Frequently Asked Questions
Medical billing is the process of submitting and following up on claims with health insurance companies to receive payment for services provided by a healthcare provider.
CPT (Current Procedural Terminology) codes describe the services provided. These codes must be accurate for proper reimbursement.
Eligibility checks if the client has active insurance coverage. Authorization is approval from the payer to provide specific services under certain conditions.
Both are required before services begin to ensure reimbursement.
Verify eligibility & obtain authorization.
Provide the service.
Document services and progress.
Submit claims using correct codes and modifiers.
Follow up on denials or rejections.
Post payments and address outstanding balances.
Modifiers give extra information about a service provided. Common examples:
95: Telehealth
GT: Synchronous telecommunication
59: Distinct procedural service
HN/HO: Indicates provider level (Bachelor’s or Master’s)
Common reasons:
Incorrect/missing codes or modifiers
Services not authorized
Patient not eligible on date of service
Timely filing limits missed
Documentation issues
At least monthly. Always verify expiration dates and number of approved units/sessions.
Rejection: Claim never entered the payer’s system (fix and resubmit).
Denial: Payer processed the claim but refused to pay (requires appeal or correction).
Progress notes (daily/session-based)
Treatment plans
Supervision notes (ABA)
Evaluation reports
Parent signatures (as required)
Typically:
Private insurance: 15–45 days
Medicaid: 30–90 days
Cash pay: At time of service or within billing cycle
Practice management systems:
CentralReach
WebABA
SimplePractice
Fusion
Clearinghouses:
Availity
Office Ally
EHRs:
Athena
Kareo
TherapyNotes
Errors in client info, diagnosis codes, or provider NPI can lead to denials, compliance issues, and lost revenue.
Depends on the payer. Some allow initial sessions or evaluations without prior authorization. Always confirm with payer-specific policies.
No. Services must be documented appropriately to meet compliance standards and payer requirements.
Review the denial code/reason
Correct the issue (e.g., add modifier, resubmit with proper documentation)
File an appeal if necessary
Track follow-up