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Results-Driven Billing Solutions for TMS Therapy
< 30
Days in AR
10-15%
Revenue Increase
97%
First Pass Ratio
96%
Collection Ratios
98%
Clean Claims Rate
TMS Billing Services We Offer
Have you ever considered partnering with a reliable medical billing company that can cater to all your requirements? If yes, you are in luck! MediBillMD offers a one-window solution to practices billing for TMS therapies. So, whether you need TMS billing and coding services, credentialing support, denial management, old A/R recovery, or revenue cycle management (RCM), we have you covered.
What's more? We can help you streamline claim submissions, eliminate authorization delays, maximize reimbursements, and improve denial management. The best part is that we offer around-the-clock support and assign a dedicated account manager. This ensures you get insights into your billing operations whenever you want.
Common Challenges in TMS Medical Billing
From complex authorization requirements to CPT code sequencing management and medical necessity documentation, TMS billing challenges can easily overwhelm practices. Why? Most small psychiatric practices do not have the funds to set up an in-house billing department with certified coding experts, as they are costly to hire. This leads to the second option: juggling billing operations and clinical activities themselves.
The result? A complete disaster! Physician burnout, high denial rate, unsteady cash flow, and patient dissatisfaction due to high copays and deductibles. While navigating all these pitfalls, quality care delivery takes a backseat, ultimately leading to the downfall of TMS practices.
The Fail-First Requirement
Most insurance carriers follow a strict fail-first policy when reviewing TMS therapy pre-authorization requests. That is, you must submit documented evidence that a patient tried and failed 4-6 different antidepressant medications from at least two different drug classes to get the approval. Incomplete patient records can lead to pre-auth denials.
Complex CPT Code Sequencing
TMS billing involves a specific sequence of codes. For example, 90867 (initial motor threshold mapping), 90868 (daily delivery and management), and 90869 (subsequent re-mapping). The challenge? Payers closely monitor the frequency of re-mapping. Thus, billing 90869 too early or too frequently without justification will lead to claim denial and audit risks.
Medical Necessity Documentation
Another TMS billing challenge is that payers require evidence of a reduction in depression score (e.g., 50%) or steady functional improvement throughout the 6 to 9-week treatment course. As a result, you must utilize the validated depression scales, such as BDI, HAM-D, or PHQ-9, consistently to ensure continued reimbursement.
Strict Session & Tapering Limits
The standard TMS protocol is highly structured. That is, it typically consists of 30 induction sessions followed by a 6-session taper. However, guidelines for scheduling these may vary significantly across payers. Besides, if a patient misses several days of treatment due to illness or personal reasons, the tapering window may shift.
Outsource TMS Billing & Coding to MediBillMD
When we started MediBillMD, we had one specific goal. That is, to create separate teams of billers and certified professional coders (CPCs) for each specialty. The reason? Each specialty has its own unique set of challenges. Besides, even within the same specialties, the challenges across practices may vary significantly. That is, one of the major reasons why we always conduct an audit before onboarding a new client.
With that said, if you are a TMS therapy provider or running a psychiatric practice, know that when you collaborate with MediBillMD, you will get many benefits. Some of these include our ability to provide specialized TMS billing support, direct communication with CPCs, pre-authorization workflow optimization, payer-specific expertise, and session and tapering limits tracking.
Our expert team of CPCs and TMS billing specialists has mastered TMS-specific code sets. Thus, when you acquire TMS billing and coding services from MediBillMD, we ensure each session is reported with the highest degree of specificity and appropriate modifiers. This ultimately eliminates the likelihood of incorrect code pairing errors.
Securing approval for TMS requires a rigorous documentation hurdle known as step therapy. However, our dedicated authorization team proactively manages the exhaustive collection of pharmacy logs and clinical records to build a bulletproof case for medical necessity. The result? Reduced front-end rejections, leading to a seamless billing cycle.
Typically, payers limit TMS coverage to a specific number of induction and tapering sessions. However, when you get our billing services for TMS therapy, we implement a systematic tracking cadence, alerting you before a patient reaches their authorized limit. This helps you secure secondary authorizations in advance and prevent uncollectible claims.
Transcranial magnetic stimulation billing requirements vary significantly across payers, particularly regarding double TMS sessions or same-day evaluation and management visits. But, at MediBillMD, we stay current on policy shifts to ensure our partnered practices remain compliant with payer-specific frequency limits and documentation standards.
It doesn’t matter whether you run a TMS therapy center in Texas or Hawaii; when you partner with MediBillMD, you do not have to worry about state-specific laws and policies. The reason? We offer TMS therapy medical billing and coding services across all fifty states of the US. Thus, you can leverage our customized TMS medical billing solutions beyond state lines, from the East Coast to the West Coast.
Overcome TMS Billing Challenges with MediBillMD
Are you overwhelmed by challenges encountered during billing for TMS therapy, and do not know how to handle the financial aspects of your practice in-house? Dump all your worries, and outsource. Why? Because our TMS medical billing services are provided by specialists who know all the ins and outs of streamlining the billing operations, maximizing reimbursements, and reducing days in accounts receivable.
| TMS Billing Challenge | MediBillMD Solution | |
|---|---|---|
| CPT Code Specificity and Daily Limits | At MediBillMD, our team of CPCs is proficient in these technical code sets. Besides, we implement automated checks to ensure daily sessions are billed accurately as per specific payer guidelines. | |
| Medical Necessity-Related Denials | WeOur TMS billing team proactively manages denials. How? We submit the clinical data required to overturn these specific denials by analyzing the trends and coordinating with providers. | |
| Authorization Expiration Tracking | We employ a systematic tracking cadence that alerts providers before authorizations expire. This ensures continuous coverage and uninterrupted patient care. | |
| Prior Authorization Requirements | Our TMS medical billing specialists manage the entire authorization lifecycle. That is, we ensure all specific medical-necessity criteria are met and documented to prevent front-end denials. | |
Best Rates Guaranteed
Getting professional billing services for TMS therapy does not have to break your bank. With MediBillMD, you get access to tailored services, CPCs, and billing specialists, all at market-competitive rates.
Get in Touch with Our TMS Billing Experts
Are you looking for a TMS billing company that can assign you a dedicated account manager, share bi-weekly reports, and offer around-the-clock support? If yes, MediBillMD has got you covered!
FAQs
At MediBillMD, we offer specialty-specific services. That is, we have a dedicated team that understands the nuances of medical billing for TMS, such as initial motor threshold mapping and the documentation required for prior authorizations.
The pricing varies depending on the size and complexity of your practice. However, MediBillMD generally takes a small percentage from your net monthly collections. Simply put, it is a performance-based pricing model, meaning our success is tied to yours.
Some of the major TMS billing challenges include navigating prior authorization requirements, maintaining medical necessity documentation, and tracking authorization expirations.
