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Plutus Health Specialties

Behavioral Health Billing Services

Behavior & Mental health billing can get complicated due to the various type of services offered to patients and the insurance plans, deductibles and other variations by state, payer and plan.

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Behavior & Mental health billing can get complicated due to the various type of services offered to patients and the insurance plans, deductibles and other variations by state, payer and plan.

Plutus Health Inc.’s trained team of mental health coders offers data-driven solutions for psychiatrists, psychologists, therapists, social workers, clinicians, counsellors, and other behavioral health care providers. We are proficient in CPT, HCPCS, and ICD-9/10 coding and are certified by the American Academy of Professional Coders. Our behavioral health billing service is customizable to your needs and may include:

  • Verification of benefits
  • Billing and collections
  • Utilization review
  • Claim audits
  • Appeals
  • Reimbursement negotiations
  • Patient responsibility collections

 

Plutus Health has decades of experience in coding and billing for the mental health field. As your revenue cycle management partner, our goal is to make your behavioral health billing system a lot less stressful—and a lot more successful.

 

We specialize in designing and implementing effective processes that will boost the financial viability of our clients. You can expect a hands-on approach and a commitment to high-quality results. Talk to us today about our behavioral health billing service.

 

Behavior & Mental health billing can get complicated due to the various type of services offered to patients and the insurance plans, deductibles, and other variations by state, payer, and plan. 

 

Top Denials facing Mental health billing insurance

  • Non-covered service under the patient benefit plan
  • Claims need to be billed to the correct payer
  • Incorrect CPT has been billed
  • Missing / Invalid Authorization
  • Provider not enrolled

 

Critical challenges in Mental Health billing include

Challenges

Solution

Claims are processed and paid based on the provider type, and fee schedules vary for every kind of provider.

Plutus team will verify the provider type during the eligibility verification, and exact provider information will be added.

Patient benefits need to be verified before submitting the claims. Most of the patients might not have Mental health benefits. They might have only Health benefits coverage.

Eligibility verification is done to determine whether the services will be covered by the payer for the appointment date or not; if not covered same will be updated to the client.

Usual commercial payers will be completely different; for instance, we need to bill the claims to Aetna Behavioral health instead of Aetna. (Exact payers need to be verified before claim submission)

Proper payer ID#, Address will be verified before claims submission, and documents in PM software.

Medicaid CO and a few other commercial payers require an Authorization number to process the claims.

Based on client SOW, Plutus will be sending a notification for obtaining prior Authorization, or the Plutus Health team will obtain Authorization and update them in PM.

 

We support mental health billing for services offered by Psychiatrists, Psychologists, Counselors, Clinicians, Therapists, Social workers, and Primary care physicians.

 

We also support Behavioral health billing for

  • Psychotherapy billing
  • Psychologist billing
  • Psychiatric billing
  • Therapy billing

 

Some of the Mental Health CPT Codes we bill include

  • 90785 - Add-on code for interactive complexity
  • 90791 – Psychiatry / Psychology intake secession – Without Medical secession
  • 90792 - Psychiatry / Psychology intake secession – With Medical secession
  • 90832 to 90837- Psychotherapy established secessions
  • 90846 to 90847- Family psychotherapy
  • 90853 – Group Therapy
  • 96127 - Brief emotional/behavioral assessment
  • 96130 - Psychological testing evaluation
  • 96131 - Psychological and Neuropsychological Testing Evaluation Services
  • 96136 – 96137 - Psychological or neuropsychological test administration/scoring
  • 99051 – Add on for Psychiatry secession
  • 99404 – New / Established EAP code

 

We specialize in designing and implementing effective processes that will boost the financial viability of our clients. You can expect a hands-on approach and a commitment to high-quality results. Talk to us today about our behavioral health billing service.

 

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Plutus Health Mental Health Billing Approach:

  • Before rendering service to patient, Plutus team will obtain the future appointment reports and verify the eligibility and benefits for the patient.
  • During appointment time, Patient collectables like Co-pay, Deductible collected from patient during visit. (Deductibles are collected based on the allowed amount by payer)
  • Claim audit is done before transmitting the claim to payer which would help is reducing the denials and rejections
  • Plutus plan in a way that patient collectable will be done before the claim submission and payer payments in the first submission.
  • For Non-covered and no coverage notification will be sent to client where they can reach patient and get updated payer information if no insurance Self-pay rate can be collected.

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Top Mental health billing insurance denials:

  • Non-covered service under patient benefit plan
  • Claims need to be billed to correct payer.
  • Incorrect CPT has been billed.
  • Missing / Invalid Auth#
  • Provider not enrolled

Above major denials are completely fixed by Plutus team by verifying the complete benefits, network status & Authorization requirement.

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Learn more from our Resources section:


Blogs :
Case Studies :

55,000

+

Claims

120,000

+

ABA Therapy Sessions

10,000

+

Kids Receiving Care

$

50

Million+

Insurance Revenue

Last 12 Months
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