Billing software for psychologists is judged on a claim that looks simple and is not: one session code per visit, a diagnosis the payer accepts, an authorisation number that has to be on the claim and has visits left on it, and a client who owes a copay every week and a coinsurance every month. A solo or small group psychology practice bills more claims per dollar than almost any other specialty, so the denial rate and the posting discipline matter more than any feature. This page sets out what the software has to carry for a psychology practice, the two places its claims fail, and what the practice keeps beside the software so the client statement is right and the client's privacy is kept.
What the software has to carry for a psychology claim
The session code with its time band, the add-on codes where the session runs long, the diagnosis, the authorisation number with the visits remaining, the rendering provider's taxonomy, and the place of service including telehealth. The claim goes out as an 837 through a clearinghouse under the HIPAA transaction standards, and the remittance comes back as an 835 the software posts against the claim. Software that cannot hold the authorisation and count down its visits is software that will produce authorisation denials every month.
The two places a psychology claim fails
Authorisation: the visit was the eleventh on a ten-visit authorisation, or the authorisation lapsed, and the claim comes back denied for lack of it. Medical necessity and frequency: the payer's policy limits sessions per week or per condition, and the claim comes back with a non-covered or not-medically-necessary code. Both are prevented at the front desk and worked from the denial queue with the reason code; neither is fixed by a better claim form. The claims cycle worksheet on this site shows what they do to the denial rate.
The client statement, and the privacy it has to keep
A psychology practice's statement carries the diagnosis code and the session dates, which is protected health information under the HIPAA privacy rule, and the software has to render it, store it and send it accordingly. The EOB reconciliation worksheet here works one session's posting: the charge, the allowed amount, the contractual adjustment, the copay and coinsurance, and the payer payment, with the check that the posting balances to the charge. A statement built from a balanced posting is a statement the client can be shown the working of.
What the practice keeps beside the software
The claims register: every session's claim with its payer, the authorisation it drew on, the posted EOB, the denial and the appeal, and the client's balance, in a form the practice owns and can export when the software contract ends. Eobify Pro keeps that register; the billing software carries the claim to the payer. A practice that keeps only the software's own records discovers at the contract's end that the history belongs to the vendor.
Questions people ask about billing software for psychologists
Do psychologists need medical billing software or is a spreadsheet enough?
For electronic claims and remittance posting, software with a clearinghouse is needed. The spreadsheet fails at the authorisation count and the posting, which are exactly the two places psychology claims fail.
What is the most common denial for a psychology practice?
Authorisation: the visit outside the authorised count or after the authorisation lapsed. The software has to count visits down against the authorisation, and the front desk has to check before the session.
Can billing software for psychologists handle telehealth sessions?
It has to: the place of service and the telehealth modifier the payer requires go on the claim, and the software should hold the payer's rule for each. Check it against your own payers rather than the vendor's list.
Is the client statement covered by HIPAA?
Yes. It carries diagnosis codes and dates of service, which are protected health information, and the software that renders and sends it is held to the privacy and security rules in 45 CFR Part 164.