Medical billing can be extremely complicated on its own, but medical billing for mental health services bring its own set of unique challenges. Between the types of services offered, pre-authorization, unbundling concerns, and the size and time availability of office staff, mental health facilities are often at a disadvantage compared to other health professionals.
By understanding the process for behavioral health billing, providers can spend more of their time and energy focusing on what truly matters—their patients. That’s why Denials Management believes in doing as much as possible to lift the weight of medical billing off of medical professionals whose time is better served in other areas.
Why is Mental Health Medical Billing So Difficult and Complex?
Medical billing for mental health services is more difficult than other areas of healthcare because of the types of services, time, scope, and restraints placed on mental health treatments. For instance, if an individual goes to see a doctor for a routine check-up, they will most likely go through a standard series of exams and tests. This typically includes checking the patient’s height and weight, checking blood pressure, listening to the patient’s heart, and possibly a blood draw. For the most part, these exams are standardized across all patients, take the same amount of time, and only differ slightly from patient to patient. In the same way, when providers bill these routine checkups to health insurers, the billing is standardized and repetitive, and are often bundled into one overall charge.
However, the same cannot be said about mental or behavioral health treatments. These types of services differ greatly from others, depending on a multitude of factors such as session length, therapeutic approach, the location in which services are rendered, the age and willingness to participate of the patient, and other contributing factors. Because of these variables, it is difficult to standardize treatment and therefore billing. In an effort to minimize payment, many insurance companies have tried to standardize mental and behavioral health billing by dictating how long treatments can take, how many treatments can be received per day or week, and what the maximum number of treatments covered can be. And, mental health services often require “pre-authorization” to be covered, making it even more complex and difficult.
Another reason medical billing for mental health services is difficult is because of the lack of resources available for mental health providers. Many mental health services are small group practices or even solo practices with limited or no administrative support. This means the physicians themselves carry the burden of medical billing.
Tips for Billing for Mental Health Services
How can mental health providers overcome the difficulty of medical billing? Here are some tips to help mental health practices effectively and efficiently bill for services provided, leading to fewer denials, more funds for the business, and more time to help patients.
1. Double-check each patient’s insurance and coverage
Our first tip is to ensure that you know each of your patient’s insurance plans and benefits before each visit. This may sound extremely time intensive—and it can be. However, making sure you know the coverage available for each patient before they receive any services will lead to a larger return in the end. In order to know what coverage your prospective patients have, we recommend conducting a verification of benefits (VOB) for each patient before any treatment or services are received.
What Is a Verification of Benefits?
A verification of benefits checks the patient’s policy in regards to the service they visiting for, and gives providers information that is not readily available from a patient’s insurance card. Performing a VOB is important because even if a patient has active insurance, the service you provide may not be a benefit that is covered. By checking the VOB, you can ensure that a patient is covered for the services they are seeking, and determine how much their insurance company will pay for these services.
How to Perform a Verification of Benefits
Many insurance companies have online provider portals where you can quickly and easily verify a patient’s eligibility and benefits. If the insurance does not have an online portal or the portal does not answer all of your questions, you can also call the insurance company’s provider helpline using the patient’s account number from their insurance card to discover their benefits. Another option may be to hire a third-party billing company, or utilize a third party VOB software, to conduct the VOB for you.
Overall, it’s extremely important to understand what benefits and coverage each patient has so that you don’t end up with rejected claims and unpaid bills.
2. Understand CPT Codes
CPT codes are “common procedural technology” codes and insurance providers use CPT codes to determine the amount of reimbursement given to healthcare facilities. When dealing with behavioral health billing, or really any type of medical billing, it is critical to understand the services your practice offers and know the associated CPT codes. Some mental health service providers will use the same CPT code for every patient, however, this is not legal or recommended.
For behavioral healthcare practitioners, there are two types of CPT codes you might use: E/M codes and psychiatric evaluation codes. E/M codes should be used when evaluating a new medical issue and must have three documentation elements provided. These three elements are history, examination, and medical decision-making.
- History: The history section includes the history of the present illness, review of systems, and the past family and social history.
- Examination: The examination section includes the type of examination performed, the patient’s history, and the nature of the problem.
- Medical decision-making: The medical decision-making section includes the number of diagnoses or treatment options documented during the specific encounter, the complexity of the data reviewed, and the risk of complications.
Psychiatric evaluation codes, on the other hand, are used for a diagnostic assessment. A psychotherapy session can include E/M services, but the time associated with the E/M service cannot count toward the time of the psychotherapy service. One example of this would be discussing new medication options and side-effects during a psychotherapy session.
To reduce the risk of claim rejections, it’s important to know which CPT code to use and how to use them. You can discover the criteria for CPT codes here to determine which code to use for which service. It’s imperative that you use the correct code because if you don’t the claim can and may be rejected.
3. Understand How to Submit Claims Properly
In order to receive reimbursement from a claim, not only do you have to file the correct code to the correct insurer, but you also have to submit the claim in the correct billing format, which can vary depending on the insurance company. Make sure you know the insurance company’s preferred filing method and that you file within the time allowed by the insurance plan. (The insurer’s preferred method of receiving claim filings is a great question to ask during the Verification of Benefits process!)
The UB-04 form is the claim form used by many of the major insurance companies for specialized health centers such as mental health and rehabilitation clinics, so this is the form you will want to familiarize yourself with. The UB-04 can be filled out on paper or electronically, with numerous software programs loaded with the current version of the form and instructions for filing. For more information on filling out and submitting the UB-04, this blog can help you through the process.
Ensuring that your claim is properly filed will lead to less time spent on the claim for you.
Third Party Mental Health Medical Billing
As you can see, there is a large amount of work that goes into filing claims correctly for mental health providers. Because of this, it is not surprising that many providers choose to employ a third party billing company to handle claims, so they have more time to focus on patient care and treatment. Here at Denials Management, we partner with providers for pre-authorization, third-party medical billing, claims follow-up, and to assist with appeals for any denied insurance claims. Check out the services we offer providers and contact us today if you think this is the right choice for your facility. We want your time spent where it matters most- on patient health, not handling disputes with insurance companies.