Group therapy is a powerful treatment modality for many patients and can be cost-effective for practitioners. But for many therapists, maximizing reimbursement for these sessions is challenging. Group therapy involves unique documentation and coding practices that can significantly impact your bottom line. However, with the right tools and strategies, it’s possible to be well-paid for this type of service.

From understanding billing to leveraging cutting-edge electronic health record (EHR) systems, here’s everything you need to know about group therapy reimbursement.

Understanding Group Therapy Reimbursement

The billing and payment process for group therapy is similar to that of individual therapy: the provider documents the session, creates the bill, selects the appropriate service code(s), and sends it to the payer. But for group therapy, the bill itself may look different.

Group therapy has its own set of CPT codes and modifiers. These codes are used to document the services provided within a group context. For example, the HQ modifier indicates a group setting for services. In addition, billing must cover multiple clients per session, and session bills may be sent to more than one payer depending on the coverage of different group members. This takes organization and diligence on the part of the biller.

You may find the per-patient reimbursement rate lower for group sessions than individual sessions, since the therapist’s time is divided between multiple people in a group setting.

Accurate Documentation for Group Therapy

Accurate documentation is the cornerstone of successful reimbursement. It supports your claims and demonstrates compliance with insurance regulations. Follow these best practices for documenting group treatment:

1. Be specific. Record the focus of each session, techniques used, and each participant’s engagement and progress.
2. Take attendance. Keep a clear record of who attended so you can document the size of each gathering and gauge which patients participate regularly.
3. Track the time. Note the session’s start and end times, as well as the duration of therapeutic interaction.
4. Record therapeutic interventions. Describe specific interventions used and how they were tailored to the group setting.
5. Review payer-specific guidelines regularly. Stay up-to-date on unique documentation requirements for group therapy.
6. Implement standardized documentation. This helps all providers at the practice stay consistent.
7. Audit documentation. Do it regularly so you can address gaps or areas for improvement.

Choosing the Right CPT Codes and Modifiers

You want to be paid your worth, so make sure everything you contribute to each group session is reflected in the CPT coding. Remember that group therapy requires different codes than individual therapy.

Common group codes and modifiers include:

• 90853: Group psychotherapy (other than of a multiple-family group)
• 90847: Family psychotherapy (conjoint psychotherapy) with patient present
• 90849: Multiple-family group psychotherapy
• HQ (modifier): Group setting
• 59 (modifier): Distinct procedural service

Common Challenges and How to Overcome Them

Dealing with rejected group therapy claims? Overwhelmed with billing for multiple clients per session? If you’re getting stuck with group therapy reimbursement, try these solutions.

Challenge: Rejected claims due to incomplete documentation

Solution: Use a checklist so that all required elements are included in every session note.

Challenge: Incorrect participant counts

Solution: Use a sign-in sheet for each session and cross-reference it with your documentation before submitting claims.

Challenge: Mismatched time reporting

Solution: Time-tracking features can accurately record session times. If possible, find a time tracker that integrates with your EHR.

Challenge: Incorrect coding

Solution: Study up on CPT and modifier codes for group therapy. Post them somewhere visible while billing.

Leveraging Electronic Health Record (EHR) Systems

An EHR system built for behavioral health can be a game-changer in managing group therapy and maximizing reimbursement for it. Take advantage of the features these systems have to offer:

• Batch eligibility checking. Check eligibility for each patient up front to prevent insurance snafus. Many EHRs let you do batch checks to save time.
• Easier documentation. Customizable templates tailored to group therapy save you time and ensure all necessarily elements are included. The easier the documentation, the less likely that a practitioner will fall behind, and the better your practice’s cash flow.
• Integrated billing. If your billing integrates directly with the EHR, you can auto-generate bills for each patient and reduce the likelihood of errors, improving your claims acceptance rate.
• Help with CPT codes. An EHR library of CPT codes makes it easier to find the correct code every time. Some systems even offer automated code suggestions based on the documentation.
• Compliance checks. Many systems have built-in alerts for potential documentation or coding issues, so you can catch mistakes before claims submission.
• Reporting tools for billing. Track reimbursements, denials, and other key performance indicators. This helps you or your billing department stay on top of rejected claims so you can resolve them promptly.

Before choosing an EHR, remember that behavioral health EHRs offer benefits compared to generic EHRs. Mental health providers often spend time creating customizations or workarounds for generic EHRs, because these programs simply aren’t built to reflect the needs and workflows of a mental health practice. On the other hand, a behavioral health EHR tailors its templates, billing, patient records, and other features specifically to your industry. You’ll have the right set of CPT codes in your library.

Save time. Improve adherence. Reduce frustration. A behavioral health EHR is well worth the investment.

Staying Up-to-Date with Reimbursement Policies

Regulations around healthcare reimbursement are always changing. It can be tough to stay informed. To keep your practice up-to-date, try the following strategies.

• Attend workshops and webinars focused on behavioral health coding.
• Sign up for newsletters published by your most common payers.
• Join professional associations like the American Psychological Association, which often publish news about regulations.
• Reach out to your EHR vendor to see if they provide training on reimbursement best practices.
• Hold training sessions for all staff who manage coding in order to set them up for success.
• Ensure that all internal processes such as documentation templates and billing procedures are up-to-date at your practice.
• Conduct regular claims audits. Reviewing samples of claims can help you spot and correct recurring problems.

Finally, if you’re ever worried about complex billing questions or changes to reimbursement policies, consider working with a healthcare billing specialist.

Ongoing Process

Maximizing reimbursement for group therapy requires attention to detail, along with the right tools. The key to success is viewing reimbursement optimization as an ongoing process rather than a one-time fix. Regularly review your practices, stay informed about industry changes, and don’t hesitate to leverage technology and expert resources.

Take action today to enhance your group therapy reimbursement strategy. Consider exploring specialized EHR solutions designed for behavioral health practices, which can streamline your documentation, coding, and billing. By investing in the right tools, you can capture fair compensation for the vital group services you provide.