Frequently Asked Questions
1
What is medical billing?
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.
4
What is the billing process?
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.
7
How often should authorizations be checked?
At least monthly. Always verify expiration dates and number of approved units/sessions.
10
How long does it take to get paid?
Typically:
Private insurance: 15–45 days
Medicaid: 30–90 days
Cash pay: At time of service or within billing cycle
13
Do all services need to be authorized?
Depends on the payer. Some allow initial sessions or evaluations without prior authorization. Always confirm with payer-specific policies.
2
What are CPT codes and why are they important?
CPT (Current Procedural Terminology) codes describe the services provided. These codes must be accurate for proper reimbursement.
5
What are modifiers in billing?
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)
8
What is the difference between a rejection and a denial?
Rejection: Claim never entered the payer’s system (fix and resubmit).
Denial: Payer processed the claim but refused to pay (requires appeal or correction).
11
What systems or platforms are used for billing?
Practice management systems: CentralReach, WebABA, SimplePractice, Fusion
Clearinghouses: Availity, Office
Ally
EHRs: Athena, Kareo, TherapyNotes
14
Can services be billed if documentation is missing?
No. Services must be documented appropriately to meet compliance standards and payer requirements.
3
What is the difference between authorization & elibility?
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.
6
Why do claims get denied?
Common reasons:
Incorrect/missing codes or modifiers
Services not authorized
Patient not eligible on date of service
Timely filing limits missed
Documentation issues
9
What documentation is needed to support billing?
Progress notes (daily/session-based)
Treatment plans
Supervision notes (ABA)
Evaluation reports
Parent signatures (as required)
12
What’s the importance of accurate data entry?
Errors in client info, diagnosis codes, or provider NPI can lead to denials, compliance issues, and lost revenue.
15
What should I do if a claim is denied?
Review the denial code/reason
Correct the issue (e.g., add modifier, resubmit with proper documentation)
File an appeal if necessary
Track follow-up