Medical billing is already complex in itself, and it comes with even more challenges when applied to mental health services. This is why behavioral health specialists and facilities often find themselves overwhelmed by a range of concerns around: the services offered, unbundling, pre-authorization, and availability of staff. As a result, they have less time to spend with their patients. Does this sound like you? Understanding behavioral health billing processes will allow you to focus on your patients and deal with the most common issues promptly and easily.
What makes mental health billing complicated?
The difficulties and complications in behavioral health billing are attributed to the time, types of services, scope, and restrictions placed on mental health treatments. These variables make it challenging to standardize treatment and billing. To reduce payment, most insurance companies attempted to standardize billing by dictating the length and the number of treatments that can be covered. Many of them now also require pre-authorization, which leads to even more difficulties.
But the good news is that there are ways for mental health facilities and practitioners to overcome these challenges. Here are some suggestions:
Verify every patient’s insurance and coverage
Double-check the insurance plan and the benefits before a patient’s visit to understand the coverage. Consider doing a verification of benefits, which means checking the patient’s policy related to the service they require. This gives you information that may not be readily available from the insurance card.
Understand CPT codes
Common procedural technology codes are essential to behavioral health billing. They’re used by insurance providers to determine the amount that can be reimbursed.
Know how to properly submit claims
Besides filing the correct code to the right insurer, you need to ensure that the claim is submitted in the correct billing format according to the insurance company. Most major insurance companies use the UB-04 form, so consider familiarizing yourself with it. It can be filled out electronically or manually.
Choose the right behavioral health billing service
Hiring a qualified team of mental health coders is the best way to implement data-driven solutions in your practice. Plutus Health Inc. is a good choice. The team is certified by the American Academy of Professional Coders and is proficient in CPT, ICD-9/10, and HCPCS coding.