by Plutus Health
Mental and Behavioral health billing is a uniquely challenging endeavor. It has additional challenges on top of what you face in billing for other medical specialties. Limited staff, limited time, unbundling, and pre-authorization are problem areas shared between the two healthcare types.
However, unlike medical specialties, mental health treatment is frequently ill-defined. A patient who comes into an office for a routine physical check-up will receive standardized care. Weight and height measurements, blood pressure checks, and heartbeat monitors are homogenous. As a result, billing is relatively repeatable from client to client.
Unfortunately, this same consistency does not apply to mental health. Each treatment plan varies with session length, therapeutic approach, age, and client willingness. So, behavioral health billers must be more diligent to avoid denials and get maximum reimbursements.
Here are six tips for mental and behavioral health billing.
Ensure that your clients’ records are up to date. These records should include personal data, insurance details, and medical history/goals. Update your client records at least once a year. Consider establishing an online system where consumers can verify their information before coming to an appointment.
Document your discussions with payer representatives. Note the time of conversation, their name, and what information they provided. This habit prevents confusion and holds payers accountable for miscommunication, should they deny claims that have pre-authorization.
Before scheduling any client to receive therapy, verify their benefits. This process can be tedious and unnecessary, especially for returning clients. However, insurance policies can change quickly, and clients rarely know the minutiae of their medical plan.
Verification of benefits is the process of confirming the client’s insurance plan covers a service. Insurers’ online portals are the easiest way to verify this information. Call the payer for more details for those who lack online portals or have limited information. Staff should also note the degree of coverage, any max limits, and whether pre-authorization is required.
Current Procedural Terminology (CPT) codes are part of a HIPAA-regulated information system that matches services with specific codes. Medical professionals use codes to describe a procedure and detailed additional information through Modifiers. Misreading or mismatch of codes is a common reason for denials and inadequate reimbursements.
Medical coders often use Provider notes to understand the details of the service done in that session. Ensure that your Providers write in detail that can clearly distinguish similar procedures. The CPT Editorial Panel constantly updates codes, so always refer back to an official source to check the latest codes for that service.
Behavioral healthcare practitioners commonly employ two types of codes. Coders use evaluation and management (E/M) codes when a physician evaluates a new medical problem. There are three documentation types E/M code users must provide.
● History: Includes the history of the illness, social and family history, and a review of systems.
● Examination: Includes the type of examination performed, the nature of the problem, and the client’s history.
● Medical Decision Making: Includes the number of diagnoses or treatment options documented during the session, the complexity of the reviewed data, and the risk of complications.
By contrast, psychiatric evaluation codes are for diagnostic assessment. This assessment can include items that would typically fall under evaluation and management. However, coders must avoid using E/M codes for the diagnostic process.
Different payers hold unique standards for how they want their claims submitted. An insurer may deny claims even with correct CPT codes if other information is required or need to be corrected. Additionally, insurers may create narrow timely filing limits by when practices can request reimbursements. Check this timely filing limit (TFL) for each payer since they vary by payer.
Many claim denials are appealable. Document the types of denials you receive to find any patterns. Typically, insurers will delineate the error type in their report. Remember, insurers may have a limited, timely filing limit (TFL) for re-submissions or appeals.
At Plutus Health, we understand how arduous accurate billing and coding can be. That’s why we provide a billing and collections service to help your practice succeed. Contact one of our representatives today to learn our plan to maximize your organization’s reimbursements.
1. Maintain accurate documentation for client and insurer conversations.
2. Verify your client’s benefits before providing them a service.
3. Check CPT codes to translate services accurately.
4. Know the difference between E/M codes and psychiatric evaluation codes.
5. Ensure compliance with insurers’ billing standards to avoid denials.
6. Review claim denials to fix them and look for patterns.
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