Basic Billing Tips for Mental Health Providers
Challenges in Mental Health Billing
Medical billing can be extremely complicated on its own, but medical billing for mental health services brings its own set of unique challenges. Between the types of services offered, pre-authorization, unbundling concerns, and the size and time availability of office staff, mental health facilities are often at a disadvantage compared to other health professionals. By understanding the process for behavioral health billing, providers can spend more of their time and energy focusing on what truly matters—their patients. That’s why we believe in doing as much as possible to lift the weight of medical billing off of medical professionals whose time is better served in other areas.
Billing Tips for Mental Health Services
Medical billing for mental health services is more difficult than other areas of healthcare because of the types of services, time, scope, and restraints placed on mental health treatments. Mental or behavioral health treatments differ greatly from others, depending on a multitude of factors such as session length, therapeutic approach, the location in which services are rendered, the age and willingness to participate of the patient, and other contributing factors. Because of these variables, it is difficult to standardize treatment and therefore billing. Here are some tips to help mental health practices effectively and efficiently bill for services provided, leading to fewer denials, more funds for the business, and more time to help patients.
Patient’s insurance and coverage
Our first tip is to know each of your patient’s insurance plans and benefits before each visit. This may sound extremely time intensive. However, making sure you know the coverage available for each patient before they receive any services will lead to a larger return in the end. In order to know what coverage your prospective patients have; we recommend conducting a verification of benefits (VOB) for each patient before any treatment or services are received.
Many insurance companies have online provider portals where you can quickly and easily verify a patient’s eligibility and benefits. If the insurance does not have an online portal or the portal does not answer all of your questions, you can also call the insurance company’s provider helpline using the patient’s account number from their insurance card to discover their benefits. Overall, it’s extremely important to understand what benefits and coverage each patient has so that you don’t end up with rejected claims and unpaid bills.
Understand Mental Health Coding
CPT codes determine the amount of reimbursement given to healthcare facilities. When dealing with behavioral health billing, it is critical to understand the services your practice offers and know the associated CPT codes. Some mental health service providers will use the same CPT code for every patient; however, this is not legal or recommended. For mental health providers, there are two types of CPT codes you might use: E/M codes and psychiatric evaluation codes. Psychiatric evaluation codes, are used for a diagnostic assessment. A psychotherapy session can include E/M services, but the time associated with the E/M service cannot count toward the time of the psychotherapy service. One example of this would be discussing new medication options and side-effects during a psychotherapy session.
Avoid Claim Rejections
In order to receive reimbursement from a claim, not only do you have to file the correct code to the correct insurer, but you also have to submit the claim in the correct billing format, which can vary depending on the insurance company. Make sure you know the insurance company’s preferred filing method and that you file within the time allowed by the insurance plan. The UB-04 form is the claim form used by many of the major insurance companies for specialized health centers such as mental health and rehabilitation clinics, so this is the form you will want to familiarize yourself with. The UB-04 can be filled out on paper or electronically, with numerous software programs loaded with the current version of the form and instructions for filing.
As you can see, there is a large amount of work that goes into filing claims correctly for mental health providers. Because of this, it is not surprising that many providers choose to employ a third-party billing company to handle claims, so they have more time to focus on patient care and treatment. We partner with providers for pre-authorization, third-party medical billing, claims follow-up, and to assist with appeals for any denied insurance claims. To know more about our mental health medical billing services contact us at 888-552-1290 / [email protected]