Lost Revenues For TMS Claims

A growing number of Mental Health physicians are choosing non-invasive, non-drug, TMS therapy for treatment of depression. This therapy has helped many patients get better, but doctors are growing frustrated with unpaid claims from insurances. This is a high-cost treatment requiring up to 36 sessions. If one of the invoices does not get paid, it causes a domino effect for the rest of the claims for remaining sessions. TMS therapy payments from insurances range from $7750.00 to $19,710.00, depending on the number sessions provided. Back desk preparation with insurances is crucial for ensuring this treatment can be made available to patients.

For processing TMS therapy claims, the billing department needs to pay attention to minutiae details of Mental Health plan coverage, just as the doctor carefully prepares for delivering the treatment. 

The best preparation for good work tomorrow is to do good work today.” 

-Elbert Hubbard

In my years of billing for TMS therapy, there are a few things I found to be very helpful to get claims paid and keep accounts updated. I have summarized my findings below. 

TMS Claims

Health Coverage Verification

To understand insurance coverage for a patient, biller must gain mastery of Mental Health plan coverage and benefits. A patient will most probably have separate plan coverage for mental health, so the biller has to make sure not to verify coverage for patient’s medical plan. Mental health plans might also have separate claim mailing addresses and payer IDs for submitting claims.

All information received from insurances for pre-authorization of TMS therapy must be noted in the patient’s file. Many times, billers will need to give all details of authorization back to the insurance, as insurances are often denying TMS claims after authorizing the services. 

Claim Submission

The CMS claim form is a single sheet of paper that holds all the information about a patient’s visit/treatment that is required by insurance. Any incorrect information will result in the claim getting denied. When filling out the claim form, some of the information to review is patient demographics, insurance ID and insurance details, designated CPT and diagnosis codes, and provider and practice information.

Individual insurances might have different requirements on what information to include for TMS claims. It is very important not to apply one insurance rule to another. Understanding a payer’s requirement is a must in getting TMS claims paid. 

Pursue Each Claim

If a claim goes beyond three weeks without getting paid, follow-up on it diligently to know the payment status. Billers must ensure that previous claims have been paid before the patient comes in for subsequent treatments. Identifying claim and payment issues on time will have a great impact on practice income and patient care. 

Along with therapy sessions and drug management, more Psychiatry practices are adding on additional treatment methods, such as TMS and Esketamine therapies. More options mean better care for patients. As billers, our responsibility is to make sure payments have come in for all services in order to give the medical practices the boost they need to continue to deliver excellent service to patients. 

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