Medical billing can be extremely complicated on its own, but medical billing for behavioral health services bring its own set of unique challenges. Between the types of services offered, pre- authorization, unbundling concerns, and time availability of office staff, behavioral health facilities are often at a disadvantage compared to other health professionals. By understanding the process for behavioral health medical billing, providers can spend more of their time and energy focusing on what truly matters – their patients.
Behavioral heatlh services differ greatly from others, depending on a multitude of factors such as session length, therapeutic approach, the age and willingness to participate of the patient, the location in which services are rendered, and other contributing factors. Because of these variables, it is difficult to standardize treatment and therefore billing. In an effort to minimize payment, many insurance companies have tried to standardize behavioral health medical billing by dictating how long treatments can take, how many treatments can be received per day or week, and what the maximum number of treatments covered can be. Mental health services often require “pre-authorization” to be covered, making it even more complex and difficult.
Another reason behavioral health medical billing is difficult because of the lack of resources available for behavioral health providers. Many behavioral health services are small group practices or even solo practices with limited or no administrative support. This means the physicians themselves carry the burden of medical billing.
How can behavioral health providers overcome the difficulty of medical billing? Here are basic solutions to help behavioral health practices to bill effectively and efficiently for services provided, leading to fewer denials, more funds for the business, and more time to help patients.
First thing in behavioral health medical billing is to verify each patient’s insurance plans and benefits before each visit. This is extremely time-consuming process. 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. By checking the Verification of Benefits (VOB), we ensure that patients are covered for the services they are seeking, and determine how much their insurance company will pay for these services. It is extremely important to understand what benefits and coverage each patient has so that you don’t end up with rejected claims and unpaid bills.
When dealing with behavioral health medical billing, or really any type of medical billing, it is critical to understand the services your practice offers and know the associated CPT codes. Some behavioral health service providers will use the same CPT code for every patient, however, this is not legal or recommended. For behavioral healthcare practitioners, there are two types of CPT codes you might use: E/M codes and psychiatric evaluation codes. E/M codes should be used when evaluating a new medical issue and must have three documentation elements provided. These three elements are history, examination, and medical decision-making. Psychiatric evaluation codes, on the other hand, are used for a diagnostic assessment. To reduce the risk of claim rejections, it’s important to know which CPT code to use and how to use them.
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. We know each insurance company’s preferred filing method and the time allowed by the insurance plan. The CMS-1500/ 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.
Our average billing fee ranges from 2.5% to 7%. We offer add-on services like provider credentialing, old AR clean-up, and patient collection. We don’t have any start-up fee or software setup fee. We don’t use restrictive, long-term contracts. You can cancel your agreement at any time with only 30 days’ notice. You can call us at 888-552-1290 or request a customized quote by submitting the inquiry form below.
Our billing team has great expertise in following billing softwares. If you choose our billing services, you don’t have to change your current billing software. We will continue from the point where your last biller had left. So no claims or denials will remain unattended. In simple words, peace of mind for you.