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
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Solution
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Claims are processed and paid based on the provider type, and fee schedules vary for every kind of provider.
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Plutus team will verify the provider type during the eligibility verification, and exact provider information will be added.
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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.
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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.
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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)
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Proper payer ID#, Address will be verified before claims submission, and documents in PM software.
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Medicaid CO and a few other commercial payers require an Authorization number to process the claims.
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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.
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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.