03 Jan Differences Between Behavioral Health Billing and Medical Billing
Health insurance doesn’t cover mental and behavioral health services the same way it does for other medical services. The billing process can be complicated and difficult.
Because mental health professionals furnish diverse and unique services, there’s a more complex billing process. (For example, with mental health providers, sessions have incredible variance.) As a result, mental health billing is less standardized than medical billing.
What Are the Challenges Involved in Behavioral Health Billing Services?
- Helping to provide comprehensive treatment for patients with severe or incapacitating behavioral problems, which often require specialty-specific programs
- Inadequate time to plan, carry out, and meet patient demands
- The manual nature of claims management procedures can make it take longer to resolve accounts receivable, and they add administrative workload.
- If patients aren’t properly informed of financial responsibilities, collection problems will result.
- A major medical billing error: inaccurate coding
- Inaccurate patient data will delay claims reimbursement.
Insurance Plans Restrict Coverage
- In billing for mental health services, it’s key to understand the restrictions placed on providers and patients. Insurers often impose a daily, weekly, or monthly maximum limit for treatments delivered by mental health providers, and there can be time limits on the actual visit. Before visits are covered, pre-authorization is sometimes required. Because of these service limits, mental health billing becomes more complex.
- Since some insurance plans fail to cover mental health services and patients can choose providers out of network, mental health providers must be prepared for patients who are paying out of pocket for services.
Pre-Authorization
Often pre-authorization is required for mental health services in advance, before claims are filed. Mental health billing can be more difficult because it can be unlikely to get pre-authorization for mental health claims.
Billing Complications
Mental health patients and insurers can be billed in very differing ways, since insurers have different rules about their coverage based on factors like length of session, frequency, and treatment maximums.
A major challenge to mental health billing is that it’s common for a patient’s mental health needs to be greater than the services covered by the insurer. As a result, it can be a serious challenge for mental health providers to create a balanced treatment plan backed by a sound reimbursement strategy.
Behavioral Health Medical Coding is Very Different From Medical Billing Coding
- Evaluation and management (E&M) codes are not as uncomplicated as medical billing.
- Psychotherapy includes time associated with a visit.
- Payers may require specific codes to be submitted with claims.
- The billing format you use is critical, because it varies from one payer to another; it could be a CMS1500, a UB-04, or electronic billing through the facility’s electronic health record (EHR) system.
Insurers place coding regulations on mental and behavioral health claims to guarantee that the services are captured accurately and that reimbursement is paid suitably.
When coding for mental and behavioral health services, it’s vital to understand the differences in coding and the restrictions in a patient’s insurance plan. There is greater difficulty because of service variation not found in primary or specialty care.
Additionally, CPT codes can change over time as different rules and regulations are updated, unused codes are decommissioned, and new codes are created for new services.
Behavioral health billing can include the services of community social workers, behavioral specialists, or other experts, which adds another layer of complexity when coding.
Psychotherapy Coding
Psychotherapy billing can be very tangled because a patient’s needs can be intricate and unique. To code for their psychotherapy services properly, therapists must consider such factors as timing, testing, assessment, crisis codes, and other salient factors.
Substance Abuse Billing
Psychotherapy billing can be very tangled because a patient’s needs can be intricate and unique. To code for their psychotherapy services properly, therapists must consider such factors as timing, testing, assessment, crisis codes, and other salient factors.
Superbills
The dynamic nature of mental health practices often makes them incompatible for superbills for mental health services. Mental health billing is typically a longer, more complicated process without superbills.
Telehealth
Since telehealth and its insurance policy coverage are constantly changing, behavioral health practices must keep current on policy updates to meet the latest patient needs.
Some Solutions to These Problems
To confirm insurance eligibility and understand the full picture of a patient’s benefits, you must gather all information necessary to assemble a strategic plan for paying a patient’s care.
Here are few tips for streamlined behavioral health billing services:
Pre-authorization to Prevent Wasting Time
Whenever your in-house team works with a new client, pre-authorization is required. This is often mandatory when it comes to the first sessions of the behavioral health system.
Updating Patient Information
It’s very crucial to keep a track of accurate and up-to-date information regarding patients. To make accurate claims, even the smallest detail must be completely correct. If a patient’s marital status or address changes, you must change the details immediately, or the claim will be denied.
Filing Claims in a Timely Manner
You must submit claims in time and within a certain time period. Consequently, create a streamlined schedule to have smooth and transparent timely claims filing.
What Are the Advantages of Outsourcing Behavioral Health Billing?
Because most mental health practitioners lack a dedicated employee to focus exclusively on mental health billing, they often manage both patient care and billing themselves. A third-party provider can eliminate the administrative responsibilities associated with behavioral health billing. Using a specialized provider also helps to eliminate staff mistakes.
Other advantages of outsourcing behavioral health billing include:
- Greater productivity: Because mental health specialists aren’t required to use the many PCP-specific codes, they don’t need these codes to slow them down while billing. By outsourcing medical billing, you can reduce tedious tasks and enhance your productivity.
- Better patient management: If patients are dissatisfied with every office visit or phone call, or if they’re unable to visit because of financial difficulties, it can be difficult to engage them. But medical billing companies are well versed in handling these situations to maintain an effective patient management system.
