Benefits of Mental Health Billing Services in 2023

Even without the added complexity of mental health billing services, medical billing laws may provide several difficult situations. Between the sorts of treatments supplied, pre-authorization, unbundling issues, and the size and time available of the office personnel, mental health institutions are sometimes at a disadvantage compared to other health providers.

Providers may devote more time and effort to what matters to their patients by knowing the behavioral health billing procedure. Denial Management is committed to doing all in its power to relieve the burden of medical bills from the shoulders of medical professionals, whose time is better spent in other areas.

Why is Mental Health Billing so Challenging and Complicated?

The types of services, duration, breadth, and restrictions on mental health treatments make medical billing for these services more challenging than in other healthcare settings. For instance, if someone visits the doctor for a usual checkup, they undergo a typical set of examinations and tests.

This often includes measuring the patient’s height and weight, taking their blood pressure, hearing their heartbeat, and maybe drawing blood. These tests are generally the same for every patient, require the same amount of time, and slightly vary from patient to patient. The same is true when healthcare professionals charge these regular examinations to health.

However, the same cannot be accurate for mental or behavioral health therapies. These services vary significantly based on various elements, including:

  • Session duration
  • Therapeutic approach
  • The setting in which services are provided
  • The patient’s age and level of participation

Among other contributing variables.

It is challenging to standardize therapy and mental health billing because of these factors.

  • Several insurance companies have attempted to standardize mental and behavioral health billing to reduce payment by establishing the length of sessions,
  • the number of treatments that may be obtained each day or week,
  • and the maximum number of treatments that can be reimbursed.
  • Moreover, pre-authorization is frequently required to refund mental health therapies, which adds to the complexity.

Due to a shortage of resources for mental health professionals, medical billing for mental health treatments is often challenging. Many mental health treatments are provided by solo or small-group practitioners with little to no administrative assistance. This implies that the responsibility for mental health billing services falls on the doctors themselves.

How can Mental Health Billing Services get past the Challenges of Medical Billing?

Here are some suggestions to help mental health practitioners bill for services rendered successfully and quickly, resulting in fewer denials, more revenue for the company, and more time to assist patients.

Double Check Patients’ Coverage Plan

Yet, the same cannot be said of behavioral or mental health treatments. Based on various factors, including session length, therapeutic method, the environment in which services are offered, and the patient’s age and degree of engagement, among other contributing variables, these services differ significantly from one another. These characteristics make it challenging to standardize therapy and, by extension, pricing.

To save costs, some insurance companies have standardized mental and behavioral health billing by setting the duration of sessions, the maximum number of treatments that may be covered, and the number of treatments that may be received each day or week. Pre-authorization is typically needed for mental health therapy to be paid, increasing the difficulty.

What Exactly is a Benefits Verification?

In addition to giving providers information not immediately available from a patient’s insurance card, verification of benefits verifies the patient’s policy concerning the service they are visiting for. Conducting a VOB is critical because even if a patient has active insurance, the treatment you give may not be a benefit that is covered. By consulting the VOB, you may find out if a patient is eligible for the services they need and how much their insurance company will pay for those services.

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Recognize CPT Codes

Insurance companies utilize CPT codes, or “common procedural technology” codes, to calculate how much money should be reimbursed to medical institutions. Some providers of mental health services will use the same CPT code for each patient. However, this is not permitted or advised.

E/M codes and psychiatric assessment codes are two CPT codes that behavioral healthcare professionals may employ. When assessing a new medical problem, E/M codes should be utilized, and three documentation components must be supplied. History, examination, and medical judgment are these three components.

History: The history comprises a review of the systems, the history of the current sickness, and the previous familial and social history.
Examination: The sort of examination done, the patient’s medical history and the nature of the issue are all covered in the examination part.

Making medical decisions The number of diagnoses or treatment alternatives recorded during the particular encounter, the complexity of the data evaluated, and the possibility of consequences are all included in the section on medical decision-making.

Nonetheless, a diagnostic evaluation makes use of psychiatric evaluation codes.

E/M services are permitted in psychotherapy sessions; however, their duration cannot be deducted from the time allotted for the therapeutic session. During a psychotherapy session, one illustration of this would be to talk about new pharmaceutical possibilities and adverse effects.

Knowing which CPT codes to use and how to apply them is crucial to lowering the chance that a claim will be rejected. To decide which CPT code to use for which service, you may see the requirements for CPT codes here. Use the correct code at all times because failing to do so may result in the claim being denied.

You must submit a claim in the proper billing format, which varies depending on the insurance provider and file the correct code to the right insurer to be reimbursed for a claim. Be sure you submit according to the insurance plan’s deadline and are aware of the recommended filing method used by the insurance provider. (During the Verification of Benefits process, it’s a fantastic idea to inquire about the insurer’s preferred way of receiving claim files!)

You should become familiar with the UB-04 form since it is the claim form used by many major insurance carriers for specialty healthcare facilities, including mental health and rehabilitation clinics.

Third-Party Medical Billing for Mental Health

As you can see, submitting claims accurately for mental health providers requires much work. It is not surprising, however, that many healthcare practitioners opt to engage a third-party billing business to manage claims so they can devote more time to patient care and treatment. Here at Denials Management, we collaborate with providers to pre-authorize, charge third parties for medical services, follow up on claims, and support appeals for any refused insurance claims.

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