Behavioral & Mental Health
The Behavioral health involves the study of emotions, biology, and mentality and their impact on a person's behavior and day-to-day existence. Billing for mental and behavioral health services is challenging due to the nature of the care provided to patients and the financing available for treatment. In the US healthcare industry, the widespread misuse of opioids, including heroin and prescription painkillers, has had a severe impact. Substance abuse and substance use disorder treatment have traditionally been provided separately from other mental health and general healthcare services.
Patients with behavioral problems receive treatment from counselors and psychiatrists using various methods, including counseling, medication, meditation, and more. Depending on the patient and the condition, treatment can take different amounts of time. Patients with severe behavioral issues may need further rehabilitation, literacy instruction, job training, etc. Unfortunately, insurance companies frequently allocate insufficient time for each treatment method, resulting in billing errors when services are rendered. Understanding the reasons for denied claims and delayed refunds is critical. The following are common reasons for claim denials:
Prior Authorization
Clinicians must obtain prior approval before beginning most mental and behavioral health procedures.
Documentation errors
CMS has specific documentation requirements, such as timesheets, encounter notes, date and location of treatment, and proof that the plan was created by a professional care team that included the patient and their family. Establishing the medical necessity of the treatment or procedure is crucial, and thorough documentation can help avoid denials.
Accurate Coding:
Payment for treatment is based on the number of units, and the time spent in therapy is a critical factor. Proper medical codes based on the time spent can help avoid errors that affect the number of units billed.
Violations of the law
CMS identifies specific policy violations that often occur when billing for behavioral/mental health therapies. These include:
1. Failure to promptly record progress notes
2. Billing for services that require prior approval but not obtaining those approvals
To run a successful practice or billing business, precise invoicing and clean claims submission for the services rendered are essential. Outsourcing billing processes can free up time and enable workers to focus on more important tasks. It can also prevent significant financial losses resulting from incorrect billing and claim submissions. Our team of behavioral and mental health billers utilizes best practices to increase your revenue and reduce claim rejections.
Best practices for Behavioral and Mental Health Billing
Our team specializes in behavior and mental health billing and coding, and we stay up to date with HIPAA standards. To avoid long-term denials, we ensure that patients' mental health insurance benefits and eligibility are approved in advance. With our knowledge of ICD codes for behavior and mental health, we can submit accurate claims. Here are some best practices we recommend:
• More information is better: Our staff asks patients for all relevant information, such as alternate contact information, insurance details, and social security numbers, before contacting insurance companies to ensure we have everything we need.
• Specialty-specific solutions: To prevent unnecessary complications or delays, our team has expertise in addressing the specifics of behavior and mental health billing.
• Claim follow-up: We regularly monitor submitted claims to identify and address denials promptly.
• CPT and HBAI codes: We keep up with annual CPT code changes and understand how to use HBAI codes when billing for mental health treatments provided to mitigate the impact while treating a physical health issue.