blue Cross Blue Shield of Vermont and Cigna, according to a 2020 report by the Green Mountain Care Board. MVP also has a visible share of the commercial insurance market. For those providers who have never enrolled as a provider in the commercial insurance market, you must first be credentialed through the CAQH before enrolling with the commercial insurer.
Understanding Reimbursement Challenges
Comprehensive Guide to Insurance Reimbursement Issues
Psychologists often face a myriad of challenges when dealing with insurance reimbursements. These can include delayed payments, denied claims, and complex billing codes. Navigating these issues requires a deep understanding of insurance policies and effective communication with insurance providers. Many practitioners struggle with the administrative burden, which can detract from their focus on patient care. By familiarizing themselves with common pitfalls and proactive strategies, psychologists can streamline their reimbursement processes and improve their practice’s financial health.
Resources for Negotiating with Insurers
Psychologists often face a myriad of challenges when dealing with insurance reimbursements. These can include delayed payments, denied claims, and complex billing codes. Navigating these issues requires a deep understanding of insurance policies and effective communication with insurance providers. Many practitioners struggle with the administrative burden, which can detract from their focus on patient care. By familiarizing themselves with common pitfalls and proactive strategies, psychologists can streamline their reimbursement processes and improve their practice’s financial health.
Provider Relations Contacts
| Medicaid/DVHA | |||
| Misty Griffith | misty.griffith@gainwelltechnologies.com | (802) 497-6969 | Psychologists, LADC |
| [Unnamed] | vtproviderreps@gainwelltechnologies.com | (802) 497-6969 | Other mental health care providers |
| Medicare/NGS | |||
| [No contact available] | www.ngsmedicare.com | ||
| Blue Cross Blue Shield of Vermont | |||
| Nichole Hallock | hallockn@bcbsvt.com | (802) 371-3318 | |
| Cindy Foster | fosterc@bcbsvt.com | (802) 371-3300 | |
| MVP | |||
| Lori Bombardier | (802) 264-6505 |
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| Jill Bushey | (802) 264-6535 |
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| Carla Renders (Professional Relations Manager) | crenders@mvphealthcare.com | (518) 991-3960 |
Common Questions About Insurance Reimbursement
Understanding insurance reimbursement can be challenging. Here, we answer some of the most frequently asked questions to help you navigate these complexities with confidence.
What is the first step in filing an insurance claim?
The initial step is to verify the patient’s insurance benefits and obtain pre-authorization if necessary. This ensures that the services you provide are covered and reduces the likelihood of claim denials.
How can I reduce claim denials?
Make sure you know the particular insurer’s billing requirement and reimbursement policies for your services. Ensure all submitted claims are accurate and complete. Double-check patient information, procedure codes, and ensure compliance with the insurer’s guidelines to minimize errors that lead to denials.
What should I do if a claim is denied?
Review the denial reason provided by the insurer, correct any errors, and resubmit the claim. If necessary, contact the insurance company for clarification or to appeal the decision.
How long does it take to receive reimbursement?
Reimbursement timelines vary by insurer, but typically, you can expect payment within 30 to 45 days after claim submission, provided there are no issues with the claim.
Can I bill patients for the balance after insurance pays?
Yes, you can bill patients for any remaining balance after insurance has paid its portion, unless prohibited by the insurance contract or state regulations.
What resources are available for understanding insurance policies?
Our ebook and the resources available on the Vermont Psychological Association website offer detailed guidance on navigating insurance policies and understanding reimbursement processes.